Rheumatology

Rheumatol Int DOI 10.1007/s00296-014-3117-9

INTERNATIONAL

Review Article - Educational Review

Future perspectives of Smartphone applications for rheumatic diseases self‑management Ana Rita Pereira Azevedo · Hugo Manuel Lopes de Sousa · Joaquim António Faria Monteiro · Aurea Rosa Nunes Pereira Lima 

Received: 9 June 2014 / Accepted: 13 August 2014 © Springer-Verlag Berlin Heidelberg 2014

Abstract  Rheumatic diseases (RD) self-management interventions are designed to improve health-related quality of life, health care utilization, and perceived self-efficacy. Despite these demonstrated good results, there are several issues that hinder or render less appealing these interventions. One economically and socially viable solution is exploiting the potential of Smartphone technology. This potential comes from Smartphones pervasive presence in actual society, combined with the advantages of being personal, intuitive, and computationally powerful, with capability to support applications and assist its user throughout different activities of daily living and environments persistently. With their global acceptance increasing quickly, there is a great opportunity for mobile health in using Smartphone applications for RD self-management. Besides the potential of such applications, research on the development and evaluation of such applications is in the

Electronic supplementary material The online version of this article (doi:10.1007/s00296-014-3117-9) contains supplementary material, which is available to authorized users. A. R. P. Azevedo · H. M. L. de Sousa  Faculty of Medicine of University of Porto (FMUP), Al. Prof. Hernâni Monteiro, 4200‑319 Porto, Portugal e-mail: [email protected] A. R. P. Azevedo · H. M. L. de Sousa · A. R. N. P. Lima  Molecular Oncology Group CI, Portuguese Institute of Oncology of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200‑072, Porto, Portugal H. M. L. de Sousa  Virology Service, Portuguese Institute of Oncology of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200‑072 Porto, Portugal e-mail: [email protected]‑saude.pt

early stages. Therefore, it is important to foresee its future applicability in order to meet the needs of the twenty-first century. Keywords  Smartphone applications · Self-management · Rheumatic diseases · Mobile devices · Mobile health

Introduction Rheumatic diseases (RD) are non-traumatic functional disorders of musculoskeletal system (bones, joints, muscles, and/ or tendons) with a wide spectrum of conditions with diverse pathophysiology, signs, symptoms, and duration time (acute onset, short duration, or chronic progressive course) [1–3]. The RD include more than one hundred diseases that can be classified into (1) non-inflammatory: degenerative spine diseases, osteoarthritis, osteoporosis, and fibromyalgia; (2) inflammatory: rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, spondyloarthritis, reactive arthritis, connective tissue diseases, rheumatic polymyalgia, J. A. F. Monteiro · A. R. N. P. Lima (*)  CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Pharmaceutical Sciences, Higher Institute of Health Sciences - North (ISCS-N), Rua Central de Gandra 1317, 4585‑116 Gandra, PRD, Portugal e-mail: [email protected]; [email protected] J. A. F. Monteiro e-mail: [email protected] A. R. N. P. Lima  Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050‑313 Porto, Portugal

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gout, systemic lupus erythematosus, and scleroderma [3]. It is estimated a worldwide prevalence of RD between 12.0 and 24.0 %, generally affecting more females and increasing with age [2, 4–6]. More than one-quarter of all Europeans are affected by at least one type of RD [2]. In addition to high prevalence, RD are a major cause of morbidity and reduction in life expectancy [1, 7]. Therefore, and with the aging of population and longer working lives, RD represent an expanding social and economic problem, inflicting high costs, both on health and social care systems [1, 7]. To reduce these problems and improve patient outcome, self-management has been seen as a key intervention [8]. Self-management is defined as the “patient’s ability to manage the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition” [9]. Health professionals and patients look into self-management interventions from different perspectives [10]. Health professionals associate self-management as structured education to develop patients’ self-management skills, while patients view these strategies as a way to bring order into their lives, helping them to recognize boundaries; mobilize resources; handle with the change in self-identity; and plan, pace, and prioritize [11]. Therefore, self-management interventions, besides being problem-focused and action-oriented, emphasize patient-centered care plans that include educational, behavioral, and cognitive approaches, in order to influence health knowledge, attitudes, beliefs, and behaviors [12]. Despite self-management interventions demonstrated good results [13–25], there are several issues in these interventions, which includes difficulties in involving patients, physicians, and organizations; problems in the evaluation of interventions; and limitations related to content, timing, economic, and social impacts [8, 26–28]. One economically and socially viable solution should be exploiting the benefits of new technologies. In fact, the future of mobile health (mHealth) technologies is an important topic in health care with great potential for disease-associated selfmanagement strategies. Therefore, in this review, we aimed to characterize current self-management interventions for RD and exploit the actual and future applicability of Smartphone applications.

