Acceptability of a Nurse-led Telehealth Remote Self-monitoring Model of Care in Patients With Rheumatoid Arthritis

Acceptability of a Nurse-led Telehealth Remote Self-monitoring Model of Care in Patients With Rheumatoid Arthritis, a Multicentre Randomized Pilot Study

Canada urgently needs new ways to provide rheumatology care that improve treatment and make it easier for people to get high-quality care. E-health technology is a new and promising way to do this, but it hasn't been studied much yet in rheumatology.

The investigators will test a new way to help people with rheumatoid arthritis at four clinics in Quebec. This study will check if the new approach is easy to use, fits well into the clinics' daily routine, and if both patients and healthcare workers find it helpful and acceptable.

This new approach involves nurses helping patients check their own health from home using an online platform.

104 adults who have rheumatoid arthritis and who have had a flare-up or a change in their medication in the last three months, will participate. Some will start using the online self-monitoring tool right away for 16 months, while others will continue with their usual care for 8 months before trying the tool. During the time they use the tool, they will fill out monthly online questionnaires to check their health. A rheumatology nurse will review their answers, suggest any needed care, provide personalized health information, and be available to answer questions through messages.

This new way of care, where nurses help patients monitor their rheumatoid arthritis from home, helps make better use of limited specialist time. It's more convenient for patients, especially those who live far away, and helps meet their needs between regular doctor visits while keeping the quality of care high.

Study Overview

• Status: Not yet recruiting
• Conditions: Rheumatoid Arthritis (RA)
• Intervention / Treatment: Other: Nurse-led telehealth remote self-monitoring

Detailed Description

Background: Limited access to rheumatologists in Canadian remote regions leads to delays in new-onset rheumatoid arthritis (RA) diagnosis and inadequate follow-up for disease flares or treatment adjustments. There is a critical need for innovative models of care addressing these unmet needs in resource-limited settings. E-health technologies offer a promising solution by bridging the gap between in-person rheumatology appointments. These tools can optimize the use of scarce specialist resources, enhance the continuity and quality of care, and provide greater convenience for patients-particularly in underserved or geographically isolated areas. By supporting timely interventions and patient-centered monitoring, e-health can play a vital role in improving outcomes and ensuring equitable access to care.

Objectives: This study will evaluate the acceptability and feasibility of a nurse-led telehealth remote self-monitoring model of care for patients with RA.

Primary Objective: Acceptability of a nurse-led telehealth remote self-monitoring program, defined as patient-reported perceptions of usefulness, ease of use, attitudes, and overall experience, and assessed with questionnaires and semi-structured interviews.

Secondary Objectives: Feasibility using the RE-AIM implementation framework:

• Reach: Proportion of eligible patients enrolled and comparison of participant versus non-participant characteristics.
• Effectiveness: Frequency and relevance of nurse calls, healthcare utilization, health-related quality of life, disease activity, and medication adherence.
• Adoption: Completion rate of remote monitoring questionnaires, study retention, and reasons for discontinuation.
• Implementation: Fidelity to protocol, appropriateness of alerts, subsequent actions, and timeliness of in-person visits; identify barriers and facilitators.
• Maintenance: Intention for continued use among healthcare providers and patients.

Methods - The investigators will recruit 104 adults with RA who experienced a flare or required a DMARDs switch within the preceding three months, from 4 rheumatology practices (community and academic sites) providing care to >15,000 RA patients. All participants will be randomized 1:1 to receive either immediate intervention (for 16 months) or delayed, i.e. usual care for 8 months (control period) followed by 8 months of intervention, consisting of remote self-monitoring using a web platform co-developed with patients, rheumatologists, and nurses. Rheumatology visits will be scheduled every 3-6 months, with additional visits as necessary. The intervention includes nurse-led remote self-monitoring of RA, with patients completing monthly self-assessments of disease activity (RADAI), symptoms and function (PROMIS-29). Rheumatology nurses will receive alerts if monitoring suggests moderate/high disease activity and will contact participants to determine care needed. Tailored information based on PROMIS-29 answers will be sent to facilitate self-management. Asynchronous messaging with rheumatology nurses and information on RA self-management will be available. Data will be collected using questionnaires and semi-structured interviews. Analysis will use quantitative (generalized linear mixed-effect models comparing within group changes [8 months - baseline, both groups combined] and between groups differences [intervention versus control] in continuous variables), and qualitative methods (thematic content analysis by two independent researchers).

Impact and feasibility. A nurse-led remote self-monitoring of RA using a web-based platform codeveloped with patient input, has potential to enhance access to care and more efficiently use scarce rheumatology resources while providing high quality care.

