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administered through tablet computers, Web pages, and smart phones. In comparison
to the paper format, there were insignifi cant differences between the paper and
online formats in terms of disease activity measures assessed in this work. On the
other hand, the electronic format helped to handle the complex skip patterns,
provided accurate time and date of recording, achieved higher patient compliance
versus paper with better data quality recorded, and facilitated the availability of an
outbound calling option. The equality between the electronic and paper-based
PROMs reported in this study is in agreement with the results of an earlier study,
which showed that paper- and Web-based surveys provide data that are essentially
equivalent [ 89 ].
As far as disease management and monitoring response to therapy, it was feasi-
ble, using ePROMs, to sum the patient’s disease activity parameters, and based on
the scores calculated, clinical relevant actions tailored to the patient’s disease activ-
ity were taken that have refl ected on the disease control and target achieved. In
addition to its value in monitoring disease activity in standard clinical practice,
ePROMs helped to optimize the patients’ adherence to their treatment. This agrees
with the outcome of earlier studies that reported that by using an iterative design
process that focuses on patient outcome measures and disease activity parameters,
the patients’ perception of their therapy was augmented with sensor technology [ 18 ,
90 ]. In addition to the reported fi nding that implementing a PROMs system in stan-
dard clinical practice did improve patient–rheumatologist communication during
clinic visits [ 91 – 93 ], results of this work showed that ePROMs was able to alert
clinicians to acute needs for symptom management between visits. This comes in
agreement with outcomes of earlier studies revealing values of electronic systems in
the management of patients’ chronic conditions in between their clinic visits [ 87 ,
94 – 98 ]. Furthermore, some systems have been designed to provide educational
materials to patients, tailored to their reported symptoms and needs, right after they
complete a survey [ 95 , 97 ]. The electronic format enabled the treating
rheumatologist(s) to have systematically collected symptom data that can support
clinical decision-making. These features have been found to improve patient satis-
faction with their care and have the potential to improve symptom management [ 99 ,
100 ]. On another front, the signifi cant correlation between adherence to therapy and
the information the patient gets about his medication, as well as the patient’s contri-
bution in the decision-making, highlight the importance of Shared Decision-Making
in the management process.
Conclusion
The fi eld of PROs in RA is of great interest, and is clearly relevant in these days of
patient-centered care. Assessments based on patients’ opinions (PROMs) have
received increasing recognition as being critically important end points in both
clinical trials and standard rheumatology practice for rheumatoid arthritis patients
in the last decade. PROMs’ role has expanded from merely assessing disease
Y. El Miedany