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Peer-reviewedCC BY 4.0Clinical Rheumatology

Digital self-management engagement and long-term patient-reported outcome trajectories in inflammatory arthritis: a real-world retrospective cohort study

  • Dmytro Fedkov1,2,3
  • Danylo Yevstifeiev1
  • Jan Leipe4
  • Oleg Iaremenko1
  • Daria Koliadenko1
  • Liubov Petelytska1
  • Felix Lang3
  • Abdullah Khalil3
  • Türker Kurt5
  • Stefan Vordenbäumen5,6
6 affiliations
  1. 1Department of Internal Medicine, Bogomolets National Medical University, 13 Blvd Shevchenka, Kyiv, 01032 Ukraine
  2. 2Medical Center Medical Clinic Blagomed LLC, Kyiv, Ukraine
  3. 3Midaia GmbH, Heidelberg, Germany
  4. 4Rheumatology Department, Kiel Campus, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
  5. 5Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Hauptstr. 74-76, 40668 Meerbusch, Germany
  6. 6Department of Rheumatology & Hiller Research Center, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Abstract

Introduction/objectives: Patient Global Assessment of Disease Activity (PtGADA), pain, and Routine Assessment of Patient Index Data 3 (RAPID3) are core patient-reported outcomes in inflammatory arthritis. We examined whether digital self-management engagement was associated with their long-term trajectories.

Method: This retrospective cohort included 3513 adults using a certified digital self-management application. Patients were grouped by completion of 0, 1–2, or ≥3 structured self-management plans. Longitudinal models with patient-level cluster-robust standard errors estimated post-baseline change trajectories. Sensitivity analyses addressed differential attrition, measured confounding, and reverse causality.

Results: Of 2895 patients with baseline PtGADA, 1026 (35.4%) contributed post-baseline observations. Patients completing ≥3 plans had more favourable PtGADA, pain, and RAPID3 trajectories than zero-plan patients (group-effect p=6.2×10−5, p=0.0055, and p=0.0044, respectively), without diverging slopes. At weeks 12–48, PtGADA improved by 11.1–12.1 points and pain by 7.2–7.3 points in the high-engagement group. After attrition weighting, PtGADA remained significant, RAPID3 retained a significant joint group effect, and pain was no longer significant.

Conclusions: Higher engagement was most robustly associated with more favourable long-term PtGADA trajectories; support for pain was directionally similar but statistically more limited, and RAPID3 findings were the least consistent of the three outcomes. These results describe an engagement-associated phenotype rather than a causal treatment effect and support its evaluation as a potential marker of sustained digital engagement in future prospective stratification studies.

Key Points

• In this real-world cohort of 3513 patients with inflammatory arthritis, higher digital self-management engagement was most robustly associated with more favourable PtGADA trajectories; the association with pain was directionally similar but less robust, while RAPID3 findings were less consistent.

• Engagement-group trajectories were approximately parallel, and the findings remained directionally consistent in analyses examining sensitivity to differential follow-up, measured baseline differences, and reverse-causality concerns, although statistical significance varied by outcome and landmark.

• The engagement-outcome association was directionally consistent across multiple sensitivity analyses addressing measured confounding and differential follow-up, although temporal exposure assignment could not be established and residual reverse-causality bias cannot be excluded.

• Digital self-management engagement, operationalised by action-plan completion, represents a potential marker of sustained digital engagement for future prospective stratification studies, rather than a validated tool for baseline risk stratification.

Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s10067-026-08425-z.

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Cite

BibTeXRIS
BibTeX
@article{fedkov2026digital,
  title = {{Digital self-management engagement and long-term patient-reported outcome trajectories in inflammatory arthritis: a real-world retrospective cohort study}},
  author = {Dmytro Fedkov and Danylo Yevstifeiev and Jan Leipe and Oleg Iaremenko and Daria Koliadenko and Liubov Petelytska and Felix Lang and Abdullah Khalil and Türker Kurt and Stefan Vordenbäumen},
  journal = {Clinical Rheumatology},
  year = {2026},
  month = sep,
  doi = {10.1007/s10067-026-08425-z},
  url = {https://doi.org/10.1007/s10067-026-08425-z},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Digital self-management engagement and long-term patient-reported outcome trajectories in inflammatory arthritis: a real-world retrospective cohort study
AU  - Dmytro Fedkov
AU  - Danylo Yevstifeiev
AU  - Jan Leipe
AU  - Oleg Iaremenko
AU  - Daria Koliadenko
AU  - Liubov Petelytska
AU  - Felix Lang
AU  - Abdullah Khalil
AU  - Türker Kurt
AU  - Stefan Vordenbäumen
PY  - 2026
DA  - 2026/09/29
JO  - Clinical Rheumatology
DO  - 10.1007/s10067-026-08425-z
UR  - https://doi.org/10.1007/s10067-026-08425-z
AB  - Introduction/objectives: Patient Global Assessment of Disease Activity (PtGADA), pain, and Routine Assessment of Patient Index Data 3 (RAPID3) are core patient-reported outcomes in inflammatory arthritis. We examined whether digital self-management engagement was associated with their long-term trajectories.  Method: This retrospective cohort included 3513 adults using a certified digital self-management application. Patients were grouped by completion of 0, 1–2, or ≥3 structured self-management plans. Longitudinal models with patient-level cluster-robust standard errors estimated post-baseline change trajectories. Sensitivity analyses addressed differential attrition, measured confounding, and reverse causality.  Results: Of 2895 patients with baseline PtGADA, 1026 (35.4%) contributed post-baseline observations. Patients completing ≥3 plans had more favourable PtGADA, pain, and RAPID3 trajectories than zero-plan patients (group-effect p=6.2×10−5, p=0.0055, and p=0.0044, respectively), without diverging slopes. At weeks 12–48, PtGADA improved by 11.1–12.1 points and pain by 7.2–7.3 points in the high-engagement group. After attrition weighting, PtGADA remained significant, RAPID3 retained a significant joint group effect, and pain was no longer significant.  Conclusions: Higher engagement was most robustly associated with more favourable long-term PtGADA trajectories; support for pain was directionally similar but statistically more limited, and RAPID3 findings were the least consistent of the three outcomes. These results describe an engagement-associated phenotype rather than a causal treatment effect and support its evaluation as a potential marker of sustained digital engagement in future prospective stratification studies.  Key Points  • In this real-world cohort of 3513 patients with inflammatory arthritis, higher digital self-management engagement was most robustly associated with more favourable PtGADA trajectories; the association with pain was directionally similar but less robust, while RAPID3 findings were less consistent.  • Engagement-group trajectories were approximately parallel, and the findings remained directionally consistent in analyses examining sensitivity to differential follow-up, measured baseline differences, and reverse-causality concerns, although statistical significance varied by outcome and landmark.  • The engagement-outcome association was directionally consistent across multiple sensitivity analyses addressing measured confounding and differential follow-up, although temporal exposure assignment could not be established and residual reverse-causality bias cannot be excluded.  • Digital self-management engagement, operationalised by action-plan completion, represents a potential marker of sustained digital engagement for future prospective stratification studies, rather than a validated tool for baseline risk stratification.  Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s10067-026-08425-z.
SN  - 0770-3198
SN  - 1434-9949
ER  -