Mobile health (mHealth) technologies can transform the mode and quality of healthcare by connecting patients, their families, and health care professionals by creating a network with mobile and specialized devices with wearable sensors, recording health parameters, and gathering health data. With the help of these innovative medical application interfaces, health information can be converted and transferred to physicians and other health care professionals involved in the care of patients. mHealth empowers patients to become more engaged and take the initiative in self-management and shared management of their health.

As per Palazzo et.al. (2014), 17.3 million people worldwide were reported to have rheumatic and musculoskeletal diseases (RMDs), the most frequent being low back pain and osteoarthritis (OA). As RMDs have multidimensional consequences on health, the increasing availability of apps has a critical role in enabling people with RMDs to better self-manage their health. On the wider mHealth market, various apps have been developed for different healthcare conditions. The number of available mobile health applications has exponentially grown over the past few years, and so has the number of users. These apps are developed for disease prevention among healthy users as well as for people living with long-term conditions including, but not limited to, rheumatic and musculoskeletal diseases (RMDs), psychiatric, respiratory, cardiovascular diseases, and diabetes mellitus.

The Importance of Self-Management in RMDs

Self-management includes an empowered individual taking charge of their care and enacting strategies to maintain or improve their health and well-being. Chronic diseases like rheumatoid arthritis (RA) and RMD are challenging for both patients and physicians. For an individual with a chronic disease, self-management generally includes a level of awareness, behavioral changes, and monitoring. While partnering with their physician as the leader of their health care team through self-management, individuals can identify needs, troubleshoot problems, and experience improved outcomes. And high-quality, evidence-based self-management interventions developed by healthcare providers and persons with these diseases support and empower patients to become the leaders of their healthcare team.

Self-management also shows potential as a valuable tool for preventative health care. By establishing healthy practices and promoting self-efficacy, individuals create habits that can improve their overall health and mitigate risks of other potential comorbidities. Moreover, by raising the awareness of health and healthy behaviors and activating the patient as a responsible party in their health, the quality and length of life can be improved.

Features of Self-management Applications

Mobile applications are an ideal platform to deliver self-management interventions, in this article we have discussed self-management applications that were designed for individuals with rheumatic diseases, including those related to disease education, lifestyle education and monitoring, clinician applications with utility for consumer use, community connection–based apps, apps that connect patients to their rheumatologists, and self-monitoring apps. We have discussed the applications for the general consumer which can be used to self-manage RMDs (Self-Management of Rheumatoid Arthritis: Mobile Applications, n.d.).

Digital treatments have come a long way, leveraging technology to complement or even replace traditional clinical care. mHealth applications are emerging as a potential treatment for the management of rheumatoid diseases. Many revolutionary and award-winning apps help patients self-manage and redefine their standard treatment by providing an entirely new perspective on the patient’s experience. Such apps are categorized based on their application and usability for the patients.

1. Pain/symptom tracker and Analyzer

The unpredictability of rheumatoid disease symptoms makes it difficult for patients to recall their symptoms (where, when, severity of the impact) felt a week ago, much less in the months since their last session with the doctor, and report that symptom in their next session. If the patient is not tracking their symptom between the consultations, the doctor might also be not able to best provide the treatment.

Therefore, the use of mHealth apps plays a greater role in making it easy for the patients to track pain and symptoms by tapping a graphic to show where the pain is or using a sliding scale to explain how much it hurts with the flick of a thumb or finger and report to the doctors. These applications are highly customizable to suit one’s specific tracking needs, and patients can gather as much data as they need and track their symptoms as often as they desire.

Moreover, based on the symptoms and their trend, the apps analyze and create visual snapshots/graphs of data. This allows patients to better understand their disease, and subsequently, both the patient and the doctor can monitor the performance and how things have changed since the last doctor visit. This can assist the patient in getting better treatment based on the progress of their symptoms.

Applications available for tracking and analyzing the RMD symptoms include My Pain Diary, myVectra, Painscale, RheumaBuddy, Track and React, Rheumatoid Arthritis Diary, Pain tracker and symptom tracker, ArthritisPower, Manage my pain, Chronic Pain tracker, FibroMapp™ Pain Manager+ app, and Cliexa-RA ( Greenhalgh, n.d.).

2. Personalized Guide

Living with RMDs entails much more than just pain management. There is a lot to keep track of between medications, doctor’s appointments, and lifestyle modifications, all of which are likely to change from month to month. While exercising with chronic pain and stiffness from rheumatoid diseases can be tough, people who stay active and include exercise in their daily routine report improved quality of life, functionality, and less fatigue and pain. Thus it is foremost important to follow a routine for management of the symptoms (Self-Management of Rheumatoid Arthritis: Mobile Applications, n.d.).

Apps such as the Pain Toolkit App, Arthritis Tracker, My Arthritis App, Elsa, Living With, Vim Pain Mgmt, Pathway Pain Relief, Kaia Health, and Branch Health: Pain Management offer a solution by providing individuals with a healthy routine to follow. The Self-management Toolkit is a simple guide that gives patients some handy tips and skills to help them understand and manage their long-term health conditions better and get them back in the driving seat and on track.

They also postulate a healthy diet and symptom monitoring, which can be important in the self-management of the disease. Therefore, the app narrows down the gap and helps people to be more in touch with the state of their condition to understand their triggers and flare-ups and prevent long-term damage to the joints.

3. Social Support Platform and Self-management

When someone is initially diagnosed, it is natural to feel isolated and unsure of where to turn for the finest information and resources. Some apps such as MyRA and ArthritisID are helpful in understanding the concern faced by the patients and make it simple to find the people with the same condition to assist them in obtaining the answers they require, as well as finding support from people who can actually connect.

