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      Digitale Gesundheitsanwendungen – was sollten wir als Rheumatolog:innen wissen Translated title: Digital health applications—What we should know as rheumatologists

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          Abstract

          Digitale Gesundheitsanwendungen (DiGA) revolutionieren die Patientenversorgung durch verbesserten Zugang zu evidenzbasierter Therapie und fördern aktives Selbstmanagement. Die kontinuierlich wachsende Anzahl an DiGA ermöglicht es Patient:innen, durch digitale Unterstützung eigenständiger zu handeln. Die budgetneutrale Verordnung und Kostenübernahme durch gesetzliche Krankenkassen senken finanzielle Barrieren für Behandler:innen und Patient:innen. Erste Studien belegen, dass DiGA erfolgreich zur Behandlung von Komorbiditäten und rheumatischen Erkrankungen eingesetzt werden können. Mehrere DiGA für entzündlich-rheumatische Erkrankungen befinden sich in fortgeschrittener Entwicklung. Die Identifikation geeigneter Patient:innen und die Unterstützung durch Shared Decision Making (SDM) sind entscheidend für die erfolgreiche Implementierung. Herausforderungen bestehen weiterhin in der Adhärenz und Akzeptanz der Anwendungen. Dieser Artikel bietet einen Überblick über die Verordnung in der Praxis, erste Daten und Erfahrungen aus der rheumatologischen Versorgungsrealität und berichtet über aktuelle Entwicklungen.

          Translated abstract

          Digital health applications (DHAs) are revolutionising patient care by improving access to evidence-based therapy and promoting active self-management. The continuously growing number of DHAs enables patients to act more independently through digital support. The budget-neutral prescription and cost coverage by statutory health insurance companies reduce financial barriers for practitioners and patients. Initial studies show that DHAs can be used successfully to treat comorbidities and rheumatic diseases. Several DHAs for inflammatory rheumatic diseases are at an advanced stage of development. The identification of suitable patients and support through shared decision making are crucial for successful implementation. Challenges remain in adherence and acceptance of the applications. This article provides an overview of prescription in clinical routine, initial data and experiences from the reality of rheumatology care, and reports on current developments.

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          German Mobile Apps in Rheumatology: Review and Analysis Using the Mobile Application Rating Scale (MARS)

          Background Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety. Objective The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists. Methods The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers. Results In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms. Conclusions To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital.
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            Maximizing Engagement in Mobile Health Studies

            The widespread availability of smartphones, tablets, and smartwatches has led to exponential growth in the number of mobile health (mHealth) studies conducted. Although promising, the key challenge of all apps (both for research and nonresearch) is the high attrition rate of participants and users. Numerous factors have been identified as potentially influencing engagement, and it is important that researchers consider these and how best to overcome them within their studies. This article discusses lessons learned from attempting to maximize engagement in 2 successful UK mHealth studies—Cloudy with a Chance of Pain and Quality of Life, Sleep and Rheumatoid Arthritis.
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              Digital rheumatology in the era of COVID-19: results of a national patient and physician survey

              Objective To analyse the impact of the COVID-19 pandemic on rheumatic patients’ and rheumatologists’ usage, preferences and perception of digital health applications (DHAs). Methods A web-based national survey was developed by the Working Group Young Rheumatology of the German Society for Rheumatology and the German League against Rheumatism. The prospective survey was distributed via social media (Twitter, Instagram and Facebook), QR code and email. Descriptive statistics were calculated, and regression analyses were performed to show correlations. Results We analysed the responses of 299 patients and 129 rheumatologists. Most patients (74%) and rheumatologists (76%) believed that DHAs are useful in the management of rheumatic and musculoskeletal diseases (RMDs) and felt confident in their own usage thereof (90%; 86%). 38% of patients and 71% of rheumatologists reported that their attitude had changed positively towards DHAs and that their usage had increased due to COVID-19 (29%; 48%). The majority in both groups agreed on implementing virtual visits for follow-up appointments in stable disease conditions. The most reported advantages of DHAs were usage independent of time and place (76.6%; 77.5%). The main barriers were a lack of information on suitable, available DHAs (58.5%; 41.9%), poor usability (42.1% of patients) and a lack of evidence supporting the effectiveness of DHAs (23.2% of rheumatologists). Only a minority (<10% in both groups) believed that digitalisation has a negative impact on the patient–doctor relationship. Conclusion The COVID-19 pandemic instigated an increase in patients’ and rheumatologists’ acceptance and usage of DHAs, possibly introducing a permanent paradigm shift in the management of RMDs.
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                Author and article information

                Contributors
                knitza@uni-marburg.de
                Jutta.Richter@med.uni-duesseldorf.de
                Journal
                Z Rheumatol
                Z Rheumatol
                Zeitschrift Fur Rheumatologie
                Springer Medizin (Heidelberg )
                0340-1855
                1435-1250
                10 September 2024
                10 September 2024
                2024
                : 83
                : 10
                : 859-865
                Affiliations
                [1 ]GRID grid.411067.5, ISNI 0000 0000 8584 9230, Institut für Digitale Medizin, , Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg, ; Baldingerstraße, 35042 Marburg, Deutschland
                [2 ]III. Medizinische Klinik und Poliklinik für Nephrologie, Rheumatologie und Endokrinologie, Universitätsklinikum Hamburg-Eppendorf, ( https://ror.org/01zgy1s35) Martinistr. 52, 20251 Hamburg, Deutschland
                [3 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Klinik für Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, ; Moorenstr. 5, 40225 Düsseldorf, Deutschland
                [4 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Hiller Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, ; Moorenstr. 5, 40225 Düsseldorf, Deutschland
                [5 ]GRID grid.461714.1, ISNI 0000 0001 0006 4176, Klinik für Rheumatologie & Klinische Immunologie, , KEM | Evang. Kliniken Essen-Mitte gGmbH, ; Pattbergstr. 1–3, 45239 Essen, Deutschland
                Author notes
                [Redaktion]

                Philipp Klemm, Bad Nauheim

                Ulf Müller-Ladner, Bad Nauheim

                Article
                1570
                10.1007/s00393-024-01570-3
                11615091
                39254855
                9ac7be0d-79e3-414f-a7cf-c6a14c5c2f31
                © The Author(s) 2024

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                History
                : 14 August 2024
                Funding
                Funded by: Philipps-Universität Marburg (1009)
                Categories
                Originalien
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2024

                Rheumatology
                diga,digitale gesundheitsanwendung,digitalisierung,rheumatologie,e‑health,dha,digital health applications,digitalization,rheumatology

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