Background/Purpose: Mobile medical Applications (mApps) with integrated patient-reported
outcome instruments (PROs) allow patients (pts) with rheumatoid arthritis (RA) self-monitoring
and might strengthen self-management. Use of mApps might simplify PROs’ information
transfer between pts and physicians. Within the MiDEAR (Mobile medically
supervised patient management in rheumatoid arthritis patients using DocuMed.rh
and RheumaLive (RL-) App)) project we studied pts’ mobile data entry of PROs
using the mApp RL on an iPhone in comparison to paper-pencil versions to evaluate
media bias ahead of routine clinical application.

Methods: As the project’s concept
relies on ‘bring your own
device’ 271 consecutive RA out-pts
were screened for App compatible devices. 156 owned App compatible devices and
were thus eligible. 60 pts agreed to complete established (electronic (e)) PROs
(Funktionsfragebogen Hannover FFbH/calculated HAQ; RA disease activity index
(RADAI)) by using the RL-App installed on an iPhone 3 GS (installed iOS 6.1.3) owned
by the clinic and as paper-pencil versions. Pts answered their questions and
saved their data themselves. The quality and validity of data obtained using RL-App
and the capability of disabled pts to handle it were tested; pts’ experiences,
App/internet use and sociodemographic respectively clinical data were assessed.
Ethic approval and signed informed consents were obtained.

Results: Pts were predominantly female (78.3%), mean age was 50.1±13.1 years
(yrs), mean disease duration 10.5±9.1 yrs. 50% had a high education level. 91.7%
reported substantial experience with a smartphone, 68.3% with a TabletPC. 56.7%
used iOS and 53.3% Android on their App compatible devices. 90.0% already used
Apps. Mean confidence in Apps in general was rated 3.2±1.5 (1-6 Likert scale).

Scores obtained
by pts direct data entry on the smartphone did not differ significantly from
the scores obtained by the paper-pencil questionnaires, see Table1. Even when
pts were splitted by FFbH groups (≤50;51-70;>70) paper-pencil and e scores did not differ
significantly and correlated well.

Three pts did
not complete both PRO versions. In one patient the paper-pencil version of the FFbH/HAQ
could not be calculated due to too many missing values. Five pts reported
problems with the data entry on the touchscreen, no other major difficulties using the RL-App for the ePROs occurred.

Table 1 Median scores ranges; #bivariate
correlation; *Wilcoxon Rank test

Conclusion: RA pts are able to complete ePROs in a mApp on a smartphone. Thus, monitoring disease activity, disability and treatments’ efficacy
continuously apart from the physician visit by a mApp seems feasible. Regular
and broader use of mApps offers new opportunities for tight disease control
concepts. Before the mApp with PROs is used in routine care its acceptance from
patients’ and physicians’ perspectives needs further evaluation.