Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project

Knitza, Johannes; Knevel, Rachel; Raza, Karim; Bruce, Tor; Eimer, Ekaterina; Gehring, I.; Mathsson‐Alm, Linda; Poorafshar, Maryam; Hueber, Axel J.; Schett, Georg; Johannesson, Martina; Catrina, Anca I.; Klareskog, Lars

doi:10.2196/17507

Cited by 30 publications

(29 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One of the top reasons for the reluctance of rheumatologists to use apps may be lack of evidence [ 31 ]. The combination of electronic PROs [ 28 ] and objective serology and genetic testing promises to result in the earlier diagnosis of RMDs [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study

Muehlensiepen¹,

Knitza²,

Marquardt³

et al. 2021

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

Background The worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease, is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners. Objective The goal of this study was to investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners. Methods A nationwide, cross-sectional, self-completed, paper-based survey on telerheumatology care was conducted among outpatient rheumatologists and general practitioners during the pre-COVID-19 period. Results A total of 73.3% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 74.6%) answered that they do not currently use telemedicine, although 62.3% (291/467) would like to. Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62.3%), administration (181/292, 62.0%), and poor reimbursement (156/292, 53.4%). A total of 69.6% (117/168) of the surveyed physicians reckoned that telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81.3%) than to communicate with patients (213/455, 46.8%). Among treatment phases, 64.4% (291/452) of participants would choose to use telemedicine during follow-up. Half of the participants would choose telecounseling as a specific approach to improve rheumatology care (91/170, 53.5%). Conclusions Before COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge on the part of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.

show abstract

Section: Discussionmentioning

confidence: 99%

Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study

Muehlensiepen¹,

Knitza²,

Marquardt³

et al. 2021

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Measures include the introduction of digital health applications into the statutory health insurance scheme, the implementation of digital patient records, and the promotion of video consultation hours [ 3 , 5 ]. Due to aggravating challenges, such as the declining number of rheumatologists [ 6 ], the aging population, and the need for early diagnosis [ 7 ] and continuous monitoring [ 8 ], rheumatology is considered to have a great potential to benefit from a digital health transition [ 2 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Digital Health Transition in Rheumatology: A Qualitative Study

Muehlensiepen

Kurkowski

Krusche

et al. 2021

IJERPH

Self Cite

View full text Add to dashboard Cite

The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendation resulting from the insights is that both patients and rheumatologists need more information and education to successfully implement digital health tools into clinical routine.

show abstract

“…a web-based screening tool Rheumatic? is a web-based screening tool to identify individuals with early signs of or at high risk for developing Rheumatoid Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematosus, Myositis, Systemic Sclerosis, or Sjögren's Syndrome (in this paper called immune-mediated rheumatic diseases) (13). A team of designers, engineers, clinical experts, patients, and at risk individuals worked together to build a test that was both medically correct and effortless to use for an average person.…”

Section: Methodsmentioning

confidence: 99%

“…Digital diagnostic decision support systems (DDSS) and in particular online self-referral (OSR) systems and symptom checkers (SC) promise to accelerate diagnosis in rheumatic diseases (11)(12)(13) and improve health care e ciency. Currently more than 100 SCs exist (14) and are increasingly used by patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rheumatic? - A Digital Diagnostic Decision Support Tool for Individuals Suspecting Rheumatic Diseases: A Multicenter Validation Study

Knevel

Knitza

Hensvold

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundDigital diagnostic decision support tools promise to accelerate diagnosis and increase health care efficiency in rheumatology. Rheumatic? is an online tool developed by specialists in rheumatology and general medicine together with patients and patient organizations. It calculates a risk score for several rheumatic diseases. In the current pilot study, we retrospectively test Rheumatic? for its ability to differentiate symptoms from immune-mediated diseases from other rheumatic and musculoskeletal complaints and disorders in patients visiting rheumatology clinics. MethodsThe performance of Rheumatic? was tested using data from 175 patients from three university rheumatology centers covering two different settings:A. Risk-RA phase setting. Here, we tested whether Rheumatic? could predict the development of arthritis in 50 individuals with musculoskeletal complaints and anti-citrullinated protein antibody positivity from the KI (Karolinska Institutet)B. Early arthritis setting. Here, we tested whether Rheumatic? could predict the development of an immune-mediated rheumatic disease in i) EUMC (Erlangen) n=52 patients and ii) LUMC (Leiden) n=73 patients.In each setting, we examined the discriminative power of the total score with the Wilcoxon rank test and the area-under-the-receiver-operating-characteristic curve (AUC-ROC). Next, we calculated the test characteristics for these patients at a rheumatology setting passing the first or second threshold for at least one of the rheumatic diseases.ResultsThe total test score clearly differentiated between: A) individuals developing arthritis or not, median 245 versus 163, P < 0.0001, AUC-ROC = 75.3B) patients with an immune-mediated arthritic disease or not, in EUMC median 191 versus 107, P < 0.0001, AUC-ROC = 79.0, and LUMC median 262 versus 212, P < 0.0001, AUC-ROC = 53.6.Threshold-1 (advising on seeking primary care doctor) was highly specific in two centers (0.72, 0.87 and 0.23, respectively) and far more sensitive (0.67, 0.61 and 0.67) in KI, EUMC respectively LUMC.Threshold-2 was very specific in all three centers but not very sensitive: specificity of 1.0, 0.96 and 0.91, sensitivity 0.05, 0.07, 0.14 in KI, EUMC respectively LUMC. ConclusionsRheumatic? is a web-based patient-centered multilingual diagnostic tool capable of differentiating immune-mediated rheumatic conditions from other musculoskeletal problems. The scoring system might be further optimized, for which we will perform a prospective study.

show abstract

Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project

Cited by 30 publications

References 39 publications

Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study

Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study

Digital Health Transition in Rheumatology: A Qualitative Study

Rheumatic? - A Digital Diagnostic Decision Support Tool for Individuals Suspecting Rheumatic Diseases: A Multicenter Validation Study

Contact Info

Product

Resources

About