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Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Norelee Kennedy, University of Limerick, Ireland
- Second opponent: Senior Consultant Johannes Knitza, Philipps University of Marburg, Germany
- Third member and chair of the evaluation committee: Associate professor Maren Falch Lindberg, University of Oslo
Chair of the Defence
Professor emeritus Reidun Birgitta Jahnsen, University of Oslo
Principal Supervisor
Professor Nina Østerås, University of Oslo
Summary
Patients with inflammatory joint disease (IJD), including axial spondyloarthritis (axSpA), require lifelong care. Digital health technologies - such as remote care, electronic patient-reported outcomes (ePROs), and wearable activity trackers - offer promise in improving care efficiency. However, their adoption, adherence, and feasibility in rheumatology care remain unexplored.
The aim of this thesis was to examine the willingness of healthcare professionals and patients to adopt remote care, identify facilitators and barriers to its use among healthcare professionals, evaluate axSpA patients’ adherence to ePRO reporting, and assess the feasibility of long-term use of wearable activity trackers in axSpA patients.
Paper I explored healthcare professionals’ willingness to use remote care and perceived facilitators and barriers. Surveying 130 professionals in Norwegian rheumatology departments, most participants reported high willingness. Barriers included concerns over the inability to perform physical examinations and mistrust in technology. Willingness was positively associated with professionals' perceptions that patients wanted remote care.
Paper II assessed axSpA patients’ willingness to use remote care and their adherence to ePRO reporting over 18 months. Among 243 patients, most expressed willingness to use remote care. Among the 160 patients receiving remote care, adherence to monthly and quarterly ePROs reporting was high (88% and 83% respectively). No significant associations were found between adherence and factors like age, sex, disease activity, or eHealth literacy.
Paper III evaluated the feasibility of using wearable activity trackers in axSpA patients over one year. Of 160 eligible patients, 75 agreed to use the tracker, and 64 were included in the final analysis. Adherence was moderate (median wear-time 66%), and three distinct usage patterns was found, though these patterns were not linked to patient characteristics. Low adherence and limited uptake suggested challenges for routine clinical use.
Overall, both healthcare professionals and axSpA patients showed willingness to adopt remote care. Long-term ePRO reporting was feasible and well-adhered to. However, while wearable activity trackers showed potential, their feasibility was limited by moderate adherence and attrition.
This thesis shows that remote care is acceptable for healthcare professionals and patients, and highlights the need for improvements in the integration of wearable technology. These findings could inform the future development and implementation of remote care in rheumatology.
Additional information
Contact the research support staff.