The clinical impact of electronic patient-reported outcome measures in the remote monitoring of inflammatory arthritis: a systematic review and meta-analysis

The inflammatory arthritides (IA) make up a significant proportion of conditions followed-up in rheumatology clinics. These patients require regular monitoring, but this is increasingly difficult with rising patient numbers and demand on clinics. Our objective is to evaluate the clinical impact of electronic Patient Reported Outcome Measures (ePROMs) as a digital remote monitoring intervention on disease activity, treatment decisions and healthcare resource use in patients with IA. Five databases (MEDLINE, Embase, PubMed, Cochrane Library and Web of Science) were searched, with randomised controlled trials (RCT) and (non-randomised) controlled clinical trials included, and meta-analysis and forest plots conducted for each outcome. Risk of bias was assessed using the Risk of Bias (RoB)-2 tool and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I). Eight studies were included with a total of 4,473 patients, with 7 studies assessing patients with rheumatoid arthritis. Compared with control, the disease activity in the ePROM group was lower (standardised mean difference (SMD) -0.15; 95% CI -0.27 to -0.03) and rates of remission/low disease activity were higher (OR 1.65; 95% CI 1.02 to 2.68), but 5 of 8 studies provided additional combined interventions (eg. disease education). Fewer f2f visits were needed in the remote ePROM group (SMD -0.93; 95% CI -2.14 to 0.28). Most studies were at high risk of bias with significant heterogeneity in design, but our results suggest there is an advantage in using ePROM monitoring in patients with IA, with potential for reduction in healthcare resource use without detrimental impact in disease outcomes. This article is protected by copyright. All rights reserved.