The app features valuable interactive screening tools and questionnaires to understand the concern of patients and others as well. Individuals, families, and patients are brought together by these apps, which use a science-based motivational and educational support system to aid them in learning from one another and help patients live a higher quality of life. Elsa, a personalized guide that offers lifestyle habit tracking and access to educational articles and programs, works in a two-way approach and gives patients a platform to communicate with others dealing with the same challenges (Managing Your RA | NRAS | Self-Management, n.d.).

EULAR Considerations for development, evaluation, and implementation of mobile health applications

mHealth technology has the potential to revolutionize the mode and quality of healthcare by allowing people to take a more active part in their health and well-being. The EULAR task force has identified points to consider (PtC) for the evaluation and deployment of RMD self-management mobile applications. This was done through the systematic literature review of app content and development strategies in accordance with the patient focus group and an online survey. The points mentioned for the self-management of rheumatic and musculoskeletal diseases (RMD) include:

• The information content in self-management apps should be up to date, scientifically justifiable, user acceptable, and evidence-based where applicable
• Apps should be relevant and tailored to the individual needs of people with RMDs
• The design, development, and validation of self-management apps should involve people with RMDs and relevant healthcare providers
• There should be transparency on an app’s developer, funding source, content validation process, version updates, and data ownership
• Data collection as part of an app must adhere to all applicable regulatory frameworks, particularly the data protection
• Apps must not result in physical or emotional harm to people with RMDs
• Apps could facilitate patient–healthcare provider communication and contribute to electronic health records or research
• App design should consider the accessibility of people with RMDs across ages and abilities
• If a social network is an important component of an app, structures should be in place to ensure appropriate content moderation
• The rheumatology community should consider the cost-benefit balance of apps before endorsement and/or promotion (Najm et al., 2019)

Barriers to Mobile Application Use in RMD

Some barriers to using mobile apps for self-management of rheumatoid diseases include resistance to technology adoption, patient preference, hand disability, quality of application, and concerns about security. Another barrier is that the acceptability of mobile applications tends to be lower in older age cohorts and most individuals with RA begin showing symptoms as older adults.

An issue of concern for both physicians and patients is the mobile health marketplace. Even though the current app market is ripe for innovation, there is still no common standard of evidence used to create self-management RMD-related mobile applications. Only 35% of apps for RMD involved a health care provider in their development. It is difficult for a consumer or a health care provider to determine which apps are of high quality and may improve their health or well-being, which shows that there is a lack of awareness among the patients (Knitza et al., 2020).

Moreover, individuals with RMD have the unique barrier of being more likely to have a hand disability, preventing them from using a mobile device. There are accessibility options in most smart devices that can be utilized to increase usability for individuals with hand disabilities or pain.

Future Perspective

mHealth is fast-growing, and there are a plethora of health apps to choose from. mHealth has the potential to help patients and scientists solve present issues such as a lack of information, coping challenges, and treatment adherence. Though these promises are encouraging, studies have consistently demonstrated that app quality varies greatly. Expert-created guidelines based on scientific data, such as the ACR and EULAR guidelines, are ideal for mHealth. The involvement of a behavioral scientist could also improve the effectiveness of apps and reduce the risk of injury (MP et al., 2019).

Since demand for care is predicted to increase, adoption of different apps will also increase and will require collaboration between rheumatologists, people with RMD, app developers, and health systems, as well as careful consideration of local regulatory environments, health service delivery, and user experience to provide apps that are appealing, engaging, simple to use and have functionalities relevant to the clinical management of rheumatoid diseases (Grainger et al., 2017).

For more detailed analysis, visit: Rheumatoid Arthritis market

References

1. Grainger, R., Townsley, H., White, B., Langlotz, T., & Taylor, W. J. (2017). Apps for People With Rhematoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality. JMIR MHealth and UHealth, 5(2). https://doi.org/10.2196/MHEALTH.6956

2. Knitza, J., Simon, D., Lambrecht, A., Raab, C., Tascilar, K., Hagen, M., Kleyer, A., Bayat, S., Derungs, A., Amft, O., Schett, G., & Hueber, A. J. (2020). Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study. JMIR MHealth and UHealth, 8(8). https://doi.org/10.2196/19661

3. Managing your RA | NRAS | Self-management. (n.d.).

4. MP, M., H, Y., TWJ, H., & R, K. (2019). Mobile health applications in rheumatology: Could they improve our care and research? International Journal of Clinical Rheumatology, 14(1), 44-. https://doi.org/10.4172/1758-4272.1000223

5. Najm, A., Nikiphorou, E., Kostine, M., Richez, C., Pauling, J. D., Finckh, A., Ritschl, V., Prior, Y., Balážová, P., Stones, S., Szekanecz, Z., Iagnocco, A., Ramiro, S., Sivera, F., Dougados, M., Carmona, L., Burmester, G., Wiek, Di., Gossec, L., & Berenbaum, F. (2019). EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases. RMD Open, 5(2), e001014. https://doi.org/10.1136/RMDOPEN-2019-001014

6.      Self-Management of Rheumatoid Arthritis: Mobile Applications. (n.d.).

7.       Tom Greenhalgh. (n.d.). 5 Best Apps for Rheumatoid Arthritis - Rheumatology Advisor. Retrieved June 1, 2022, from https://www.rheumatologyadvisor.com/home/topics/rheumatoid-arthritis/5-best-apps-for-rheumatoid-arthritis/