ePROM Monitoring of Patients With Inflammatory Arthritides May Be Beneficial, Review Suggests

Monitoring electronic patient-reported outcome measures (ePROMs) for patients with inflammatory arthritides (IAs) such as rheumatoid arthritis may help reduce health care resource utilization without negatively affecting disease outcomes, suggests a review published in Arthritis & Rheumatology.

IAs account for a large proportion of patients seen at rheumatology clinics, and consistent monitoring is key to optimize patient outcomes. In those with active disease, recommended management includes documentation of disease measures as often as monthly and drug therapy adjustment at least every 3 months, the authors explained. However, growing numbers of patients and the resulting demand on clinics can make regular monitoring difficult.

Therefore, their study assessed the potential of remote monitoring of ePROMs to help identify and intervene at times of disease activity, assist providers in making treatment decisions, and facilitate appropriate health care resource use. Digital health care can allow patients to take a more active role in their health, support self-monitoring and self-management of symptoms, and help clinicians understand disease activity over time between in-office visits.

Researchers combed through 5 databases (MEDLINE, Embase, PubMed, Cochrane Library, and Web of Science) to identify randomized controlled trials and nonrandomized controlled clinical trials. Eight studies, 7 of which assessed patients with rheumatoid arthritis, were included in the review. The studies included 4473 patients.

Meta-analyses and forest plots were done to assess the outcomes of interest, including difference in between-group disease activity scores and rates of remission, rates of treatment intensification, rates of disease flare, rates of face-to-face appointments, and telephone physician or total health care use between groups.

In the ePROM meta-analysis of 6 studies, disease activity was lower in the ePROM group vs the control group, with a standardized mean difference (SMD) of ­–0.15 (95% CI, -0.27 to -0.03). Although the change was small, the authors noted that none of the studies showed worsened disease activity among patients monitored via ePROMs.

The rates of remission or low disease activity were higher among the ePROM group in a meta-analysis of 5 studies, with an odds ratio (OR) of 1.65 (95% CI, 1.02-2.68). The remote ePROM cohort also needed fewer in-person visits (SMD, ­–0.93; 95% CI, –2.14 to 0.28) in a meta-anaylsis of 5 of the studies.

Notably, 5 of the studies included additional interventions along with ePROMs, such as disease education. Most of the studies were also at a high risk of bias and had significant heterogeneity, the authors wrote.

Despite limitations, the findings suggests that ePROM monitoring may be beneficial when managing patients with IAs, potentially mitigating health care resource utilization without having an impact on patient outcomes, the authors wrote.

“We cannot draw firm conclusions as to whether the use of remote ePROMs alone as an adjunct to usual care improves disease activity, as this was often used as part of a digital intervention with other combined features,” the authors concluded. “However, our data is suggestive of at least equivalent disease activity outcomes with using ePROM remote monitoring; importantly, there is no evidence to suggest worse outcomes with this method of asynchronous digital health care, and no detrimental impact in clinic attendance frequency with ePROMs.”

Reference

Arumalla N, Chan CKD, Gibson M, et al. The clinical impact of electronic patient-reported outcome measures in the remote monitoring of inflammatory arthritis: a systematic review and meta-analysis. Arthritis Rheumatol. Published online May 19, 2023. doi:10.1002/art.42559