Rheumatic? A diagnostic decision support tool for individuals suspecting rheumatic diseases: Mixed-methods usability and acceptability study

BMC Rheumatology, vol. 9, pp. 59

Abstract

BACKGROUND: The early diagnosis of inflammatory rheumatic diseases (IRDs) is of paramount importance in order to prevent irreversible damage to joints and to optimize treatment outcomes. Nevertheless, conventional care pathways frequently entail diagnostic delays spanning several months. Symptom checkers (SCs) have the potential to provide a solution by offering validated symptom assessments, improving triage systems and expediting diagnostic evaluations. The objective of this mixed-methods study is to assess the usability and acceptability of the SC Rheumatic? among individuals with suspected rheumatic diseases. METHODS: A total of 105 individuals with suspected IRDs who were newly presenting at an outpatient rheumatology clinic completed the Rheumatic? symptom checker and an evaluation questionnaire. The questionnaire comprised the System Usability Scale (SUS) and Net Promoter Score (NPS). Additionally, 14 participants were interviewed by telephone in order to gain further insights through the qualitative method. RESULTS: The Rheumatic? symptom checker received a "good" usability score, with an average SUS of 78 ± 16 (range 0-100). Younger participants reported significantly higher usability scores (p < 0.03). However, the NPS was - 15 (range - 100 to 100), indicating lower acceptability. Qualitative data supported the positive usability ratings but emphasized the need for enhancements to increase user engagement and perceived value, such as a current perceived lack of immediate benefit for many users. Their experience varied in terms of impact, with some patients suggesting an increased awareness of their symptoms while others did not notice any difference. CONCLUSION: Rheumatic? demonstrates good usability, particularly among younger users. Interviews revealed valuable suggestions for improvements, which could enhance overall acceptability and user satisfaction. Implementing Rheumatic? could lead to more efficient triage, potentially reducing diagnostic delays and an optimized allocation of resources. Future iterations should prioritize implementation strategies to maximize user impact and benefit. CLINICAL TRIAL NUMBER: Not applicable.

Authors 13

1. Stefan Jakobi

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

   Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany

2. Katharina Boy

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, Germany

3. Magali Wagner

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, Germany

4. Susann May

   Medizinische Hochschule Brandenburg Theodor Fontane

   Affiliation as printed

   Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, Germany

5. Selahattin Alp Temiz

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

   Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany

6. Anna‐Maria Liphardt

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

   Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany

7. Elizabeth G. Araujo

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

   Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany

8. Loreto Carmona

   Instituto de Salud Musculoesquelética

   Affiliation as printed

   Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain

9. Rachel Knevel Aachen Department of Rheumatology, Leiden Universitair Medisch Centrum

   Leiden University Medical Center · Newcastle upon Tyne Hospitals NHS Foundation Trust · Newcastle upon Tyne Hospital

   Affiliation as printed

   Department of Rheumatology, Leiden Universitair Medisch Centrum, Leiden, 2333 ZA, The Netherlands

   Department of Rheumatology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK

10. Georg Andreas Schett

    Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

    Affiliation as printed

    Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

    Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany

11. Johannes Knitza

    Philipps University of Marburg · Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Gießen und Marburg · Universitätsklinikum Erlangen · Université Grenoble Alpes

    Affiliation as printed

    AGEIS, Université Grenoble Alpes, Grenoble, France

    Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

    Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany

    Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany

12. Felix Muehlensiepen

    Medizinische Hochschule Brandenburg Theodor Fontane · Université Grenoble Alpes

    Affiliation as printed

    AGEIS, Université Grenoble Alpes, Grenoble, France

    Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, Germany

13. Harriet Morf corresponding

    Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

    Affiliation as printed

    Department of Internal Medicine 3 - Rheumatology & Immunology, Universitätsklinikum Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany. harriet.morf@uk-erlangen.de

    Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, Erlangen, Germany. harriet.morf@uk-erlangen.de