Mobile Apps for Individuals With Rheumatoid Arthritis

A Systematic Review

Dee Luo, BA; Penny Wang, BA; Fengxin Lu, MD; Josephine Elias, MPH, MBA; Jeffrey A. Sparks, MD, MMSc; Yvonne C. Lee, MD, MMSc

Disclosures

J Clin Rheumatol. 2019;25(3):133-141. 

In This Article

Abstract and Introduction

Abstract

Background: Mobile health applications (apps) have the potential to help individuals with chronic illnesses learn about, monitor, and manage their condition, but these apps are largely unexamined, with the state and direction of development unclear.

Objective: We performed a systematic review of publicly available apps, directed toward individuals with rheumatoid arthritis (RA); described their current features; and determined areas of unmet need.

Methods: We searched the iTunes and Google Play App Stores for the term "arthritis" and reviewed the descriptions of these apps for specific mentions of RA. Applications that met inclusion criteria were downloaded and reviewed. Using a set of quality measures identified from literature review, we assessed each app for 4 features: basic characteristics, content source, functionality, and security. Frequencies for each feature were recorded, and percentages were calculated.

Results: Twenty apps intended for use by RA patients were identified in December 2016. Fifty percent of apps (n = 10) offered only symptom tracking. Five (20%) provided only information about RA, and 5 (20%) engaged patients by providing both symptom tracking and educational information. Fewer than 50% of apps provided means to contact health care providers or link to an online community, and only 6 (30%) offered security protection for the user.

Conclusions: Most current RA apps do not provide a comprehensive experience for individuals with RA. Areas for optimization include the implementation of smartphone accessibility features and secure methods of protecting individual health information.

Introduction

Health applications (apps) have experienced a rapid growth in adoption and development.[1–3] For example, the percentage of those who own a smartphone with at least 1 downloaded health app rose from 19% in 2012 to 58% in 2015.[4,5] As the number of people who downloaded health apps increased, the number of commercially available apps also increased.[6] In 2013, 43,000 iOS mobile health apps were available in the US, but by 2015, the number had increased approximately 2-fold to 90,000 with over 165,000 total mobile health apps available between the iTunes and Google Play platforms.[7,8]

This proliferation of health apps has not been limited to general diet and fitness apps aimed at healthy individuals. Many apps focus on specific diseases, with the objective of helping those with chronic illnesses better manage their conditions. For example, of the 165,000 apps available in 2015, approximately 14,850 apps (9%) were focused on management of specific chronic health conditions, and this number continues to grow.[8] Considering the ability of mobile health apps to provide real-time support, track daily changes, and store large amounts of data, apps may be especially suited to help systems tackling the realities of chronic disease management meet the expectations of reimbursement structures and patients.[9,10]

Applications addressing chronic conditions have already shown benefits for patients in research studies. Studies of conditions such as obesity, depression, and diabetes have shown that mobile apps may improve clinical outcomes and maintain continuity of care. For example, an electronic journaling app helped individuals with obesity self-monitor their weight and lose 4.6 kg in 6 months, as compared with losing 2.9 kg through traditional paper journaling.[11] In addition, for those with clinical depression, cognitive behavioral therapy administered through a mobile platform resulted in a significant decrease in symptoms post treatment, with high retention rates.[11–13]

For rheumatology, mobile apps may hold unique potential. El Miedany[14] first coined the term "e-Rheumatology" in 2015, placing the growth of portable technology and interoperable information systems in the context of rheumatology. Since then, electronic tools, such as digitally recorded joint counts and electronic patient-reported outcomes measures (e-PROMs), have demonstrated positive outcomes for rheumatoid arthritis (RA) patients in research studies. Patients with RA who regularly completed e-PROMS and digitally tracked their disease were more adherent to their medications, better able to manage activities of daily living, and were less worried about their future.[15] In the mobile arena, an app that enabled patients to input joint symptoms and activity limitations was able to accurately predict disease activity without a physician's input, allowing better self-monitoring of RA.[16] These apps, however, are typically available only in the context of research studies and are not readily available to the general public.

For individuals with RA, who are not involved in research, a wide selection of mobile apps is available, but the majority of these apps have not been rigorously evaluated. There are still many gaps and barriers in app adoption and integration that come from lack of physician involvement, unclear assessment measurements, and vague guidelines.[17,18] Moreover, because there is no official review system for apps on the market, it is unclear to the average user which apps offer evidence-backed tools and education and which ones are less useful. Concerns about the validity of app content,[19] balancing regulation against innovation, and patient security and confidentiality are growing,[20] as evidenced by new multistakeholder collaborations such as Xcertia, tasked with creating app development guidelines and supported by the American Medical Association, The American Heart Association, Healthcare Information Management Systems Society, and digital nonprofit DHX Group.[21]

The state and direction of development are unclear in this emerging field. Therefore, we assessed RA apps for functionalities and future directions to optimize patient engagement and utilization. Specifically, this review aims to (1) examine the state of mobile apps for RA patients and (2) identify areas for improvement in this rapidly developing field.

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