• Study Type: Interventional
• Enrollment (Estimated): 104
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Laetitia Michou, MD PhD; Phone Number: 48383 +14185254444; Email: laetitia.michou@crchudequebec.ulaval.ca

Study Locations

• Canada
  • Quebec
    • Montreal, Quebec, Canada, H3H 1V6
      • Hopital general de Montreal
      • Principal Investigator: Ines Colmegna, MD
      • Contact: Ines Colmegna, MD; Phone Number: 35639 +1 (514) 934-1934; Email: ines.colmegna@mcgill.ca
    • Québec, Quebec, Canada, G1V4G2
      • CHU de Quebec-Universite Laval
      • Contact: Laetitia Michou, MD PhD; Phone Number: 48383 +14185254444; Email: laetitia.michou@crchudequebec.ulaval.ca
      • Principal Investigator: Laetitia Michou, MD PhD
    • Québec, Quebec, Canada, G1V 2M1
      • Centre de l'ostéporose et de rhumatologie de Québec
      • Contact: Louis Bessette, MD; Phone Number: +1 418-650-0698; Email: louis.bessette@crchudequebec.ulaval.ca
      • Contact: Louis Bessette, MD; Phone Number: + 1 418-650-0698; Email: louis.bessette@crchudequebec.ulaval.ca
      • Principal Investigator: Louis Bessette, MD
    • Sherbrooke, Quebec, Canada, J1H 5H3
      • Hopital Fleurimont et Hotel Dieu de Sherbrooke
      • Contact: Hugues Allard-Chamard, MD; Phone Number: 15261 +1 819 821-8000; Email: hugues.allard-chamard@usherbrooke.ca
      • Principal Investigator: Hugues Allard-Chamard, MD
      • Sub-Investigator: Javier Marrugo, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 18 years
• Diagnosis of rheumatoid arthritis (RA) according to the ACR 2010 criteria
• Disease duration ≥ six months
• Who experienced a flare defined by an increase of the clinical disease activity index (CDAI) ≥ 4.5 or a DMARDs switch or addition within the preceding three months
• Understanding French or English

Exclusion Criteria:

• Inability to consent
• Inability to complete questionnaires
• No Internet access

