OBJECTIVE: In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. METHODS: Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen's κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots. RESULTS: Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83-0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training. CONCLUSION: Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)].

From The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen; Research Unit of Rheumatology Department of Clinical Research University of Southern Denmark Odense University Hospital Odense; Zitelab ApS Copenhagen Denmark; Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre of Head and Orthopaedics Rigshospitalet Glostrup; Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark; Institute of Rheumatology Prague; Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic; Botnar Research Centre Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK

M Skougaard MD The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg; H Bliddal MD DMSc Professor The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg; R Christensen BSc MSc PhD Professor The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg and Research Unit of Rheumatology Department of Clinical Research University of Southern Denmark Odense University Hospital; K Ellegaard PT PhD The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg; S M Nielsen BSc MSc The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg and Research Unit of Rheumatology Department of Clinical Research University of Southern Denmark Odense University Hospital; J Zavada MD PhD Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University; S Oreska MD Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University; N S Krogh CEO Zitelab ApS; C C Holm MSc The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg; M L Hetland MD DMSc Professor COPECARE Center for Rheumatology and Spine Diseases Centre of Head and Orthopaedics Rigshospitalet and Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen; J Vencovsky Professor Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University; H Røgind MD PhD COPECARE Center for Rheumatology and Spine Diseases Centre of Head and Orthopaedics Rigshospitalet; P C Taylor Professor Botnar Research Centre Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford; H Gudbergsen MD PhD The Parker Institute Copenhagen University Hospital Bispebjerg and Frederiksberg

N S Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform

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ClinicalTrials.gov
NCT02317939