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24. A Smartphone App for Self-Monitoring of Rheumatoid Arthritis Disease Activity to Assist Patient-Initiated Care: Protocol for a Randomized Controlled Trial

Author

Seppen, Bart F, L'ami, Merel J, Duarte dos Santos Rico, Sharon, ter Wee, Marieke M, Turkstra, Franktien, Roorda, Leo D, Catarinella, Fabio S, van Schaardenburg, Dirkjan, Nurmohamed, Michael T, Boers, Maarten, and Bos, Wouter H

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundTelemedicine based on self-measurement of disease activity could be one of the key components to create the health care system of the future. Previous publications in various medical fields have shown that it is possible to safely telemonitor patients while reducing the number of outpatient clinic visits. For this purpose, we developed a mobile phone app for patients with rheumatoid arthritis (RA), which allows them to self-monitor their disease. ObjectiveThe objective of this study is to assess the safety and efficacy of self-initiated care assisted by a smartphone app in patients with RA. MethodsThis is a randomized controlled trial that will be performed for 1 year. A total of 176 patients with RA will be randomized to either self-initiated care with only one scheduled follow-up consultation assisted by our app or usual care. The coprimary outcome measures are the number of outpatient clinic consultations with a rheumatologist taking place during the trial period and the mean disease activity score as measured by the disease activity score 28 (DAS28) at 12 months. The secondary outcomes are patient satisfaction, adherence, patient empowerment, and cost evaluation of health care assisted by the app. ResultsRecruitment started in May 2019, and up to 18 months will be required for completion of recruitment. Thus far, 78 patients have been randomized, and thus far, experiences with the app have been positive. The study results are expected to be published by the end of 2021. ConclusionsThe completion of this study will provide important data regarding the following: (1) safety of self-initiated care supported by a smartphone app in terms of DAS28 and (2) efficacy of lowering health care usage with this new strategy of providing health care. Trial RegistrationNetherlands Trial Register NL7715; https://www.trialregister.nl/trial/7715 International Registered Report Identifier (IRRID)DERR1-10.2196/15105

Published
2020
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31. Country-specific reference values for PROMIS® pain, physical function and participation measures compared to US reference values.

Author

Terwee, Caroline B. and Roorda, Leo D.

Subjects
REFERENCE values, PHYSICAL mobility, PATIENTS' attitudes, SOCIAL role, SOCIAL skills
Abstract

Patient-Reported Outcomes Measurement Information System (PROMIS®) is commonly used across medical conditions. To facilitate interpretation of scores across countries, we calculated Dutch reference values for PROMIS Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), Pain Behavior (PROMIS-PB), Ability to Participate in Social Roles and Activities (PROMIS-APSRA), and Satisfaction with Social Roles and Activities (PROMIS-SSRA), as compared to US reference values. A panel completed full PROMIS-PF (n=1310), PROMIS-PI and PROMIS-PB (n=1052), and PROMIS-APSRA and PROMIS-SSRA (n=1002) item banks and reported their level of health per domain (no, mild, moderate, severe limitations). T-scores were calculated by sample and subgroups (age, gender, self-reported level of domain). Distribution-based and anchor-based thresholds for mild, moderate, and severe scores were determined. Mean T-scores were close to the US mean of 50 for PROMIS-PF (49.8) and PROMIS-APSRA (50.6), lower for PROMIS-SSRA (47.5) and higher for PROMIS-PI (54.9) and PROMIS-PB (52.0). Distribution-based thresholds for mild, moderate, and severe scores were comparable to US recommended cut-off values (except for PROMIS-PI) but participants reported limitations 'earlier' than suggested thresholds. Dutch reference values were close to US reference values for some PROMIS domains but not all. We recommend country-specific reference values to facilitate worldwide PROMIS use. PROMIS offers universally applicable IRT-based efficient and patient-friendly measures to assess commonly relevant patient-reported outcomes across medical conditions. To support the use of PROMIS in daily clinical practice and research across the world, country-specific general population reference values should be obtained. More research is necessary to obtain reliable and valid cut-off values for what constitutes mild, moderate and severe scores from the patients' perspective. [ABSTRACT FROM AUTHOR]

Published
2023
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35. Measuring Mobility Limitations in Children with Cerebral Palsy: Interrater and Intrarater Reliability of a Mobility Questionnaire (MobQues)

Author

Van Ravesteyn, Nicolien T., Dallmeijer, Annet J., Scholtes, Vanessa A., Roorda, Leo D., and Becher, Jules G.

