ReMonit

Remote monitoring of patients with spondyloarthritis

Project managers

Physiotherapist | PhD

Professor Nina Østerås

Post doc

Specialist in rheumatology | PhD

Inger Jorid Berg

PhD fellow

Physical therapist

Emil Eirik Kvernberg Thomassen

ABOUT THE PROJECT

Spondyloarthritis is a serious, chronic, rheumatic joint disease that requires lifelong follow -up in the specialist health service. The purpose of this three-armed randomized, controlled trial was to investigate whether two new models for follow-up are as effective as the current follow-up practice of regular physical attendance at the outpatient clinic in maintaining low disease activity over time.

Experience and results from this study may change how patients with spondyloarthritis are followed up by the specialist healthcare services in the future.

Who could join?

Patients aged 18 and older diagnosed with spondyloarthritis and followed at Diakonhjemmet Hospital were recruited if they met the inclusion criteria which included low disease activity and stable medication for the past six months.

Recruitment of participants for the study has now concluded.

What did this study involve?

All participants met for a face-to-face consultation at study start and study end at 18 months. Participants in group 1 received follow-up with face-to-face consultations at the hospital every 6 months, in accordance with the usual follow-up when the study began in 2021. Participants in group 2 and 3 did not meet to any pre-scheduled consultations during the study.

In group 2, participants received remote digital follow-up via an app, where they reported their symptoms monthly. A study-nurse contacted patients if the reports indicated a worsening of the disease, and the patient was offered an evaluation of their condition.

Participants in group 3 received patient-initiated care, and were not scheduled for regular consultations during the 18 months. Similar to group 1 and 2, they were instructed to contact health-care personnel at the hospital in they experienced a significant worsening of the disease, and patient were offered an evaluation of their condition.

DURING THE STUDY:

Patients completed standardized questionnaires every six months regarding symptoms and functioning. They also reported on their satisfaction with care, medication use and adverse medical events. CRP levels were measured regularly through-out the study. We have also extracted data from four national registries on healthcare utilization, medication use, and sick leave in order to evaluate the cost benefit of the three different follow-up methods.

Results from the study

Both the digital and the patient-initiated care preformed as well for the patients as traditional follow-up with regular pre-scheduled consultation. No significant differences were observed in disease activity, functioning or medication use among the three follow-up strategies. The patients were satisfied with care, regardless of which model they participated in. No differences in adverse medical events were noted either.

In the qualitative sub-study with in dept-interviews of patients with the new follow-ups, concerns about technology failure emerged, and many patients expressed a desire for occasional personal contact with a health-care provider. At the same time, patients reported increased decision-making power, more flexibility, and better understanding of their condition with alternative follow-up.

Patients with patient-initiated care had less frequent follow-up, compared to the other groups, with fewer consultations or telephone calls with the health-personnel. The patients receiving remote digital monitoring had fewer consultations compared to traditional follow-up, but they had the highest number of telephone calls with healthcare-personnel, many of which were initiated by health-care personnel based on the patients’ reports in the app.

This study demonstrated that these new follow-up strategies can save patients time while also liberating recourses for healthcare-personnel to focus on patients with more severe illnesses. The alternative follow-up can be attractable follow-up of patients with chronic disease in a stable phase. The study has provided valuable knowledge to offer patients more flexible, personalized, and effective follow-up for managing patients with a chronic disease.