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Rigshospitalet - a part of Copenhagen University Hospital

Patients with Rheumatoid Arthritis Acquire Sustainable Skills for Home Monitoring: A Prospective Dual-country Cohort Study (ELECTOR Clinical Trial I)

Research output: Contribution to journalJournal articleResearchpeer-review


  • Marie Skougaard
  • Henning Bliddal
  • Robin Christensen
  • Karen Ellegaard
  • Sabrina M Nielsen
  • Jakub Zavada
  • Sabina Oreska
  • Niels S Krogh
  • Christian C Holm
  • Merete L Hetland
  • Jiri Vencovsky
  • Henrik Røgind
  • Peter C Taylor
  • Henrik Gudbergsen
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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 ( 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. [ (NCT02317939)].

Original languageEnglish
JournalJournal of Rheumatology
Issue number5
Pages (from-to)658-667
Number of pages10
Publication statusPublished - 1 May 2020

Bibliographical note


    Research areas

  • Activity score, Home monitoring disease, Reliability, Rheumatoid arthritis, Self-management

ID: 60007724