Patients with rheumatoid arthritis acquire sustainable skills for home monitoring

a prospective dual-country cohort study (ELECTOR clinical trial I)

Marie Skougaard, Henning Bliddal, Robin Christensen, Karen Ellegaard, Sabrina M Nielsen, Jakub Zavada, Sabina Oreska, Niels S Krogh, Christian C Holm, Merete L Hetland, Jiri Vencovsky, Henrik Røgind, Peter C Taylor, Henrik Gudbergsen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: In an eHealth setting, to investigate intra- and inter-rater reliability and agreement of joint assessments and disease activity score (DAS28CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training.

METHODS: Patients with DAS28CRP ≤5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intra-rater reliability and agreement of patient-performed joint counts were assessed through completion of five joint assessments over a two-month period. All patients received training on joint assessment at baseline, only half of the patients received repeated training. A subset of patients was included in an appraisal of inter-rater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCPs), and ultrasonography. Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28CRP. Agreement was assessed using Bland-Altman plots.

RESULTS: Intra-rater reliability was excellent with ICC of 0.87 (95%CI: 0.83 to 0.90) and minimal detectable change of 1.13. ICCs for inter-rater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28CRP slightly higher than HCPs. In patient receiving repeated training, a mean difference in DAS28CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCPs was similar between groups receiving single or repeated training.

CONCLUSION: Patient-performed assessments of joints and DAS28CRP in an eHealth home-monitoring solution were reliable and comparable with HCPs. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training.

Original languageEnglish
JournalJournal of Rheumatology
ISSN0315-162X
DOIs
Publication statusE-pub ahead of print - 15. Aug 2019

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Cohort Studies
Clinical Trials
Joints
Delivery of Health Care
Joint Diseases
Ultrasonography
Prospective Studies

Cite this

Skougaard, Marie ; Bliddal, Henning ; Christensen, Robin ; Ellegaard, Karen ; Nielsen, Sabrina M ; Zavada, Jakub ; Oreska, Sabina ; Krogh, Niels S ; Holm, Christian C ; Hetland, Merete L ; Vencovsky, Jiri ; Røgind, Henrik ; Taylor, Peter C ; Gudbergsen, Henrik. / Patients with rheumatoid arthritis acquire sustainable skills for home monitoring : a prospective dual-country cohort study (ELECTOR clinical trial I). In: Journal of Rheumatology. 2019.
@article{37f6c50ce1dc43dc8aa9e391037b9fa2,
title = "Patients with rheumatoid arthritis acquire sustainable skills for home monitoring: a prospective dual-country cohort study (ELECTOR clinical trial I)",
abstract = "OBJECTIVE: In an eHealth setting, to investigate intra- and inter-rater reliability and agreement of joint assessments and disease activity score (DAS28CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training.METHODS: Patients with DAS28CRP ≤5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intra-rater reliability and agreement of patient-performed joint counts were assessed through completion of five joint assessments over a two-month period. All patients received training on joint assessment at baseline, only half of the patients received repeated training. A subset of patients was included in an appraisal of inter-rater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCPs), and ultrasonography. Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28CRP. Agreement was assessed using Bland-Altman plots.RESULTS: Intra-rater reliability was excellent with ICC of 0.87 (95{\%}CI: 0.83 to 0.90) and minimal detectable change of 1.13. ICCs for inter-rater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28CRP slightly higher than HCPs. In patient receiving repeated training, a mean difference in DAS28CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCPs was similar between groups receiving single or repeated training.CONCLUSION: Patient-performed assessments of joints and DAS28CRP in an eHealth home-monitoring solution were reliable and comparable with HCPs. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training.",
author = "Marie Skougaard and Henning Bliddal and Robin Christensen and Karen Ellegaard and Nielsen, {Sabrina M} and Jakub Zavada and Sabina Oreska and Krogh, {Niels S} and Holm, {Christian C} and Hetland, {Merete L} and Jiri Vencovsky and Henrik R{\o}gind and Taylor, {Peter C} and Henrik Gudbergsen",
year = "2019",
month = "8",
day = "15",
doi = "10.3899/jrheum.181362",
language = "English",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology Publishing Co. Ltd.",