Rheumatic diseases self‑management Self-management interventions are seen as key components of rheumatologic care, in particular of chronic RD [8]. These are aimed to directly and/or indirectly improve health-related quality of life (HRQoL) of the most important health domains for RA patients (e.g., pain, disability, depression, and global disease severity), health care utilization (total visits to physicians and rheumatology-related visits), and perceived self-efficacy (reflection of patient

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confidence to exercise control over the disease) [13–19]. These interventions promote independence, maintain or adjust social life roles, and address the psychological impact of disease [12]. To achieve these patient- and health care-related improvements, RD self-management interventions cover several subjects, they are as follows: (1) educational and psychosocial interventions; (2) lifestyle interventions; and (3) treatment interventions (Fig. 1). Educational and psychosocial interventions Education should constitute the initial step in self-management of RD and, whenever possible, should be combined with psychosocial interventions in order to influence behavior and induce self-efficacy perception [20, 23]. Selfefficacy perception is essential to reduce the development of affective disorders (e.g., depression and anxiety), commonly present in chronic RD patients [23]. Affective disorders are manifested in worrying, tenseness, avoidance behavior, and in feelings of sadness and helplessness and can reach to such an extent that can affect how well people are able to manage their disease (e.g., anxious avoidance of physical activity may increase functional impairment, and pessimistic thoughts may lead to poor compliance to pharmacological treatment) [29]. Thus, this will be translated in increased health care consumption, medical costs, sickness leave, and job loss [29–31]. Educational and psychosocial self-management interventions have demonstrated effective results in the improvement of patients’ HRQoL and perceived self-efficacy [13, 23, 24, 29, 32, 33]. In addition, these interventions combined with other strategies such as Yoga, Tai Chi, massage, and music therapy resulted in a median pain reduction of 23 % and an improvement in disability score of 19 % [22]. Lifestyle interventions Lifestyle interventions are of great importance since due to pain and other symptoms, patients with RD are less physically active than general population [34]. Ongoing studies have shown that avoiding unhealthy behavior, maintaining optimal weight, having an adequate nutrition and sleep, and engaging in physical activities are self-management strategies recommended to improve and maintain periarticular muscle strength, flexibility and endurance, joint range of motion and protection, promote self-esteem, pain coping and self-efficacy, and improve HRQoL [20, 35–37]. Of particular interest is the participation in these interventions of overweight and obese individuals in self-management strategies, given that this population experiences more severe symptoms and impaired HRQoL when compared to those who maintain a healthy weight [38, 39] and, therefore, they are more likely to benefit of these strategies. In fact, a

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Fig. 1  Self-management interventions in rheumatic diseases

systematic review and meta-analysis of weight reduction in obese patients with osteoarthritis showed that a 5 % reduction in weight was associated with improved disability and pain [40]. Treatment interventions Treatment non-compliance rate is about 50 % in RD patients and can be of two types—intentional or unintentional [41–43]. The intentional non-compliance reflects a rational decision-making process of patient to not take the drugs or make a different dosage as instructed, whereby the benefits of pharmacological treatment are weighed against perceptions, feelings, or beliefs that drugs will not relieve symptoms, will cause serious adverse drug reactions or dependence [44–46]. On the other hand, unintentional non-compliance involves intending to take a medication as instructed but failing to do so for some reason (e.g., forgetfulness or carelessness) [45, 46]. Non-compliance is influenced by patient characteristics (e.g., educational and socioeconomic levels), treatment factors (e.g., multiple medication regimens and chronic therapy), and patient– health provider issues [45–47]. It contributes to the failure

