JMIR Publications

ABSTRACT

Background:

A rising number of people are using mobile devices such as a smartphone or tablet, which results in an increasing number of possibilities to use these devices in healthcare. Healthcare supported by mobile devices is referred to as mHealth. One advantage of mHealth is that it can be provided asynchronously, indicating that healthcare providers and patients are not communicating in real time. This eliminates the need for face-to-face contact, travel costs and travel time (for patients). This form of mHealth has been evaluated in various medical conditions such as diabetes and asthma, with promising results. However, within the field of rheumatoid arthritis (RA), a systematic review of the evidence of the use of asynchronous mHealth in clinical practice has not been performed.

Objective:

To provide an overview of the clinical outcomes of asynchronous mHealth interventions tested in clinical trials in patients with rheumatoid arthritis.

Methods:

A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the PRISMA-guidelines. Studies were initially screened, and later assessed, by two independent researchers. Disagreements on inclusion or exclusion were solved through consensus.

Results:

The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different mHealth interventions were used: 3 studies used SMS-reminders (to increase medication adherence and physical activity), 5 provided access to a web app for disease monitoring and to provide medical information, 1 with access to a smartphone app for disease monitoring and 1 with an activity tracking through a pedometer. Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS-reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS-reminders and web apps), patient-physician interaction (web apps) and self-efficacy (smartphone app).

Conclusions:

There is a limited number of controlled intervention studies on mHealth in RA, but the available studies do show promising results in various domains. mHealth may help to reduce healthcare costs and improve overall patient health in the future. However, to date, actual evidence for implementation for any of its uses in daily clinical practice is limited, which calls for more (high-quality) research.