Remote monitoring of rheumatoid arthritis (REMORA)

• Research type

  Research Study

• Full title

  Remote monitoring of rheumatoid arthritis - Investigating patterns of disease and treatment response in rheumatoid arthritis patients using the REMORA smartphone app for daily symptom tracking

• IRAS ID

  288501

• Contact name

  William G Dixon

• Contact email

  will.dixon@manchester.ac.uk

• Sponsor organisation

  The University of Manchester

• Duration of Study in the UK

  2 years, 0 months, 0 days

• Research summary

  Summary of Research
  Rheumatoid arthritis (RA) is a common long-term condition that causes painful, swollen joints and disability. Symptoms vary from day to day and the progression of the disease is unpredictable. People living with RA frequently experience flares - a temporary worsening in symptoms. Evidence suggests that early detection and treatment of flares seem essential to improve long-term outcomes. Until recently, we have not been able to capture these short-term variations in disease severity and occurrence of flares outside of asking the patient to recall them at infrequent clinic visits – usually every 6-12 months. But with the widespread use of digital technologies, opportunities for collecting patient-reported data digitally with increased frequency has emerged. This has potential to give us an understanding of what happens with RA symptoms, signs and experiences outside of clinic allowing researchers to answer questions that have previously been impossible to address.

  This study asks adult RA patients to keep track of their daily symptoms using the Remote Monitoring in RA (REMORA) app on their smartphone. The results are automatically sent to their electronic patient record for discussion at their next clinical appointment. Additionally, we will use the data from the app and the patient record to answer research questions with the aims of:
  1) Understanding the patterns of RA symptoms and flares on a day-to-day basis
  2) Investigating patterns of treatment response
  We will recruit 50-100 RA patients from Salford Royal NHS Foundation Trust to track their symptoms on their own smartphone for up to 12 months. The study is funded by the Greater Manchester Digital Fund.

  We will learn valuable insights that can lead us to better management of people living with RA in the future. Our results will provide better answers to the important questions “what does to the future hold?” and “will this drug work?”.

  Summary of Results
  Rheumatoid arthritis (RA) is a common long-term condition that causes painful, swollen joints and disability. Symptoms vary from day to day and the progression of the disease is unpredictable. People living with RA frequently experience flares - a temporary worsening in symptoms. Evidence suggests that early detection and treatment of flares seem essential to improve long-term outcomes. Until recently, we have not been able to capture these short-term variations in disease severity and occurrence of flares outside of asking the patient to recall them at infrequent clinic visits – usually every 6-12 months. But with the widespread use of digital technologies, opportunities for collecting patient-reported data digitally with increased frequency have emerged.
  The study asked adult RA patients to keep track of their daily symptoms using the Remote Monitoring in RA (REMORA) app on their smartphone. The results were automatically sent to their electronic patient record for discussion at their next clinical appointment. The aim was to use the data from the app and the patient record to
  1) Understand the patterns of RA symptoms and flares on a day-to-day basis
  2) Investigate patterns of treatment response

  The study was subject to delays and disruption due to the COVID pandemic. As a result, the recruitment window was reduced, a smaller than intended sample was recruited and full data analysis could not be completed within the timescale of the project (which was for a PhD). The preliminary findings were used to inform a larger feasibility study (REMORA 2, currently in progress).
  The project produced further progress on the technical infrastructure required to scale up use of the app. It provided valuable lessons on how to support patients to download, log in and start using the app independently and how to support clinicians in finding and using the patient-reported data. The need to provide additional support throughout the course of recruitment, consenting and on-boarding was identified. Suggestions for the REMORA 2 programme included the use of short videos to demonstrate use of the app, and monitoring data entry in order to offer support to participants who had either not begun using the app or had stopped entering data.
  The data collected during the project can be used in further ethically approved studies to meet the original aims of REMORA1.5 relating to patterns of symptoms, flares over time and treatment response.

• REC name

  North West - Greater Manchester West Research Ethics Committee

• REC reference

  21/NW/0007

• Date of REC Opinion

  29 Jan 2021

• REC opinion

  Favourable Opinion