Mobile Health Apps for Systemic Lupus Erythematosus and Lupus Nephritis

A Critical Appraisal

Akshara Ramasamy; Poojitha Dugyala; Chandra Mohan

Disclosures

Arthritis Res Ther. 2022;24(110) 

In This Article

Discussion

Our assessment of the current mHealth applications for SLE and LN patients indicates a substantial lack of patient-centered solutions for lupus patients with renal disease. The majority of the currently accessible mHealth applications for SLE and LN patients failed to adequately address the needs of the patients since they scored poorly on credibility, functionality, and/or interactivity.

Of the included apps for SLE, Lupus Ohio is the only one that offered a wide range of functionalities for SLE patients. As the app is designed by the Lupus Foundation of America, the organization already has a clear understanding of the needs of SLE patients and therefore delivered a relatively comprehensive app for these patients. The app provided credible educational material, communication with a health expert, and a medication and doctor visit tracker. On the other hand, it is only available on the Android app store and its target audience is specifically people from the Ohio chapter.

The bulk of the applications examined for LN, but ultimately excluded, only offered informational content about kidney diseases in general. Apps such as Kdigo, ASN Kidney News, The Nephrology Pocket, ResponsumforCKD, Nephrology Guide, and Kidney Diseases and Treatment appeared in our LN screening, but they did not satisfy the needs of LN patients as they failed to provide information specific to LN or offer any advanced functions. Of the 2 included apps, both Glomerulonephritis Disease and KidneyWell were rather limited in their functionalities offered to patients, as discussed under the "Results" section. The MARS scores for all of the apps included in this study had poor to mediocre ratings, demonstrating the modest quality of the available apps. The information domain scored the lowest, mainly because most of the available apps for SLE did not provide verifiable information. The majority of the apps were designed by third-party businesses with little relevance to renal disease. The applications scored poorly in the engagement and aesthetic arenas because developers did not focus on user engagement or the visual appeal of the apps. In order to produce more effective apps for SLE and LN patients, developers need to focus on offering a wider spectrum of functionalities desired by the patients. A combination of features such as support groups, discussion forums, communication with health experts, medication reminders, and regular symptom monitoring can be highly beneficial to patients. However, the apps reviewed fail to offer a comprehensive array of these features with the current apps only providing one function or the other. It would be important for app developers to continually optimize their apps based on patient feedback.

Mobile health apps, such as Lupie Diary, have the unique ability to document the nuances of the patient's condition which a brief consultation with the provider may not capture. Apps such as these provide unparalleled opportunities for collecting PGHD/PRO from the patients in between visits, though none of the currently available apps is being used to accomplish this. Considering the patient can easily generate and maintain patient-generated health data (PGHD) and patient-reported outcomes (PROs) through such apps, these data have the potential to be integrated with commonly used electronic medical record (EMR) systems. If the PGHD/PRO collected through such apps were to be shared with the provider, it may allow the provider to remotely monitor patient symptoms and PROs and this could significantly influence patient management. With the burgeoning interest in digital phenotyping, such app features are likely to play an increasingly significant role in continuous patient monitoring in the coming years.

Despite the rise in mHealth technology as a supplemental approach for patients to self-manage their autoimmune diseases, the available applications created particularly for SLE and LN patients are inadequate. The existing instruments are of moderate quality, with limited functionality, and do not fully meet the rising needs of patients with SLE and LN. This review recommends the development of patient-centric mHealth technologies that offer wide-ranging functionalities and credible educational content. Also important is to empower the SLE/LN patient to self-monitor the disease from the comfort of home, particularly for early warning signs of renal involvement in SLE. Also required is an app-based screening of health-related quality of life (HRQoL) information, and apps that allow 2-way communication with the care provider. Likewise, it will become increasingly important to transition laboratory-based diagnostic tests into simple point-of-care test formats so that essential laboratory investigations can also be performed by the patient, from their home. These considerations become even more acutely warranted during a pandemic, such as in the world we currently live in.

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