Abstract

Aim: The objective of this study was to assess the reliability of a mobility questionnaire (MobQues) that was developed to measure the mobility limitations of children with cerebral palsy (CP) as rated by their parents. A clinical version of the questionnaire, consisting of 47 items (MobQues47), is available, as well as a research version with 28 items for a specific population (MobQues28). Total scores are expressed on a scale of 0 to 100. Method: We assessed the interrater reliability between both parents of 289 children with CP (168 males, 121 females, age range 2-13y, Gross Motor Function Classification System levels I-IV) and the intrarater reliability within a subgroup of 38 parents (of 23 children) who completed the MobQues twice. Results: For the interrater reliability, high intraclass correlation coefficients (ICCs) were found for the MobQues47 (ICC 0.92) and MobQues28 (ICC 0.87). The standard error of measurement (SEM) was 7.8 and 8.9 respectively. As expected, the intrarater reliability was higher, as represented by higher ICCs (0.96-0.99) and lower SEMs (3.5-4.9) for both MobQues versions. Interpretation: The results of this study indicate that the MobQues is a reliable instrument to measure the mobility limitations of children with CP.

Published
2010
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37. Association Between Measures of Muscle Strength and Performance of Daily Activities in Patients with Knee Osteoarthritis

Author

de Zwart, Arjan, Dekker, Joost, Verberne, Simon, Roorda, Leo D., van der Esch, Martin, Lems, Willem F., van der Leeden, Marike, Psychiatry, Rehabilitation medicine, APH - Aging & Later Life, APH - Mental Health, APH - Health Behaviors & Chronic Diseases, AMS - Rehabilitation & Development, Rheumatology, AII - Inflammatory diseases, AMS - Musculoskeletal Health, AMS - Tissue Function & Regeneration, AMS - Ageing & Vitality, and APH - Societal Participation & Health

Subjects
Rehabilitation, Humans, Physical Therapy, Sports Therapy and Rehabilitation, General Medicine, Muscle Strength, Walking, Middle Aged, Osteoarthritis, Knee, Aged
Abstract

Objectives: Most studies of knee osteoarthritis use isokinetic peak strength as a measure of muscle strength. However, estimated one-repetition maximum (1-RM) may have a stronger relationship than isokinetic peak strength with daily activities. The aim of this study was to test the following hypotheses: first, the estimated 1-RM is more strongly associated than isokinetic peak strength with daily activities; and secondly, the estimated 1-RM is most strongly associated with the 6-minute walk test (6MWT), followed by the Get Up and Go test (GUG test) and the stair-climb test.Methods: Data were used for 177 patients with knee osteoarthritis from a randomized controlled trial on improving muscle strength. The patients had a mean age of 67.6 ± 5.8 years. Isokinetic peak strength was measured using a dynamometer, 1-RM was estimated with the 10-RM test, and physical performance was measured with the 6-minute walk test (6MWT), get-up and go test (GUG) test and stair-climb test, at the start and end of 12 weeks of resistance training. Linear regression analyses provided standardized betas (β) that were comparable between the different associations between measures of muscle strength and daily activities. Results: Compared with the estimated 1-RM, isokinetic peak strength was more strongly associated with all performance-based measures. The associations between the estimated 1-RM and performance-based tests were not ranked in the order hypothesized (6MWT, GUG test, stair-climb test).Conclusion: Contrary to the first hypothesis, isokinetic peak strength showed stronger associations with all daily activities than did estimated 1-RM. In addition, the second hypothesis regarding the activity-specific pattern for the 1-RM with regards walking, chair rising and stair climbing measurements was not confirmed. LAY ABSTRACTIn patients with knee osteoarthritis, greater muscle strength in the upper leg is linked with better performance in daily activities. To test muscle strength, peak muscle strength is usually measured. This study hypothesized that another test (the one-repetition maximum test) would be a more relevant measure. However, this was not confirmed, and therefore peak muscle strength remains the best measure of muscle strength at present.

Published
2022
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