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Echarri A, Vera I, Ollero V, Arajol C, Riestra S, Robledo P, Calvo M, Gallego F, Ceballos D, Castro B, Aguas M, García-López S, Marín-Jiménez I, Chaparro M, Mesonero P, Guerra I, Guardiola J, Nos P, Muñiz J. The Harvey-Bradshaw Index Adapted to a Mobile Application Compared with In-Clinic Assessment: The MediCrohn Study. Telemed J E Health 2019; 26:80-88. [PMID: 30848700 PMCID: PMC6948001 DOI: 10.1089/tmj.2018.0264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: Mobile apps are useful tools in e-health and self-management strategies in disease monitoring. We evaluated the Harvey–Bradshaw index (HBI) mobile app self-administered by the patient to see if its results agreed with HBI in-clinic assessed by a physician. Methods: Patients were enrolled in a 4-month prospective study with clinical assessments at months 1 and 4. Patients completed mobile app HBI and within 48 h, HBI was performed by a physician (gold standard). HBI scores characterized Crohn's disease (CD) as remission <5 or active ≥5. We determined agreement per item and total HBI score and intraclass correlation coefficients (ICCs). Bland–Altman plot was performed. HBI changes in disease activity from month 1 to month 4 were determined. Results: A total of 219 patients were enrolled. All scheduled assessments (385 pairs of the HBI questionnaire) showed a high percentage of agreement for remission/activity (92.4%, κ = 0.796), positive predictive value (PPV) for remission of 98.2%, and negative predictive value of 76.7%. High agreement was also found at month 1 (93.15%, κ = 0.82) and month 4 (91.5%, κ = 0.75). Bland–Altman plot was more uniform when the HBI mean values were <5 (remission). ICC values were 0.82, 0.897, and 0.879 in all scheduled assessments, 1 and 4 months, respectively. Conclusions: We found a high percentage of agreement between patients' self-administered mobile app HBI and in-clinic physician assessment to detect CD activity with a remarkably high PPV for remission. The mobile app HBI might allow a strict control of inflammation by remote monitoring and flexible follow-up of CD patients. Reduction of sanitary costs could be possible.
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Affiliation(s)
- Ana Echarri
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Isabel Vera
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Virginia Ollero
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Claudia Arajol
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Sabino Riestra
- Gastroenterology Department, Central University Hospital, Oviedo, Spain
| | - Pilar Robledo
- Gastroenterology Department, San Pedro de Alacantara University Hospital, Cáceres, Spain
| | - Marta Calvo
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Franscisco Gallego
- Gastroenterology Department, Poniente University Hospital, Almeria, Spain
| | - Daniel Ceballos
- Gastroenterology Department, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Beatriz Castro
- Gastroenterology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Instituto de Investigación Sanitaria Princesa and CIBERehd, La Princesa University Hospital, Madrid, Spain
| | - Paco Mesonero
- Gastroenterology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de La Salud e INIBIC, La Coruña University, La Coruña, Spain
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de Jong MJ, Huibregtse R, Masclee AAM, Jonkers DMAE, Pierik MJ. Patient-Reported Outcome Measures for Use in Clinical Trials and Clinical Practice in Inflammatory Bowel Diseases: A Systematic Review. Clin Gastroenterol Hepatol 2018; 16:648-663.e3. [PMID: 29074448 DOI: 10.1016/j.cgh.2017.10.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/06/2017] [Accepted: 10/07/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Mucosal inflammation must be carefully monitored to improve the long-term outcomes of patients with inflammatory bowel diseases (IBD). Patient-reported outcome measures (PROMs) are used increasingly to monitor disease activity in clinical practice and as endpoints in clinical trials. We performed a systematic review to provide an overview of the available PROMs on IBD activity and to evaluate their diagnostic value. METHODS A systematic search of the PubMed, Medline, Cochrane library, and Embase databases using defined keywords, identified 973 articles. These were screened by 2 independent reviewers, and 37 articles on development or validation of PROMs to assess IBD activity were identified for further analysis. Based on the recommendations of the Food and Drug Administration (FDA), the following measurement properties were evaluated: content, construct, and criterion validity; reliability; and responsiveness to change. In addition, data on ease of use in clinical practice were collected. RESULTS Seventeen articles presenting 20 different PROMs were included the final analysis, although none met all the FDA-recommended criteria. Only 2 PROMs (patient-reported Harvey Bradshaw Index and Simple Clinical Colitis Activity Index scores) reported patient involvement during its development. Only 6 PROMs (patient-reported global assessment, patient assessment of disease activity, mobile health index for Crohn's disease, mobile health index for ulcerative colitis, patient-reported outcome derived from the Mayo score, and the 6-point Mayo score) were validated as markers of IBD activity, using findings from endoscopy as the reference standard; these PROMs identified patients with mucosal inflammation with area under the curve values of 0.63-0.82. The mobile health index for CD and UC scores had the best measurement properties for use in clinical practice and in clinical trials. CONCLUSIONS In a systematic review, we identified more than 20 PROMS that have been developed and tested for their ability to determine IBD activity. Further studies are needed to determine their accuracy and whether they can be used effectively in routine practice, clinical trials, telemedicine systems, and value-based healthcare programs.
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Affiliation(s)
- Marin J de Jong
- Department Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands; NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roxanne Huibregtse
- Department Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ad A M Masclee
- Department Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands; NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Daisy M A E Jonkers
- Department Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands; NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marie J Pierik
- Department Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands; NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands.
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