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Mobile Health (mHealth) Tools to Improve Patient Engagement, Research and Disease Management of Children with Rheumatological Disease

Chronic arthritis in children refers to a heterogeneous collection of protracted arthritic conditions that affect children under the age of 16 [1]. Typically, children with arthritis require frequent visits to healthcare providers for objective monitoring of their affected joints. In addition, children/parents are required to report subjective levels of pain and global assessment of disease. Timely and accurate communication of the location and level of the joint pain, swelling and joint mobility is vital for accurate assessment of affected joints, decision making and disease management by healthcare providers. This is not only important for symptom control but also for evaluating the effectiveness of therapeutic interventions, drug trials and research. Joint examination specifically evaluates the presence of swelling, pain on motion or tenderness of the joint, and limitation of motion in the joint. An accurate count of the number of joints affected is critical for evaluating the effectiveness of the therapeutic regimen. The American College of Rheumatology has published guidelines on changing or escalating therapy based on response to a current regimen, and these guidelines depend on an accurate joint count [2]. Further, the joint pain, swelling and range of movement are part of many disease activity scoring systems, underpinning the importance of accurately recording them. Based on the acuteness and severity of the joints involved, disease activity needs to be monitored frequently. As it involves joints, travel itself can be cumbersome both to the patient and parents. If it can be, travel should be as minimal as required for direct face to face physician clinic visits. An alternate and accurate way to assess patients remotely, capture relevant patient data discretely for evidence based practice and a communication channel between patients and healthcare providers for patient monitoring is needed. Further, patient/parent engagement and involving children in their own care is crucial. The current ubiquitous Smartphones and mobile devices can address the above issues, specifically; patients need to be empowered with better mobile applications that change the way the medical care is delivered to them. We plan to develop a mHealth application which not only addresses the ‘distance’ and ‘travel’ factors involved with patient care but also augment patient’s access to highly trained healthcare providers, saves time, effort, commute and resources and thus impacts morbidity and mortality. The mHealth tools may also influence patient satisfaction, engagement, healthcare affordability and more importantly modify patient’s attitude and behavior towards chronic illnesses. Towards this end, this work presents an innovative application that helps patients and physicians capture the status of pain and other parameters at specific joints in a structured fashion and communicate remotely via texting. The reliable, consistent and discrete data captured can further support research and help comparative effectiveness and outcomes studies. There have been efforts in the past to utilize touch screen computers to manage chronic arthritis, but to the best of our knowledge, this is the first effort to develop and test a Smartphone application to capture and communicate joint pain and other joint parameters.

Investigators: Prabhu Shankar (Emory University), Prahalad Sampath (Emory University), Jiten Chhabra (Georgia Institute of Technology),

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