Digital Care Program Improves QoL in Patients With Autoimmune Diseases and Long COVID-19

An evidence-based digital care program (DCP) that utilized patient data to identify hidden symptom triggers and encourage non-pharmacological interventions and personalized dietary suggestions was found to be linked to clinically meaningful improvements in health-related quality of life (HRQoL) in patients with autoimmune diseases and long COVID-19. The data also showed a high level of engagement and program adherence, according to a study published in RMD Open.¹

Nicole Bundy, MD

Credit: LinkedIn

Investigators noted that patients with the least favorable Patient-Reported Outcomes Measurement Information System (PROMIS) scores at baseline reported the greatest improvements.

Recent research has indicated that lifestyle, diet, and other environmental factors influence disease activity and HRQoL in patients with autoimmune disease. Therefore, these aspects may signify underutilized opportunities for treating this patient population.²

“In November 2022, the American College of Rheumatology released for the first time a clinical practice guideline for the integrative care of rheumatoid arthritis (RA),” wrote Nicole Bundy, MD, medical director at Mymee, and colleagues. “Notably, all but one of the recommendations (‘consistent engagement in exercise’) were offered conditionally, highlighting the fact that, despite mounting evidence supporting complementary medicine’s place in the treatment armamentarium for autoimmune diseases and a growing interest from patients, conclusive evidence about what constitutes a healthy autoimmune diet and lifestyle ‘prescription’ remains elusive.”

The retrospective study investigated the impact on HRQoL using patients who participated in the DCP between April 2020 and June 2022 with available baseline and end-of-program (EOP) PROMIS scores. The changes from baseline and EOP were calculated via standardized T-score.

An intake form prior to the initiation of DCP collected self-reported information on autoimmune diagnoses, medication, race/ethnicity, weight, employment and income, education, and marital status. Symptom information provided informed the symptom tracking portion of the mobile app. At EOP, patients were asked to report current symptoms, medication, and weight.

The DCP consisted of an adaptive mobile app personalized to patients’ unique data, a data-presentation dashboard that provided health coaches, and weekly, remote health coaching sessions designed to review data correlations and suggest and evaluate lifestyle and dietary modifications.

In total, 202 adult patients, aged 17 to 82 years, completed the study, of which the mean age at baseline was 46.2 years and 77% were female. The most common diagnoses were RA (20.1%), long COVID-19 (14.9%), psoriatic arthritis (10.9%), psoriasis (8.9%), systemic lupus erythematosus (6.4%), inflammatory bowel disease (5.9%), multiple sclerosis (5.9%), ankylosing spondylitis (5.4%), and others (23.3%).

Participants entered, on average, 7.6 times per day on 86% of program days, attended 14 coach sessions, the mean total observations per participant was 756, and participants completed the program in an average of 17.2 weeks. Statistically significant improvements were observed in all 10 PROMIS domains analyzed. Patients with a higher severity of compromise at baseline had greater improvements in all 10 PROMIS domains when compared with all-comers.

Investigators noted that the retrospective nature of the study limited results, as they were subject to selection and performance biases as well as exaggeration of effect size. Further, generalizability and external validity of findings were limited due to a non-response sampling bias.

“The findings add to a growing body of research that supports the inclusion of diet and lifestyle interventions in the management of autoimmune diseases,” investigators concluded. “The results should act as a catalyst for increased funding and further exploration into the application of personalized trials to optimize the success of such interventions in individual patients.”

References

1. ^{Bundy N, De Jesus M, Lytle M, Calabrese L, Gobin C, Dyhrberg M. Self-evidence-based digital care programme improves health-related quality of life in adults with a variety of autoimmune diseases and long COVID: a retrospective study. RMD Open. 2023;9(2):e003061. doi:10.1136/rmdopen-2023-003061}
2. ^{Coras R, Martino C, Gauglitz J, et al. The "IT" diet improves fatigue in patients with rheumatoid arthritis and is associated with changes in metabolome and fecal microbiome. Arthritis Rheumatol 2021;73.Google Scholar}