of therapeutic outcome, greater number of drug-related hospitalizations, and higher costs in health care services [45, 46, 48]. Therefore, compliance monitoring should be performed routinely to ensure drug effectiveness, avoid unnecessary dose and regimen changes, and contain health care costs [49]. Currently, there have been interventions specifically designed to improve compliance, mainly based on patient education, development of reminders, counseling, family therapy, psychological therapy, telephone follow-up, supportive care, and teaching techniques of disease selfmanagement [45, 48, 50]. These traditional reminder systems are helpful compliance auxiliaries, especially when non-compliance is unintentional, but minimally involve the patient in the self-medication process and do not provide them access to their compliance data or other educational information [50].

Smartphone: an emerging technology in health Internet technologies have yielded advances in telemedicine and teleHealth. Subsequently, they are now used in every modern health care organizations [51]. Due to the

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advances of these technologies, barriers of space and time between health care providers and patients have been broken and a new term in the field of teleHealth emerged: mHealth [52]. As defined by the World Health Organization, mHealth, a component of electronic health (eHealth), is a “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices” [53]. Although personal digital assistants experienced a growth between 1990s and early 2000s, they have been replaced by other mobile devices with new functions and utilities, such as Smartphones [53]. The Smartphone market is growing quickly, and there are already more than 1.08 billion Smartphones of a total of 5 billion mobile phones around the World, with a greater penetrance between ages of 25–34 and with females taking the lead (56 % owning a Smartphone) [54–56]. These have the advantages of being personal, intuitive, userfriendly, computationally powerful, with larger and higherresolution display screens, sensor-rich (e.g., high-quality cameras, recording devices, accelerometers, and geo-positioning systems), connected, and portable [57, 58]. The internal sensors offer diverse possibilities such the ability to infer context (user location, movement, and emotion), and the connectedness facilitates the sharing of health data with health professionals or peers [58]. In addition, as portable devices, they are highly valued by individuals, tend to be switched on, and remain with the owner throughout the day, which offers the opportunity of bringing interventions into real-life context [58]. Moreover, the capability of Smartphones to support software programs, known as applications (“apps”), has stimulated significant attention in the last years, and since Smartphones global acceptance is increasing quickly, there is a great opportunity for mHealth in using these applications. Smartphone applications in health Similarly to Smartphone owning, females take the lead when it comes to using health applications, with greater use in certain life events (e.g., pregnancy) [55, 59]. There is already a growing body of evidence that supports the use of Smartphone applications in health interventions. Many thousands of commercial applications may provide cheaper, more convenient, continuous, automated tracking of health and timely interventions for specific contexts without users special training [58]. Those aiming to improve health tend to provide information, advice, instruction, prompts, support, encouragement, and interactive tools for individuals to monitor, record, and reflect [58]. Smartphone applications may address a wide variety of purposes and contexts, such as for promoting behavior changes, for example, smoking cessation [60, 61], weight management, and physical

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activity promotion [62–64]. These provide a unique opportunity to help users stay healthy, while potentially playing a key role in helping to prevent disease onset [65, 66]. Moreover, applications may improve diseases tracking and monitoring process, for example, melanoma screening [67] and quantitative assessment of the curvature in diagnosis of scoliosis [68]. In addition, applications can be applied for the self-management of diseases, mainly chronic, such as diabetes mellitus [69], asthma [70], and RD [71–73].