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Skougaard, M, Bliddal, H, Christensen, R, Ellegaard, K, Nielsen, SM, Zavada, J, Oreska, S, Krogh, NS, Holm, CC, Hetland, ML, Vencovsky, J, Røgind, H, Taylor, PC & Gudbergsen, H 2019, 'Patients with rheumatoid arthritis acquire sustainable skills for home monitoring: a prospective dual-country cohort study (ELECTOR clinical trial I)', Journal of Rheumatology. https://doi.org/10.3899/jrheum.181362

Patients with rheumatoid arthritis acquire sustainable skills for home monitoring : a prospective dual-country cohort study (ELECTOR clinical trial I). / Skougaard, Marie; Bliddal, Henning; Christensen, Robin; Ellegaard, Karen; Nielsen, Sabrina M; Zavada, Jakub; Oreska, Sabina; Krogh, Niels S; Holm, Christian C; Hetland, Merete L; Vencovsky, Jiri; Røgind, Henrik; Taylor, Peter C; Gudbergsen, Henrik.

In: Journal of Rheumatology, 15.08.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Patients with rheumatoid arthritis acquire sustainable skills for home monitoring

T2 - a prospective dual-country cohort study (ELECTOR clinical trial I)

AU - Skougaard, Marie

AU - Bliddal, Henning

AU - Christensen, Robin

AU - Ellegaard, Karen

AU - Nielsen, Sabrina M

AU - Zavada, Jakub

AU - Oreska, Sabina

AU - Krogh, Niels S

AU - Holm, Christian C

AU - Hetland, Merete L

AU - Vencovsky, Jiri

AU - Røgind, Henrik

AU - Taylor, Peter C

AU - Gudbergsen, Henrik

PY - 2019/8/15

Y1 - 2019/8/15

N2 - OBJECTIVE: In an eHealth setting, to investigate intra- and inter-rater reliability and agreement of joint assessments and disease activity score (DAS28CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training.METHODS: Patients with DAS28CRP ≤5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intra-rater reliability and agreement of patient-performed joint counts were assessed through completion of five joint assessments over a two-month period. All patients received training on joint assessment at baseline, only half of the patients received repeated training. A subset of patients was included in an appraisal of inter-rater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCPs), and ultrasonography. Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28CRP. Agreement was assessed using Bland-Altman plots.RESULTS: Intra-rater reliability was excellent with ICC of 0.87 (95%CI: 0.83 to 0.90) and minimal detectable change of 1.13. ICCs for inter-rater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28CRP slightly higher than HCPs. In patient receiving repeated training, a mean difference in DAS28CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCPs was similar between groups receiving single or repeated training.CONCLUSION: Patient-performed assessments of joints and DAS28CRP in an eHealth home-monitoring solution were reliable and comparable with HCPs. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training.

AB - OBJECTIVE: In an eHealth setting, to investigate intra- and inter-rater reliability and agreement of joint assessments and disease activity score (DAS28CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training.METHODS: Patients with DAS28CRP ≤5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intra-rater reliability and agreement of patient-performed joint counts were assessed through completion of five joint assessments over a two-month period. All patients received training on joint assessment at baseline, only half of the patients received repeated training. A subset of patients was included in an appraisal of inter-rater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCPs), and ultrasonography. Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28CRP. Agreement was assessed using Bland-Altman plots.RESULTS: Intra-rater reliability was excellent with ICC of 0.87 (95%CI: 0.83 to 0.90) and minimal detectable change of 1.13. ICCs for inter-rater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28CRP slightly higher than HCPs. In patient receiving repeated training, a mean difference in DAS28CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCPs was similar between groups receiving single or repeated training.CONCLUSION: Patient-performed assessments of joints and DAS28CRP in an eHealth home-monitoring solution were reliable and comparable with HCPs. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training.

U2 - 10.3899/jrheum.181362

DO - 10.3899/jrheum.181362

M3 - Journal article

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

ER -