Codevelopment of Patient Self-Examination Methods and Joint Count Reporting for Rheumatoid Arthritis

Rebecca Grainger; Hermaleigh R Townsley; Simon Stebbings; Andrew A Harrison; William J Taylor; Lisa K Stamp

doi:10.1002/acr2.11197

Codevelopment of Patient Self-Examination Methods and Joint Count Reporting for Rheumatoid Arthritis

ACR Open Rheumatol. 2020 Dec;2(12):705-709. doi: 10.1002/acr2.11197. Epub 2020 Nov 17.

Authors

Rebecca Grainger^{1

2}, Hermaleigh R Townsley¹, Simon Stebbings^{3

4}, Andrew A Harrison^{1

2}, William J Taylor^{1

2}, Lisa K Stamp^{5

6}

Affiliations

¹ University of Otago, Wellington, New Zealand.
² Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand.
³ University of Otago, Dunedin School of Medicine, New Zealand.
⁴ Dunedin Hospital, Dunedin, New Zealand.
⁵ University of Otago, Christchurch, New Zealand.
⁶ Christchurch Hospital, Christchurch, New Zealand.

Abstract

Objective: To determine whether training increases accuracy of self-reported joint counts in people with rheumatoid arthritis (RA) and describe the knowledge and techniques for self-examination of joints for reporting of RA disease activity.

Methods: This mixed-methods study included 10 patients with RA and four rheumatologists. A rheumatologist presented about joint inflammation and disease monitoring in RA. Patients then self-examined and reported 28-tender joint count (28-TJC) and 28-swollen joint count (28-SJC). Next, two paired rheumatologists examined patients and reported 28-TJC and 28-SJC. After watching a joint examination video for training physicians, patients discussed their training needs for self-examination, with discussion analyzed using thematic analysis. Self-examination techniques were determined by consensus. Finally, patients self-examined and reported 28-TJC and 28-SJC. Reliability between the first and second patient-reported 28-TJCs and 28-SJCs and rheumatologist pair-reported 28-TJC and 28-SJC was determined with the intraclass coefficient.

Results: The reliability for patient self-reported joint counts was higher for the 28-TJC than for the 28-SJC. Reliability improved following rheumatologist examination and training. Patients identified a preference for practical information rather than detailed information on joint anatomy and pathophysiology. Clear definitions of "swollen" and "tender" were important; patients found the concept of "tenderness" difficult. Techniques for self-examination and reporting of joint counts were agreed on and demonstrated in an instructional video.

Conclusion: Training increased reliability of patient-reported joint counts. Patients with RA identified important aspects of training for self-examination and reporting of joint counts. An 8-minute instructional video was codeveloped; the next step is the evaluation of the video's impact on patient-reported joint counts.

Grants and funding

Otago Medical School Collaborative Grant 2017/Otago Medical School