Smartphone applications for rheumatic diseases management Importance of Smartphone applications Recent literature suggests that RD self-management interventions can empower patients to become effective health care consumers in addition to improving clinical outcomes [13–24]. Moreover, these programs are both important and satisfying to patients [25]. Nevertheless, there are several problems in RD self-management interventions, including difficulty in involving patients, physicians, and organizations; issues in evaluating them; and their limited success both in terms of content, timing, and economic and social impacts [8, 26–28]. One economically and socially viable solution to mitigate some of these problems is exploiting the benefits of new technologies, using Smartphone applications. Engaging patients, clinicians, and organizations Achieving engagement of patients, clinicians, and organizations with self-management programs is challenging [26]. Particular patient groups are less engaged with “standard” programs such as patients with low levels of health literacy and low socioeconomic status, or patients from culturally and linguistically diverse communities [26]. Smartphone applications can partially solve this problem since these applications can be utilized without special training, contain user-friendly visual graphics and speech in animations, and can be provided in all languages with minor modifications to the intervention and reach almost all communities [58, 74]. Nevertheless, the Smartphone applications use also may vary according to age, gender, and socioeconomic levels, such that, for example, many patients do not have Smartphones or do not fully understand how to use them [75]. Self‑management interventions access Access to self-management programs is an issue for some patients, especially those working full time or living in rural and remote communities. Most programs are

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face-to-face interventions, which may be difficult for those who work full time to attend a program during the day [27]. Although some programs offer evening sessions, participation can be hindered by fatigue after a long workday [27]. Also, for those living in rural and remote areas, such programs may not be readily available. Smartphone applications provide good flexibility for delivering health information and resources at a time and place that is chosen by the individual [58]. Other advantage is that they allow the easy sharing of daily health and activity information among the patient and health professionals without the need to travel [72]. Self‑management interventions evaluation Evaluation of self-management interventions has problems in both terms of frequency and methodology. Since the evaluation occurs in stages before, during, and after intervention, it represents a range of snapshots along a continuum, which may miss the full impact on the patient [27]. In addition, differences in outcome data may occur depending on who has asked questions and how questions were asked [27]. Smartphone applications offer a promising method for delivering a variety of medical and psychosocial treatments and for prospectively assessing treatment outcomes in patients’ typical environment, by a continuous way, rather than depending on a return clinic visit for post-treatment assessment [71]. Still, the continuous use of these applications may result in several problems, such as interfere with school or work; decrease real-life social interaction; decrease academic ability; cause relationship problems; lead to physical health-related problems, including blurred vision and pain in the wrists or the back of the neck; and ultimately, cause addiction [76–78]. Self‑management interventions flexibility Concerns have been raised for the lack of self-management programs flexibility to incorporate individuals’ existing skills, life circumstances, and resources [8]. Evidence demonstrates that those who benefit from structured self-management programs tend to have a higher education level [79]. Moreover, a study in adolescents with chronic RD suggests that these may need additional support to achieve independence in self-management [80]. This suggests that structured programs may not include or be sufficiently adequate for all patients with RD. Smartphone applications can be useful for this issue because more and more they are reaching to all, independently of age, education level, or socioeconomic environment [54, 56]. In accordance, one study demonstrated that elderly patients with no previous experience with information and communication

technologies were capable to effectively use a Smartphone application [81]. Self‑management interventions timing Another issue is the timing of self-management interventions. Most self-management programs were tested in patients 5 to 10 years after diagnosis [28]. Sociopsychological research suggests that after a major life experience (e.g., having a child) or a health event (e.g., a disease), people tend to be more amenable to adopt healthy behaviors [82]. This “teachable moment” is thought to be the ideal time for self-management interventions because people are more motivated. A study demonstrated that about 40 % of RD participants started exercising within the first month after receiving a leaflet on osteoarthritis and completing a self-management program [83]. Although the mechanism of this behavior change is unclear, the diagnosis of a RD may present a “teachable moment” for engaging patients to self-management behaviors. In fact, Smartphones can be helpful in this moment by capturing reports and provide immediate feedback and recommendations [71]. State of the art Literature search methodology In order to evaluate the state of art of Smartphone applications for self-management in RD, a search was performed using the PubMed database. Bibliographies of retrieved articles were screened for cited references to identify additional publications not indexed in the search database. Additionally, the search was performed in the online official stores, e.g., Apple store® (Apple Inc.) and Android market® (Google Inc.). The search strategy included one or a combination of the following terms: “application,” “app,” “compliance,” “disease activity,” “management,” “medical,” “mobile applications,” “mobile phone,” “monitoring,” “Rheumatic Diseases,” “self-management,” “self-monitoring,” “Smartphone,” “treatment,” and “therapy.” The most common RD were added to the search strategy. Studies and applications were selected if were in English or Portuguese, aimed for RD, analyzed strategies of self-management in health, patient-oriented, and had the involvement of Smartphone technology. Results Recently, there has been an increase in the use of digital media technologies (e.g., Web sites, Smartphone applications, and social networking tools) to deliver self-management interventions [14, 15, 72, 73]. Until now, several

