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 specialist healthcare. The purpose of this three-arm randomised, controlled trial was to investigate whether two new models of follow-up are as good as the current follow-up with regular physical attendance at the outpatient clinic in terms of maintaining low disease activity over time.

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

Who could join?

Patients aged 18 years and older with a diagnosis of spondyloarthritis at Diakonhjemmet Hospital were recruited if they met the inclusion criteria, which included low disease activity and stable drug treatment for the past six months.

Recruitment of participants for the study has been completed.

What did this study involve?

All study participants attended a doctor's appointment at the start of the study and at the end of the study after 18 months. Participants in the control group received follow-up with physical check-ups at the hospital every 6 months, in line with the current routine when the study began in 2021. Participants in the two intervention groups, however, were not scheduled for check-ups during the study.

One intervention group received digital home monitoring via an app, where they reported their symptoms monthly. A nurse contacted them if the reporting indicated a worsening of the disease, and the patient was offered assessment in the hospital if they wished.

The second intervention group had patient-directed follow-up and were not scheduled for regular check-ups.

Participants in all three groups were instructed to contact healthcare professionals at the hospital if they experienced a significant worsening of symptoms and wanted an assessment of the illness by healthcare professionals.

During the study, patients completed standardized questionnaires every 6 months regarding symptoms and function. They also reported on their satisfaction with the follow-up, medication use, and any adverse medical events. CRP was measured regularly during the study. We also retrieved data from four national registries for health care utilization, medication use, and sick leave to investigate the cost-benefit effects of the different follow-ups.

Results from the study

Both digital home monitoring and patient-directed monitoring were equally effective for patients as traditional monitoring with regular check-ups. No clear differences in disease activity, function, or medication use were observed between the three monitoring models. Patients were satisfied with the monitoring regardless of which model they participated in. No differences in medical events were observed.

In-depth interviews with patients using new follow-up models revealed concerns about technology failure, and many patients expressed a desire to have personal contact with a therapist from time to time. At the same time, patients reported increased participation, more flexibility, and a better understanding of their own illness.

Patients with patient-directed follow-up had the least follow-up by healthcare professionals in the study. That is, they had little need for check-ups and had the fewest phone calls with healthcare professionals. The group with digital home follow-up also had little need for check-ups compared to the group with traditional, regular check-ups. There were the most short phone calls in the digital group, many of which were initiated by healthcare professionals based on the patients' reports in the app.

The study shows that new follow-up models can save patients time, while freeing up resources for healthcare professionals to focus on patients with more serious illnesses. The new models can be good alternatives for following up people with chronic illnesses in a stable phase. The study has provided important knowledge to be able to meet patients with more flexible, personalized and effective models for following up chronic illnesses