Transforming outpatient consultations by integrating symptom tracking into clinical care
The REmote MOnitoring of Rheumatoid Arthritis (REMORA) study will develop, test and evaluate a system for tracking daily symptoms in people living with rheumatoid arthritis (RA), where data are collected using a smartphone app and integrated into NHS electronic patient records.
The £2.1m research study funded by the National Institute for Health Research (NIHR), aims to improve outpatient consultations by making sure both health staff and patients have detailed information on how patients have felt in the weeks and months between appointments.
Rheumatoid arthritis (RA) is a common long-term condition that causes painful, swollen joints, and may lead to disability. Currently, people with RA are asked about changes in their condition at appointments that can be up to several months apart. This means they may struggle to accurately remember the details of these changes.
We have developed a ‘symptom tracking system’. This comprises the REMORA smartphone app, in which patients track and record symptoms on a daily basis and log the impact of their RA between appointments. The data are then sent into a central location where they are summarised graphically and viewed from within the electronic medical record.
The first phase of the REMORA study (REMORA1) ran from 2015 to 2017, when 20 patients with RA tested the app over three months at Salford Royal Foundation Trust.
The second phase (REMORA2) started in October 2021. It aims to demonstrate improvements in clinical outcomes for people living with RA, as well as evaluating cost-effectiveness and learning how similar systems can be successfully rolled out in the NHS. The research will involve 12 rheumatology departments in Greater Manchester and North-West London.
Supporting patients and clinicians
The second phase of the study aims to support patients to access and use the system, irrespective of age, background, familiarity with technology or health. We will explore what it would take to use the system across the NHS and test the system’s effects on the care and health of people with RA.
Our goal is to make it easier for people to share symptom data for research and understand issues around this.
We will switch on our symptom-tracking system in 12 RA outpatient clinics, one at a time. Chance will determine which clinic goes first. Patients joining the study after the switch-on will use our system; those joining before will receive usual care. We will support patients from across the community to take part. We will use medical records and questionnaires to learn about the system’s effects, costs and benefits. We will interview patients and specialists to understand why it is or is not working and to improve the system.
Benefits of using remote monitoring
There are a number of benefits of using remote monitoring of a long-term condition.
With the REMORA2 project we will transform outpatient consultations by:
- Providing the bigger picture of RA by identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed.
- Enabling person-centred consultations, allowing doctors and patients to look together at trends of symptoms through time and make shared decisions.
- Empowering patients to organise and self-manage their own health.
- Allowing clinicians and researchers to better understand how symptoms change and how well and quickly patients respond to treatment.
If our system is proven to improve the severity of people’s RA and their quality of life, we aim to make the system available across the NHS. Together with existing NHS networks, we will develop materials to make this happen across the country and for other related diseases. This could improve the care and lives of thousands of people with RA and other long-term conditions.
Resources for patients
We’ve developed a number of resources to help you take part in the REMORA study.
This video has been created to help people with rheumatoid arthritis to self-examine their own tender and swollen joints. It has been designed and developed by patients and clinicians working on the REMORA study.
You can read more about how the video was made on the Centre for Epidemiology blog.
We would really like to hear feedback from both patients and healthcare professionals through our anonymous online survey. We will use the information collected to improve the video in the future.
Chart and table for self-examinations
We have developed a joint count chart, or model, that shows which joints to check during self-examinations.
There is also a table so you can keep a record of the number of tender and swollen joints during your self-examination.
Frequently asked questions
See answers to commonly asked questions about checking your own joints on the frequently asked questions page.
You can read more about REMORA on the Centre for Epidemiology blog.
Video development team
The self-examination video was developed by the following core members, on behalf of the REMORA team:
REMORA1 (pilot study)
The REMORA app was designed by patients, clinicians and researchers.
The pilot study was unique because the data from the app was integrated into electronic health records in the NHS to inform consultations between patients and their doctors.
This pilot study was funded by Versus Arthritis and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester.
Who we are
See who is involved with the REMORA project.
- Prof Will Dixon, Lead for REMORA1 and co-lead for REMORA2
- Dr Sabine Van Der Veer, Co-Lead for REMORA2
- Julie Gandrup, PhD candidate
- Dr Karen Staniland, Co-PPIE Lead
- Paul Amlani-Hatcher, Co-PPIE Lead
- Prof Caroline Sanders, Co-Investigator (CoI)
- Prof Dawn Dowding, CoI
- Prof Peter Bower, CoI
- Dr Jill Firth, CoI
- Dr Felix Greaves, CoI
- Prof John McBeth, CoI
- Paul Wilson, CoI
- Dr Nicholas Bansback, CoI
- Dr Elaine Mackey, CoI
- Dr Charlotte Sharp, CoI
- Dr Matthew Parkes, CoI
- Dr Benjamin Ellis, CoI
- Prof Christopher Armitage, CoI
If you have a question about the REMORA study that isn’t answered on this website, please get in touch.