Stepwise asynchronous telehealth assessment of patients with suspected axial spondyloarthritis: results from a pilot study

Abstract

Patients with axial spondyloarthritis (axSpA) suffer from one of the longest diagnostic delays among all rheumatic diseases. Telemedicine (TM) may reduce this diagnostic delay by providing easy access to care. Diagnostic rheumatology telehealth studies are scarce and largely limited to traditional synchronous approaches such as resource-intensive video and telephone consultations. The aim of this study was to investigate a stepwise asynchronous telemedicine-based diagnostic approach in patients with suspected axSpA. Patients with suspected axSpA completed a fully automated digital symptom assessment using two symptom checkers (SC) (bechterew-check and Ada). Secondly, a hybrid stepwise asynchronous TM approach was investigated. Three physicians and two medical students were given sequential access to SC symptom reports, laboratory and imaging results. After each step, participants had to state if axSpA was present or not (yes/no) and had to rate their perceived decision confidence. Results were compared to the final diagnosis of the treating rheumatologist. 17 (47.2%) of 36 included patients were diagnosed with axSpA. Diagnostic accuracy of bechterew-check, Ada, TM students and TM physicians was 47.2%, 58.3%, 76.4% and 88.9% respectively. Access to imaging results significantly increased sensitivity of TM-physicians (p < 0.05). Mean diagnostic confidence of false axSpA classification was not significantly lower compared to correct axSpA classification for both students and physicians. This study underpins the potential of asynchronous physician-based telemedicine for patients with suspected axSpA. Similarly, the results highlight the need for sufficient information, especially imaging results to ensure a correct diagnosis. Further studies are needed to investigate other rheumatic diseases and telediagnostic approaches.

Living with axial spondyloarthritis: a cross-sectional survey of patient knowledge and perceptions

“…Studies on telehealth in rheumatology focus on video and phone consultations [ 25 ]. The asynchronous physician-based telemedicine approach to diagnose AxSpA with access to imaging results may be helpful for correct diagnosis [ 26 ].…”

Diagnosis, monitoring, and management of axial spondyloarthritis

“…Utilizing asynchronous telemedicine solutions can effectively address this issue. Obtaining radiologic images is crucial at this juncture [ 114 ]. Integrating electronic patient-reported outcomes allows for remote and standardized evaluation of treatment effectiveness and rapid modifications to the treatment plan.…”

Recommendation to implementation of remote patient monitoring in rheumatology: lessons learned and barriers to take

“…To assess the benefits and potential risks of apps, a robust assessment is essential and must consider the entire lifecycle of mobile medical apps, including design, development, deployment and postmarket surveillance. 29 While the exact assessment and criteria differ between the jurisdictions (USA, EU, UK) and specific process (primary regulatory approval, medical guidelines, reimbursement), key dimensions of assessment are universally present and include: ► Clinical validity and efficacy: digital health apps must be evaluated for their clinical validity (whether the app's measurements and outcomes are reliable) and efficacy, supported by scientific evidence and adherence to relevant clinical guidelines. Clinical trials and real-world data analysis are crucial in establishing the effectiveness of these apps.…”

“…To assess the benefits and potential risks of apps, a robust assessment is essential and must consider the entire lifecycle of mobile medical apps, including design, development, deployment and postmarket surveillance. 29 While the exact assessment and criteria differ between the jurisdictions (USA, EU, UK) and specific process (primary regulatory approval, medical guidelines, reimbursement), key dimensions of assessment are universally present and include:…”