The Clinical Impact of Electronic Patient-Reported Outcome Measures in the Remote Monitoring of Inflammatory Arthritis: A Systematic Review and Meta-analysis

IF 11.4 1区医学 Q1 RHEUMATOLOGY

Arthritis & Rheumatology Pub Date : 2023-05-19 DOI:10.1002/art.42559

Nikita Arumalla, Chun K. D. Chan, Mark Gibson, Yik L. Man, Maryam A. Adas, Sam Norton, James B. Galloway, Toby Garrood

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引用次数: 2

Abstract

Objective

The inflammatory arthritides (IAs) make up a significant proportion of conditions followed up in rheumatology clinics. These patients require regular monitoring, but this is increasingly difficult with rising patient numbers and demand on clinics. Our objective is to evaluate the clinical impact of electronic patient-reported outcome measures (ePROMs) as a digital remote-monitoring intervention on disease activity, treatment decisions, and health care resource use in patients with IA.

Methods

Five databases (MEDLINE, Embase, PubMed, Cochrane Library, and Web of Science) were searched, with randomized controlled trials and (nonrandomized) controlled clinical trials included, and meta-analysis and forest plots conducted for each outcome. Risk of bias was assessed using the Risk of Bias-2 tool and Risk of Bias in Nonrandomized Studies of Interventions.

Results

Eight studies were included with a total of 4,473 patients, with seven studies assessing patients with rheumatoid arthritis. Compared with control, the disease activity in the ePROM group was lower (standardized mean difference [SMD] −0.15; 95% confidence interval [CI] −0.27 to −0.03) and rates of remission/low disease activity were higher (odds ratio1.65; 95% CI 1.02–2.68), but five of eight studies provided additional combined interventions (e.g., disease education). Fewer face to face visits were needed in the remote ePROM group (SMD −0.93; 95% CI −2.14–0.28).

Conclusion

Most studies were at high risk of bias with significant heterogeneity in design, but our results suggest there is an advantage in using ePROM monitoring in patients with IAs, with the potential for reduction in health care resource use without detrimental impact in disease outcomes.

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炎症性关节炎远程监测中电子患者报告结果测量的临床影响：系统综述和荟萃分析。

目的：炎性关节炎（IAs）在风湿病临床随访中占很大比例。这些患者需要定期监测，但随着患者数量的增加和对诊所的需求，这变得越来越困难。我们的目的是评估电子患者报告结果测量（ePROM）作为一种数字远程监测干预措施对IA患者疾病活动、治疗决策和医疗资源使用的临床影响。方法：检索五个数据库（MEDLINE、Embase、PubMed、Cochrane Library和Web of Science），包括随机对照试验和（非随机）对照临床试验，并对每种结果进行荟萃分析和森林图。使用偏倚风险-2工具和非随机干预研究中的偏倚风险评估偏倚风险。结果：共有8项研究纳入4473名患者，其中7项研究评估类风湿性关节炎患者。与对照组相比，ePROM组的疾病活动性较低（标准化平均差[SMD]-0.15；95%置信区间[CI]-0.27--0.03），缓解率/低疾病活动率较高（比值比1.65；95%CI 1.02-2.68），但八项研究中有五项提供了额外的联合干预措施（如疾病教育）。远程ePROM组需要更少的面对面访问（SMD-0.93；95%置信区间-2.14-0.28）。结论：大多数研究都存在较高的偏倚风险，设计上存在显著的异质性，但我们的研究结果表明，在IAs患者中使用ePROM监测有优势，有可能减少医疗资源的使用，而不会对疾病结果产生不利影响。

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来源期刊

Arthritis & Rheumatology RHEUMATOLOGY-

CiteScore

20.90

自引率

3.00%

发文量

371

期刊介绍： Arthritis & Rheumatology is the official journal of the American College of Rheumatology and focuses on the natural history, pathophysiology, treatment, and outcome of rheumatic diseases. It is a peer-reviewed publication that aims to provide the highest quality basic and clinical research in this field. The journal covers a wide range of investigative areas and also includes review articles, editorials, and educational material for researchers and clinicians. Being recognized as a leading research journal in rheumatology, Arthritis & Rheumatology serves the global community of rheumatology investigators and clinicians.