FRI0629-HPR USE AND USABILITY OF THE DR. BART APP AND ITS RELATION WITH CLINICAL OUTCOMES IN PEOPLE WITH KNEE AND/OR HIP OSTEOARTHRITIS

Background:

Self-management is of paramount importance in non-surgical treatment of knee and/or hip osteoarthritis(OA). Modern technologies offer the possibility to support self-management 24/7. We developed an e-self-management application (dr. Bart app) for people with knee and/or hip OA.

Objectives:

To document the use of the dr. Bart app and its relation with health care utilization and clinical outcomes in people with knee and/or hip OA.

Methods:

For this study we used back end data of the first 26 weeks from the intervention group (N=214) of a RCT (total included 427) examining the effectiveness of the dr. Bart app. Participants were included based on self-reported knee and/or hip OA. In figure 1 the theoretical framework of the dr. Bart app is presented. A central element of the dr. Bart app is that the app proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’1(e.g. today I rise 12 times from my chair to train my leg muscles). The proposals are tailored to user characteristics and related to four themes that are core elements in the non-surgical management of OA. After a user completes one or more of the selected goals, a new selection is proposed by dr. Bart. A user can work on 3 goals simultaneously. Goals can be completed more than once by the same user. To assess the association between intensity of use of the app and health care utilization and clinical outcomes, we calculated Spearman rank correlation coefficients.

Figure 1.

Theoretical framework of the dr. Bart app.

Results:

171 / 214 participants (80 %) logged in at least once whilst 151 (71%) chose at least one goal and 114 (53 %) completed at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37 %) continued to log in up to 26 weeks, 12 (8 %) continued to select new goals from the offered goals and 37 (25 %) continued to complete goals (Figure 2). Preformulated goals regarding the themes activity (e.g. performing an exercise from the exercises library of the app) and nutrition (e.g. eat 2 pieces of fruit today) were found to be most popular by users. We found no correlations between intensity of use and health care utilization and clinical outcomes.

Figure 2.

Percentage of active users (N=151) over time.

Conclusion:

A considerable proportion of persons with knee and/or hip OA persistently used the app up to 26 weeks. Patients appear to have preferences for goals related to activity and nutrition, rather than for goals related to vitality and education. We found no relation between intensity of use of the dr. Bart app and health care utilization and clinical outcomes.

References:

[1] Fogg GJ: A behavior model for persuasive design. In: Proceedings of the 4thinternational Conference on Persuasive Technology: 2009: ACM; 2009: 40.

Disclosure of Interests:

None declared

OP0155-HPR EFFECT OF THE DR. BART APPLICATION ON HEALTHCARE USE AND CLINICAL OUTCOMES IN PEOPLE WITH OSTEOARTHRITIS OF THE KNEE AND / OR HIP IN THE NETHERLANDS; A RANDOMIZED CONTROLLED TRIAL

Background:

Self-management is of paramount importance in non-surgical treatment of knee and/or hip osteoarthritis(OA). Modern technologies offer the possibility to support self-management 24/7. We developed an e-self-management application (dr. Bart app) for people with knee and/or hip OA. A central element of the dr. Bart app is that the app proposes a selection of 72 preformulated goals to induce health behaviors based on the ‘tiny habits method’1

Objectives:

To evaluate the short-term effects of the use of the dr. Bart app, compared to usual care, on the number of secondary health care consultations and clinical outcomes in people with knee/hip OA in the Netherlands.

Methods:

A randomized controlled design involving participants ≥50 years with self-reported knee and/or hip OA, randomly allocated to the dr. Bart app or usual care. Participants were recruited from the community through advertisements in local newspapers and social media campaigns. In Figure 1 the theoretical framework of the dr. Bart app is presented. Participants received online questionnaires at baseline and after 3 and 6 months of follow-up. The primary outcome was the number of consultations in secondary health care due to OA in the knee/hip in the past six months. Secondary outcome measures were self-management behavior, pain, symptoms, functional limitations, physical activity, quality of life, and illness perceptions. Data were analyzed using negative binomial regression or linear mixed models, as appropriate, corrected for baseline, main OA-location (knee or hip), and interaction between treatment group and time.

Figure 1.

Theoretical framework of the dr. Bart app.

Results:

In total 427 eligible participants were allocated to either the dr. Bart group (n=214) or usual care (n=213). Mean age of the participants was 62.1 (SD 7.3) years, with the majority being female (72%) and having symptoms predominantly in their knee(s) (73%). Response rates for the follow-up questionnaires were 75.4% and 69.3% at 3 and 6 months, respectively. With respect to the number of consultations in secondary health care we found a non-significant incidence rate ratio (1.20 (95% CI: 0.67; 2.19)) between the dr. Bart app group and the usual care group. We found a positive overall treatment effect of the dr. Bart app on symptoms (2.6 (95% CI: 0.4; 4.9)), pain (3.5 (95% CI: 0.9; 6.0)) and, activities of daily living (2.9 (95% CI: 0.2; 5.6)), see Table 1. We found non-significant differences between groups for self-management behavior, physical activity, health-related quality of life and illness perceptions.

Table 1.

Overall treatment effect and treatment effects at 3 and 6 months of the dr. Bart app.

