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In contrast, in real life practice, time factor plays a vital role in the patients’ assess-
ment and management. Adopting an “all-in-one” service style is the most favorable
for the majority of clinicians [ 41 ]. In a standard clinical setting, disease outcomes
can be recognized as manifestations refl ecting the underlying disease process (ten-
der and swollen joints, acute phase response), measures of discomfort (pain, fatigue,
patient global assessment, and duration of morning stiffness), measures of disabil-
ity, quality of life, as well as comorbidity/comortality (such as cardiovascular risk,
organ damage, and falls risks). PROMs questionnaires can be used as the link
between outcomes and patient education. Identifying the patient’s educational
requirements from the PROMs questionnaire helps with setting up an educational
program tailored to the patient’s individual needs. Furthermore, PROMs were
reported [ 42 ] to be malleable for guided education, meaning that the educational
program can be devised to tackle the important components identifi ed by the patient
at this stage. As the patient’s PROMs reveal improvement in response to the educa-
tional activity, other educational requirement may emerge. This would lead to re-
stratifying a new self-management education activity adjusted to the patient’s newly
emerging needs.
PROMs and Cardiovascular Education in Arthritis Patients
While it is important to minimize the negative musculoskeletal aspects of arthritis,
attention has been rising toward the other complications of the condition.
F ormulating an action plan to deal with associated comorbidities can enable patients
to think positively and give them control of their situation. Recently, there has been
a surge of interest in the assessment of cardiovascular outcomes in arthritic patients
recommended by guidelines and highlighted by research studies. Earlier published
data reported a cardiovascular risk in rheumatoid arthritis patients similar to that
reported for diabetes mellitus [ 43 , 44 ]. Therefore, it was recommended to include
cardiovascular risk management, which comprises identifi cation and treatment/pre-
vention of these risk factors, in standard clinical practice [ 45 , 46 ]. Recent PROMs
questionnaires (Appendices 1 and 2) expanded the outcome measures assessed in a
trial to give a comprehensive assessment of the patient’s condition at this stage of
his/her arthritis [ 37 , 47 – 49 ]. This paved the way to include cardiovascular education
as part of the disease management in patients with infl ammatory arthritis. A recent
systematic review of patient education in cardiac patients has supported the benefi ts
of educational interventions in cardiac patients through increasing knowledge and
promoting health behavioral change [ 50 ].
Visual Feedback and Patient Education
Visual feedback is a relatively new tool that enables the patient to visualize and
monitor a real-time change of their disease activity parameters as well as the
patient’s reported outcome measures. Though research has shown that patient
D. Palmer and M. Ndosi