Adaptation of American College of Rheumatology Rheumatoid Arthritis Disease Activity and Functional Status Measures for Telehealth Visits

Bryant R England; Claire E H Barber; Martin Bergman; Veena K Ranganath; Lisa G Suter; Kaleb Michaud

doi:10.1002/acr.24429

Adaptation of American College of Rheumatology Rheumatoid Arthritis Disease Activity and Functional Status Measures for Telehealth Visits

Arthritis Care Res (Hoboken). 2021 Dec;73(12):1809-1814. doi: 10.1002/acr.24429.

Authors

Bryant R England¹, Claire E H Barber², Martin Bergman³, Veena K Ranganath⁴, Lisa G Suter⁵, Kaleb Michaud⁶

Affiliations

¹ University of Nebraska Medical Center and VA Nebraska-Western Iowa Heath Care System, Omaha, Nebraska.
² University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
³ Drexel University College of Medicine, Philadelphia, Pennsylvania.
⁴ University of California, Los Angeles.
⁵ Yale University School of Medicine, Yale-New Haven Health System Center for Outcome Research and Evaluation, and Veterans Affairs Connecticut Health System, New Haven, Connecticut.
⁶ University of Nebraska Medical Center and VA Nebraska-Western Iowa Heath Care System, Omaha, Nebraska, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas.

Abstract

Objective: To provide guidance on the implementation of recommended American College of Rheumatology (ACR) rheumatoid arthritis (RA) disease activity and functional status assessment measures in telehealth settings.

Methods: An expert panel was assembled from the recently convened ACR RA disease activity and functional status measures working groups to summarize strategies for implementation of ACR-recommended RA disease activity (the Clinical Disease Activity Index [CDAI], Disease Activity Score in 28 joints using the erythrocyte sedimentation rate or the C-reactive protein level [DAS28-ESR/CRP], Patient Activity Scale II [PAS-II], Simplified Disease Activity Index [SDAI], and Routine Assessment of Patient Index Data 3 [RAPID3]) and functional status (the Health Assessment Questionnaire II [HAQ-II], Multidimensional Health Assessment Questionnaire [MDHAQ], and PROMIS physical function 10-item short form [PROMIS PF-10]) measures in telehealth settings.

Results: Measures composed of patient-reported items (disease activity: PAS-II, RAPID3; functional status: HAQ-II, MDHAQ, PROMIS PF-10) require minimal modification for use in telehealth settings. Measures requiring formal joint counts (the CDAI, DAS28-ESR/CRP, and SDAI) can be calculated using patient-reported swollen and tender joint counts. When the feasibility of laboratory testing is limited, the CDAI can be used in place of the SDAI, and scoring modifications of the DAS28-ESR/CRP without the acute-phase reactant are available. Assessment of the validity of these modifications is limited. Implementation of these measures can be facilitated by electronic health record collection, mobile applications, and provider/staff administration during telehealth visits.

Conclusion: The ACR-recommended RA disease activity and functional status measures can be adapted for use in telehealth settings to support high-quality clinical care. Research is needed to better understand how telehealth settings may impact the validity of these measures.

MeSH terms

Arthritis, Rheumatoid*
Functional Status*
Humans
Patient Reported Outcome Measures
Rheumatology / methods*
Severity of Illness Index
Telemedicine / methods*