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Smartphone applications, not specific to any disease, have been developed as educational, psychosocial, lifestyle, and/or treatment interventions for problems related with RD and, there are only a few specific for RD (Table 1) [61–64, 71–73, 81, 84–87]. The RD-specific Smartphone applications are used to measure symptoms, provide the sharing of gather objective data between patients and health professionals, and self-measure the gait patterns [71–73]. A study in juvenile idiopathic arthritis evaluated the impact of the use of electronic diaries (e-diaries) for Smartphone by children to determine whether disabling symptoms (pain, stiffness, and fatigue) continue to be common despite the use of aggressive treatments [71]. Despite it was concluded that these symptoms persist common although the use of aggressive treatments, this study provided a daily evaluation in pain and symptoms patterns [71]. Another study reported the development of an application that analyzes gait abnormal patterns and gathers self-evaluations of HRQoL and disease activity from rheumatoid arthritis patients and shares it with health professionals [72]. The application for Smartphone was evaluated only in terms of feasibility, and results demonstrated that the rate of patient usage was very high, even though some patients had no experience in using Smartphones [72]. A study evaluated a Smartphone application combined with a sensor regarding its utility for selfassessing the gait patterns of rheumatoid arthritis patients, and results suggested that some gait parameters recorded represent an acceptable assessment tool for gait in those patients [73]. There are also many Smartphone-based medical applications available in online application stores directed for RD but they were not evaluated in any step of application development or discussed in the medical literature and, thus, lack of scientific evidence [88]. Table 2 and Table Supplementary 1 present an overview of these applications and some of their screenshots.

Future perspectives This area seems to be very promising since Smartphones can provide several advantages compared to face-to-face self-management interventions. For example, the problem of access to self-management programs will no longer be an issue for patients working full time or living in rural and remote communities, since the intervention will be brought to any place and any time by a Smartphone. Nevertheless, for future work, there are various paths to take. There is a need for the development of more Smartphone applications in RD aimed for the self-management of disease-related symptoms; treatment, physical, and psychosocial consequences of disease; and lifestyle changes. Moreover, to develop these Smartphone applications with

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success is necessary to be aware of key challenges for their widespread adoption. These challenges include the following: (1) provide a solid evidence-based approach for ensuring applications credibility; (2) certify that there is sufficient health professional and target users involvement in applications design and content; (3) guarantee that applications are provided in a reliable way, since it influences their usability; (4) make sure that concerns in relation to security and privacy are attended; (5) indicate all possible conflicts of interest since, in some cases, applications are industry-driven, hence exposing bias in information provided, including bias toward particular types of treatment or intervention procedures; and (6) standardize applications to allow their integration with the hospital information system. The integration of mobile applications with other aspects of patient care, including the use of electronic health records and patient portals, will be one of the pivotal steps on the application maturity journey to facilitate the widespread prescription of mHealth applications, but guidelines are still needed to standardize such applications.