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Immediate intervention (for 16 months); The intervention includes nurse-led remote self-monitoring of RA, with patients completing monthly self-assessments of disease activity (RADAI), symptoms and function (PROMIS-29). Rheumatology nurses will receive alerts if monitoring suggests moderate/high disease activity and will contact participants to determine care needed. Tailored information based on PROMIS-29 answers will be sent to facilitate self-management. Asynchronous messaging with rheumatology nurses and information on RA self-management will be available.	Other: Nurse-led telehealth remote self-monitoring; Remote self-monitoring will use a web platform co-developed with patients, rheumatologists, and nurses. The intervention includes nurse-led remote self-monitoring of RA, with patients completing monthly self-assessments of disease activity (RADAI), symptoms and function (PROMIS-29). Rheumatology nurses will receive alerts if monitoring suggests moderate/high disease activity and will contact participants to determine care needed. Tailored information based on PROMIS-29 answers will be sent to facilitate self-management. Asynchronous messaging with rheumatology nurses and information on RA self-management will be available.
Active Comparator: Delayed intervention ( 8 months of control period followed by 8 months with the intervention); Usual care for 8 months, consisting in rheumatology visits scheduled every 3-6 months. Followed by the intervention for 8 months: The intervention includes nurse-led remote self-monitoring of RA, with patients completing monthly self-assessments of disease activity (RADAI), symptoms and function (PROMIS-29). Rheumatology nurses will receive alerts if monitoring suggests moderate/high disease activity and will contact participants to determine care needed. Tailored information based on PROMIS-29 answers will be sent to facilitate self-management. Asynchronous messaging with rheumatology nurses and information on RA self-management will be available.	Other: Nurse-led telehealth remote self-monitoring; Remote self-monitoring will use a web platform co-developed with patients, rheumatologists, and nurses. The intervention includes nurse-led remote self-monitoring of RA, with patients completing monthly self-assessments of disease activity (RADAI), symptoms and function (PROMIS-29). Rheumatology nurses will receive alerts if monitoring suggests moderate/high disease activity and will contact participants to determine care needed. Tailored information based on PROMIS-29 answers will be sent to facilitate self-management. Asynchronous messaging with rheumatology nurses and information on RA self-management will be available.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability of the intervention evaluated by a questionnaire	The questionnaire of patients' perceived usefulness and ease of use of the remote self-monitoring web platform will be completed by participants at 16 months, rated using a 13-item questionnaire utilizing five-point Likert scales.	At 16 months
Acceptability of the intervention evaluated by a qualitative analysis	Semi-structured interviews with patients and providers will be completed with a purposive sample of participants (diverse with respect to age, gender, ethnicity, education, disease type and duration, employment, urban/rural) at study end. Participants will meet in groups of 8-12 for 60-90 minutes; groups will continue until saturation of themes is obtained (estimated to be 2-3 groups). Topics will include perceived acceptability, convenience, satisfaction, beliefs, perceived usefulness and ease of use, how care received met patient needs, barriers and enablers to adopting this new model of care.	At 16 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age category of eligible participants	Age category of eligible patients	Until the end of recruiting period
Frequency of calls to nurses	Frequency of calls to nurses will be collected on the electronic medical record of each rheumatology clinic	Up to the end of intervention at 16 months
Use of other health care services	Self-reported by patients in a survey administered every three months, including emergency room visits, hospitalizations, visits to primary care physicians, other specialists, other healthcare professionals.	Every 3 months over 16 months
Health-related quality of life evaluated by the Patient-Reported Outcomes Measurement Information System-29 questionnaire	Measured by the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) which is a patient-reported measure of symptoms and function validated in French, which includes four items from each of seven domains (physical function, depression, anxiety, fatigue, sleep disturbances and ability to participate in social roles and activities, pain interference) and a single item on pain intensity. It has been co-developed with patients and validated in rheumatic diseases. Each item has five response options, except for pain which has eleven. A total score is calculated for each domain from the sum of item answers. Range from 20 to 80.	Every 3 months over 16 months
Disease activity evaluated by the Clinical Disease Activity Index	Measured using Clinical Disease Activity Index (CDAI) at every 3-6 months rheumatology follow-up visit The CDAI is the sum of the count of swollen/tender joint count of 28 joints and patient and physician global assessment on VAS (0-10 cm) Scale for estimating disease activity. The CDAI has range from 0 to 76.	Every 3 to 6 months over 16 months
Proportion of medication adherence	The proportion of adherence will be calculated by dividing the quantity received by the quantity prescribed for each month starting three months before enrollment until six months after. The mean proportion of adherence per medication will be calculated for each time period by taking the mean of all months included in each of the periods. For each of these periods, the patient will be considered adherent if the mean is greater or equal to 80%.	Every 3 months up to the end of intervention over 16 months
Completion rate of patient questionnaires for remote self-monitoring	Completion rate of patient questionnaires for remote self-monitoring (Rheumatoid Arthritis Disease Activity Index RADAI and Patient-Reported Outcomes Measurement Information System-29, PROMIS-29)	Every month during the intervention over 16 months
Proportion of participants still connecting to the web platform at study end	Proportion of participants still connecting to the web platform at study end	At 16 months
Time spent on the web platform	Time spent on the web platform by each participant	Up to the end of intervention at 16 months
Measuring the number of alerts per patient	Measuring the number of alerts per patient	Up to the end of intervention at 16 months
Questionnaire for the evaluation of health professionals' acceptance of a new telemonitoring system	Rheumatology nurses, rheumatologists, and administrative staff will answer the questionnaire for the evaluation of health professionals' acceptance of a new telemonitoring system, a 33-item anonymous survey on their intended sustained use of nurse-led remote self-monitoring with a 7-point likert scale for each questions.	At 16 months
Sex category of eligible patients	Sex category of eligible patients	Up to the end of recruiting period
Clinical appropriateness of alerts	Clinical appropriateness of alerts based on rheumatology team subsequent actions (ex: timeliness of in-person visits, whether triggered visits led to medication change)	Up to the end of intervention over 16 months
Number of nurse-patient interactions	Number of nurse-patient interactions using the platform	Up to the end of intervention over 16 months
Reason for nurse calls	Reason for nurse calls will be collected on the electronic medical record of each rheumatology clinic	Up to the end of intervention at 16 months

Collaborators and Investigators

• Sponsor: CHU de Quebec-Universite Laval
• Collaborators: The Arthritis Society, Canada
• Investigators: Principal Investigator: Laetitia Michou, MD PhD, CHU de Quebec-Universite Laval

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: March 25, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Semi-structured interviews; Arthritis activity remote self-monitoring; Nurse-led telehealth intervention; Pilot randomised trial; Self-assessment of disease activity; RE-AIM implementation framework
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases; Skin and Connective Tissue Diseases; Arthritis, Rheumatoid
• Other Study ID Numbers: 2026-8556

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No