MeasuresTreatment effects of dr. Bart appΔ3 months§ ∞(95 % CI)Δ6 months§ ∞(95 % CI)Δ overall§(95 % CI)Number of consultations in secondary health care †1.05 (0.55; 2.02)1.32 (0.89; 2.87)1.20 (0.67; 2.16)KOOS/HOOS- Symptoms1.5 (-1.2;4.1)2.6 (-0.4; 5.6)2.6 (0.4; 4.9)*- Pain3.1 (0.2; 5.9)*0.9 (-2.0; 3.8)3.5 (0.9; 6.0)*- Activities of daily living2.5 (-0.7; 5.7)0.9(-2.6; 4.4)2.9 (0.2; 5.6)*- Functioning in sport and recreation-1.7 (-6.4; 2.9)7.7 (2.7; 12.7)*1.9 (-2.0; 5.9)

* Indicates p-value < 0.05

† Reported as incidence rate ratio

§Adjusted for baseline value, treatment group and main OA-location (knee/hip)

∞Adjusted for time, and interaction between treatment group and time

Abbreviations: KOOS; Knee Injury and Osteoarthritis Outcome Score; HOOS; Hip Disability and Osteoarthritis Outcome Score.

Conclusion:

The dr. Bart app did not reduce the number of secondary health care consultations compared to usual care. However, we found positive effects attributable to the dr. Bart app on pain, symptoms, activities of daily living and functioning in sport and recreation in people with knee/hip OA, suggesting that the dr. Bart app has potential to positively influence health in people with knee/hip OA.

References:

[1]Fogg GJ. 2009: ACM; 2009: 40.

Disclosure of Interests:

None declared

Effect of the dr. Bart application on healthcare use and clinical outcomes in people with osteoarthritis of the knee and/or hip in the Netherlands; a randomized controlled trial

OBJECTIVE

To evaluate the short-term effects of use of the dr. Bart app, compared to usual care, on the number of secondary health care consultations and clinical outcomes in people with knee/hip OA in the Netherlands.

METHOD

A randomized controlled design involving participants ≥50 years with self-reported knee and/or hip OA recruited from the community. The number of secondary health care consultations (primary outcome) and secondary outcomes were assessed at baseline, 3 and 6 months via online questionnaires. Data were analyzed using longitudinal mixed models, corrected for baseline values. Due to the design of this study, blinding of participants and researchers was not possible.

RESULTS

In total, 427 eligible participants were allocated to either the dr. Bart group (n = 214) or usual care (n = 213). We found no difference between groups in the number of secondary (i.e., orthopaedic surgeon, rheumatologist, or physician assistant) health care consultations (incidence rate ratio (IRR) 1.20 (95% CI: 0.67; 2.19)). We found positive treatment effects of the dr. Bart app on symptoms (2.6 (95% CI: 0.4; 4.9)), pain (3.5 (95% CI: 0.9; 6.0)), and activities of daily living (2.9 (95% CI: 0.2; 5.6)) on a 0-100 scale, higher score indicating less complaints, but not in any other secondary outcome.

CONCLUSION

The dr. Bart app did not change the number of secondary health care consultations compared to usual care. However, we found small positive effects (not clinically relevant) on pain, symptoms, and activities of daily living in people with knee/hip OA.

TRIAL REGISTRATION

Dutch Trial Register (Trial Number NTR6693/NL6505) (https://www.trialregister.nl/trial/6505).

Measurement characteristics of a new rapid anti-CCP2 test compared to the anti-CCP2 ELISA

OBJECTIVE

Anti-cyclic citrullinated peptide (CCP)2 antibody status is an important diagnostic tool in the work-up of undifferentiated arthritis (UA)/early rheumatoid arthritis (RA) but the results of the enzyme-linked immunosorbent assay (ELISA) are only available a few days after the test. The aim of this study was to assess the measurement characteristics of a rapid anti-CCP2 test compared to the usual anti-CCP2 ELISA test.

METHODS

In the first phase, rapid anti-CCP2 (CCPoint) tests were performed in capillary blood obtained by finger puncture (CAP), in venous blood from a clot tube (CLOT) and in serum (SERUM) in consenting RA patients. Anti-CCP2 measured in serum using the anti-CCP2 ELISA (ELISA) was set as the gold standard (reference). In the second phase of the study, specificity versus RA was confirmed in consenting non-RA patients and healthy controls. The anti-CCP2 results were negative (no visible line or anti-CCP2<25 U/mL) or positive (visible line or anti-CCP2> or =25 U/mL).

RESULTS

A total of 880 subjects (109 RA patients, 351 non-RA patients and 420 healthy controls) were enrolled in this study. For the RA patients, 5%, 15%, and 1% of CAP, CLOT and SERUM tests, respectively, were inconclusive. The sensitivity and specificity of CAP compared with ELISA were 95% (95% CI 90-100) and 95% (95% CI 89-100), respectively, and the corresponding values for SERUM were 97% (95% CI 93-100) and 98 (95% CI 94-100). The specificity for RA versus non-RA and healthy controls was 99% (95% CI 97-100) and 99% (95% CI 98-100), respectively.

CONCLUSION

The CCPoint test is a fast, valid and reliable anti-CCP2 test in both capillary blood and serum but not directly in venous blood.

[Part-time medical specialist training; experiences with job-sharing for trainee internists]

Due to various factors such as social changes, an increasing number of couples with two incomes, and a growing proportion of female doctors, there has been a growing demand for part-time work in recent years. This is also true for resident physicians. Objections such as a discontinuity in care and the decline in the quality of education frequently prevent resident physicians from working part-time. Over the past two years, the University Medical Centre Nijmegen, the Netherlands, has experimented with job-sharing on clinical wards for resident physicians in internal medicine. This approach works well in practice, as long as a number of conditions, including the proper transfer of medical information and good communication, are satisfied. Job-sharing is one means of satisfying the growing demand for part-time work among resident physicians and specialists.