A scientific review of mobile apps for tracking rheumatoid arthritis disease activity finds that most apps are either simple calculators for physicians to measure disease activity or tools for patients to track symptoms, most of which do not uniformly collect data using validated instruments or composite disease activity measures.
What’s lacking, according to researchers from the University of Otago Wellington in New Zealand writing in the Feb. 21 issue of JMIR mHealth and uHealth, are “high-quality apps for longitudinal assessment of rheumatoid arthritis disease activity.”
Not all apps are the same and it’s important to understand the function and quality of mobile apps for monitoring disease activity, wrote researchers who were led by Rebecca Grainger, Ph.D. of the University of Otago Wellington. Medical apps in general do not adhere to established treatment guidelines and some are created without input from credentialed medical experts so in assessing app quality, patients have little to go on other than user ratings.
In this study, Dr. Grainger and her team compare the features of 19 apps to the American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) rheumatoid arthritis treatment guidelines. Their findings: None of the apps included all ACR and EULAR endorsed disease activity instruments.
The apps were downloaded from iTunes and Google Play app stores. It is important note this was a New Zealand study, but apps featured in this study are available in the U.S. market.
In rating the apps, researchers considered whether the apps included a validated composite disease activity measure and whether they offered features that could record results for future reference. Two independent reviewers were enlisted to rate the apps using the Mobile App Rating Scale (MARS) which includes engagement, functionality, aesthetics and information quality. On a scale of 1 to five, none of the apps scored higher than three.
The review included 19 apps, which differed slightly:
- 14 apps included at least one validated instrument measuring RA disease activity.
- 11 apps allowed users to enter a joint count and seven of these used the standard 28 swollen and tender joint count.
- 8 apps included at least one ACR and EULAR-recommended RA composite disease activity (CDA) measure.
- 10 apps included data storage and retrieval.
- Only 1 app, Arthritis Power, included both an RA CDA measure and tracked data, but this app did not include the standard 28 tender and swollen joint count.
The median overall MARS score for apps was 3.41/5. Of the six apps that scored at least four out of five on the overall MARS rating, only one included a CDA score endorsed by ACR and EULAR, but this app did not have a data tracking function.
“Developing apps that are attractive, engaging, simple to use, and having functionalities relevant to the clinical management of the health condition will require collaboration between rheumatologists, people with RA, app developers, and health systems, and due consideration of local regulatory environment, health service delivery, and user experience,” the researchers wrote.
Regardless of the rating, mobile apps encourage patients to become more actively involved in managing their disease, researchers wrote.
“There is some evidence that mHealth (mobile health) interventions such as smartphone apps may improve outcomes for people with other chronic diseases,” the researchers wrote. Yet, improvements in quality are needed.
Rebecca Grainger, Hermaleigh Townsley, et al. "Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality," JMIR Mhealth Uhealth. Published online Feb. 21, 2017. DOI: 10.2196/mhealth.6956 PMCID: PMC5340922