Conclusion The future of “wireless mHealth technologies” is a new and evolving topic in health care services, with a great potential for supporting self-management interventions in RD, designed to improve HRQoL, health care utilization, and perceived self-efficacy. The Smartphone is a platform suitable to support these procedures, and as it has now achieved such a pervasive presence in society, it is a personal device and it assists its user throughout different activities of daily living and environments persistently. There are no doubts that in a near future, Smartphone applications will have potential to transform health care and clinical interventions. In line with this, and since the today’s digital age patients will be the tomorrow patients, it is important to start now to develop such useful applications. Although there has been much enthusiasm with concern to this, the Smartphone applications use is limited by age, gender, and socioeconomic levels and its continuous utilization may result in several problems. The state of the art suggests the existence of more Smartphone applications for self-management directed for rheumatoid arthritis and RD in general, and so most of types of RD remain unexplored by these technologies. Moreover, at this juncture, although the several applications found in online stores, there is a need for scientific research in the development of such applications. As future perspectives, the meeting of the key challenges will accelerate the movement of applications use from that of a novelty into the mainstream of health care. In conclusion, research on the development and evaluation of such applications is in

Application

iFall

Physical activity levels (PAL) calculator

Fall detector

Abnormal gait pattern analysis

Lose it!

E-diary

My meal mate

References

Sposaro et al. [80]

Bexelius et al. [62]

Silva et al. [81]

Yamada et al. [71]

Allen et al. [61]

Bromberg et al. [69]

Carter et al. [60]

Weight management/not specific (overweight)

Data self-collection/JIA

Weight loss

Gait analysis/RA

Fall detection/not specific

PAL measure/not specific

Fall detection/not specific

Aim/disease

Characteristics

Conclusions

Android/prototype

An application for fall detection Realizable and cost-effective solution to fall detection using and response. (educational and psychosocial intervention) a simple graphical interface while not overwhelming the user with uncomfortable sensors A promising tool for assessing Java/prototype Measures PAL through the levels of physical activity questionnaire application. (lifestyle intervention) Android/prototype A fall detection application for Encouraging and optimistic results regarding the feasibility Smartphone with an accelof this fall detector erometer. (educational and psychosocial intervention) Some gait parameters recorded Android/prototype A gait pattern analysis by an using the Smartphone represent acceleration sensor, a recordan acceptable assessment tool ing device, and a computer for gait in patients with RA program for processing the acceleration signals. Sensors have to be attached using a semi-elastic belt. (educational and psychosocial intervention) A promising tool for selfAndroid and iOS/5.0.8 Records food intake and exercise, calculates energy balance monitoring as an adjunct to behavioral counseling in real time, records weight and sets goals for weight loss and exercise. (lifestyle intervention) Microsoft windows/prototype Measures pain (location, dura- Provide a daily evaluation in pain and symptoms patterns tion, intensity, and unpleasantness), functional limitations, stiffness, and fatigue (intensity and duration). (educational and psychosocial intervention) Android/2.0.1 Goal setting, self-monitoring of Acceptable and feasible weight diet and activity, and feedback loss intervention via weekly text message. (lifestyle intervention)

Platform/version

Table 1  Smartphone applications for self-management of rheumatic diseases and related problems

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13 Data self-collection and sharing/not specific (patients with chronic pain)

Gait analysis, data selfcollection and sharing/RA

Kristjansdottir et al. [78] Diaries and daily situational feedback

Lifelong sharing system

REQ-mobile

ALICE

Shinohara et al. [70]

Buller et al. [59]

Mira et al. [75]

Android and iOS/prototype

Unknown/prototype

Android/prototype

Unknown/prototype

Android/prototype

Platform/version

Feasible for delivering cessation support but appeared to not move smokers to quit as quickly as text messaging because it is simple, well known, and delivered to a primary inbox. These advantages may disappear as smokers become more experienced with new handsets

Feasible promising tool

Can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation

Feasible and provides an innovative solution to encourage medication self-management

Conclusions

Personalization of prescriptions Improves compliance, helps reduce rates of forgetting and medical advice, showing and of medication errors, and images of each medication increases perceived independtogether with alerts and mulence in managing medication tiple reminders for each alert. (treatment intervention)

