Rheumatoid arthritis

REMORA smartphone app helps paint ‘the bigger picture’ in RA

A smartphone app that allows RA patients to record their daily symptoms has enabled a more patient-centred approach to clinical consults, researchers report.

According to the study authors led by Professor William Dixon from the Centre for Epidemiology Versus Arthritis at the University of Manchester, the proof-of-concept app has meant rheumatologists and patients have shared insights that have added value to clinical consultations.

Writing in Rheumatology the research team noted the difficulty healthcare professionals faced in understanding at a single consultation how a patients’ symptoms have changed between visits, which can often be six months apart.

“Patients find it difficult to recall and summarise fluctuating symptom; memory is prone to significant bias.. and short consultation times may limit how thoroughly a history is explored,” they wrote.

Consumer technology provides an unprecedented opportunity to improve collection of patient generated health data (PGHD) to inform clinical management and self management, they said

The researchers developed the Remote Monitoring of RA (REMORA) smartphone app with patients and clinicians. To assess its feasibility 20 patients submitted data, such as fatigue, tender joint count, morning stiffness and level of difficulty with activities of daily living, each day over three months.

The data was then integrated into the electronic health records of one hospital and was available in graphical format during consultations.

Most patients said they found remote monitoring acceptable and easy to use. But the graphical representation of data that could be viewed during a consultation was particularly valued by clinicians and patients.

One patient commented, “I don’t think in that half hour that you’ve got that consultation doesn’t always show the bigger picture of what you’re actually dealing with”.

Another said: “how can you talk to someone when there’s missing information? So if you’ve got that graph, there’s your information… he’s [the rheumatologist] got his information… so when it’s there it’s a shared conversation between us… rather than him asking me questions and me trying to answer them”.

“The main value of REMORA was its ability to provide insight into the ‘bigger picture’ of everyday experience of symptoms for both patients and clinicians,” the research team wrote.

“These shared insights impacted upon consultations, creating interactions that were more shared, and highlighting issues that might otherwise be missed.”

“The study is a significant first step towards demonstrating the benefits of integrating remote monitoring of PGHD into clinical care,” the authors concluded.

However they noted that there were limitations to the feasibility study such as the participants were a small group of enthusiastic self-selected patients and clinicians.

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