Digital coaching increases RA patients' medicine adherence and health while reducing flares
A 12-week, digital health coaching program with personalized support from a dedicated health coach improved well-being and decreased symptoms for participants with rheumatoid arthritis, according to new research findings presented this week at the 2017 ACR/ARHP Annual Meeting in San Diego.
Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
While there have been great advances in medications to treat RA in recent years, the disease still has a serious impact on the lives and well-being of millions of patients worldwide. Self-management by RA patients, including lifestyle changes to improve arthritis symptoms, is essential. Pack Health, a digital health coaching company in Birmingham, Alabama, conducted a study to examine the efficacy of a remote, behavior modification program for RA patients to help them reduce stressors related to their disease and make behavior changes proven to reduce RA symptoms and improve well-being.
"The hope was that when armed with the right information and tools and dedicated, one-on-one support on their schedule, participants would be able to improve key heath behaviors as well as key measures of disease management and overall health," said Uma Srivastava, Associate Director, Strategic Partnerships at Pack Health in Birmingham.
For the study, 127 patients with RA were enrolled in a 12-week digital health coaching program that included pairing each patient with a non-clinical health coach. Patients were contacted once a week by telephone, and these conversations centered on the principles of patient engagement and activation towards behavior change, said Srivastava.
To determine the impact of this telephone-based intervention, participants were surveyed about their behaviors and condition at baseline and after 12 weeks of coaching. The researchers collected information about the patients' mental and physical health using the PROMIS Global Health-10 survey. Patients were also asked to self-report the number of flares they experienced each month.
The study's results showed significant improvements among the participants. These included a decrease in body-mass index of 0.55 kg/m2, an increase in weekly physical activity of 76 percent, an increase in hours of sleep per night of 0.3 hours, and a 50 percent reduction in the number of medication doses missed each week.
There were also significant increases in the participants' scores in PROMIS Global Health-10, including a 13 percent increase in the survey's physical health domain and a 16 percent increase in its mental health domain. The participants' RA flare frequency also dropped by 50 percent after program completion. The researchers concluded that this finding suggests symptom relief is associated with improvements in healthy behaviors and stressor reduction.
"Often, patients with RA are overwhelmed, and they require both coaching and care coordination to improve their well-being. However, rheumatologists often lack the time, tools and training required to effectively coach patients in the office environment," said Srivastava. "This study shows that incorporating tools such as digital remote patient coaching into the workflow of clinicians can support better outcomes, patient experience and health care utilization. In turn, clinicians are able to overcome barriers such as time, cost and patient non-adherence to recommended care."