Storage and provision of an accurate, portable medication history and medication-taking records of patients. Provision of a reminder to take medication. Real-time medication monitoring. (treatment intervention) Analysis by questionnaire of current level and interference of pain, feelings, and thoughts related to avoidance, catastrophizing and acceptance. (educational and psychosocial intervention) Gait pattern analysis by an acceleration sensor, a recording device, and an application for processing the acceleration signals and an application to patients measure their daily RA parameters. (educational and psychosocial intervention) An application for smoking cessation. (lifestyle intervention)

Characteristics

iOS iphone operating system, JIA juvenile idiopathic arthritis, PAL physical activity levels, RA rheumatoid arthritis, Ref reference

Medication self-management

Smoking cessation

Medication history storage and reminder/not specific

Medication self-management system

Hayakawa et al. [79]

Aim/disease

Application

References

Table 1  continued

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1.2

1.2

1.6

2.0.4

1.0 1.0

TRACK + REACT®

Learn Arthritis Prevention®

MyRA®

RheumaTrack®

RHEUMATOID ARTHRITIS®

Rheumatoid Arthritis Diagnosis and Management®

1.2

My Pain Diary®

Disease model Educational and psychosocial +  lifestyle + treatment

Type of intervention

Rheumatoid arthritis

Android iOS

Rheumatoid arthritis Rheumatoid arthritis

Educational and psychosocial Educational and psychosocial

Educational and psychosocial +  lifestyle + treatment

Educational and psychosocial

Inflammatory rheumatic diseases Educational and psychosocial

Android and iOS Rheumatoid arthritis

iOS

Android

Android and iOS Inflammatory rheumatic diseases Educational and psychosocial +  lifestyle + treatment

Android and iOS Rheumatic diseases

Version Platforms

Application

Table 2  Smartphone applications for self-management of rheumatic diseases

Inform about rheumatoid arthritis Inform about diagnosis, classification and management of rheumatoid arthritis

Records pain based on the visual analogue scale Symptoms/signs check with simple functional ability assessment Clear representation of the pain diary over time, as a list or as a calendar. Tracks morning stiffness, sporting activities, times of infection, and inability to work Reminder functions for recording pain values, medication use, checks, and physicians visits

Flag and make notes on various body parts where symptoms and/or signs are present Generates reports for symptoms/signs tracking and sharing with physicians

Teach about how to manipulate joints to prevent problems and relieve pain with step-by-step video demonstrations Review quizzes

Inform and track nutrition, fitness, sleep, medication, and mood, and compare it to arthritis pain

Keep an accurate record of patient condition for physician Compare multiple conditions and metrics on a single, interactive graph, which makes finding correlations easy Learn how much patient is affected by humidity, barometric pressure, temperature, precipitation, and other factors Identify triggers, patterns, and trends Email or print a report Track complex medical condition multiple times a day Track pain condition as it occurs

Description

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Detect the presence of arthritis in patients suffering from psoriasis by a diagram (where patients mark areas of pain and swelling) and twelve questions Calculates a final score with the probability of having psoriatic arthritis

Acknowledgments The authors wish to acknowledge Miguel Bernardes (MD., M.Sc.) from the Rheumatology Department of São João Hospital Center for the helpful comments given during this paper revision. Conflict of interest The authors declare that they have no potential conflict of interests, according to the Journal’s policy.

References

Educational and psychosocial

iOS iphone operating system

1.1 PASQ®

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the early stages but there is a great potential of Smartphone applications for RD self-management.

Android and iOS Psoriatic arthritis

Educational and psychosocial +  treatment Android and iOS Rheumatoid arthritis Android and iOS Spondyloarthritis 1.0.1 1.0

Type of intervention Disease model Version Platforms

RA Helper SpA Helper®

®

Application

Table 2  continued

Tracks disease activity Reminder functions for medication use, physician appointments and laboratory controls Store laboratory results Set goals for disease activity score according to the latest guidelines

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Description



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Future perspectives of Smartphone applications for rheumatic diseases self-management.

Rheumatic diseases (RD) self-management interventions are designed to improve health-related quality of life, health care utilization, and perceived s...
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