Document text
Principal Investigator: ROBERT D HOWE
Organization: HARVARD UNIVERSITY
Fiscal Year: 2024
Award: $202,312
Funding agency: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Title
Video Disease Activity Index: a video measure to monitor rheumatoid arthritis in telemedicine
Project Summary/Abstract
Rheumatoid arthritis (RA) is a degenerative autoimmune condition of the joints that is treated with medications
that suppress the immune system. Medications must be regularly adjusted according to disease activity, based
on clinical examination. Telemedicine has gained a key role in rheumatology during the COVID-19 pandemic,
with rheumatologists amending treatment based on patient reports of disease activity and signs of swelling
observed on video. However, numerous studies have proven that telemedicine may miss critical information that
affects how disease activity is treated. The proposed project aims to improve the accuracy of assessing disease
activity and functioning in RA during telemedicine visits by using laptops and smartphone standard cameras.
This will also help reduce the costs associated with objective evaluation for RA. The overall goal of this
exploratory and developmental R21 project is to assess technical feasibility and patient usability of camera-
based remote assessment system. The first aim is to develop a web-based system that leverages computer
vision to quantify joint range of motion and joint thickness as an indication of joint swelling in RA to determine
disease activity. We also aim to modify and improve the current method of assessing functional impairment by
incorporating isometric grip strength using an in-house squeezable ball. During this first phase, the vision-based
system and the squeezable ball will be validated on young and older adults through comparison with gold-
standard techniques (e.g., motion capture). The second aim is to evaluate a new scoring system called the Video
Disease Activity Index (VDAI) in a cross-sectional feasibility investigation with RA patients (n = 50). The VDAI
scoring system will be produced by quantifying joint range of motion and joint thickness to determine the number
of swollen joints. This will provide a measure of disease activity that aligns with the clinically endorsed Clinical
Disease Activity Index (CDAI), which will be measured by a rheumatologist in the clinic. Two tests of the VDAI
will be conducted: one with a researcher present to evaluate the system's sensitivity and reliability against clinical
examination (CDAI), and another where RA patients will use the web-based application alone, while still in the
clinic, with a vision-based feedback algorithm to perform the required activities. As the VDAI and CDAI are on
the same scale (0–24), the study will use joint-level power calculations to permit standard limits of agreement
analysis between the two measures (e.g., Bland-Altman). The correlation between grip strength and functional
questionnaire scores will also be evaluated using Pearson's tests. These analyses will provide a robust
evaluation of the sensitivity and reliability of the VDAI system and its potential to improve the accuracy of
assessing disease activity and functioning in RA during telemedicine visits. By leveraging ubiquitous cameras,
this investigation has the potential to significantly increase the quality of disease activity and functioning in RA
during telemedicine visits.
Terms: <21+ years old><Access to Care><Active Follow-up><Adopted><Adoption><Adult><Adult Human><Affect><Agreement><Algorithms><Amendment><Analgesia Tests><Articular Range of Motion><Atrophic Arthritis><Autoimmune Diseases><Biological Markers><Bluetooth><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cell Phone><Cellular Phone><Cellular Telephone><Clinic><Clinical><Computer Vision Systems><Consultations><Data><Decision Making><Detection><Development><Disease><Disorder><Drugs><Early Diagnosis><Elbow Joint><Elbow joint structure><Evaluation><Feasibility Studies><Feedback><Flare><Frequencies><Functional impairment><Future><Goals><Grip strength><Hand><Hand Strength><Health Services Accessibility><Hospital Admission><Hospitalization><Hospitals><Immune system><Investigation><Investigators><Isometric Exercise><Isometrics><Joint Range of Motion><Joints><Laboratories><Measurement><Measures><Medication><Metacarpophalangeal Joint><Metacarpophalangeal joint structure><Methods><Mobile Phones><Monitor><Motion><Movement><Muscle-Setting Exercise><Nociception Tests><Pain Assessment><Pain Measurement><Pain measure><Pathway interactions><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Performance><Pharmaceutical Preparations><Phase><QOL><Quality of life><Questionnaires><Radiocarpal Joint><Reporting><Research Personnel><Research Resources><Researchers><Resources><Rheumatoid Arthritis><Rheumatology><Running><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Self evaluation><Self-Examination><Self-Surveillance><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shapes><Sight><Static Exercise><Swelling><Symptoms><Synovitis><System><Techniques><Technology><Telemedicine><Testing><Therapeutic Intervention><Thick><Thickness><Vision><Visit><Visual><Woman><Wrist joint><access to health services><access to services><access to treatment><accessibility to health services><active followup><adult youth><adulthood><autoimmune condition><autoimmune disorder><autoimmunity disease><availability of services><bio-markers><biologic marker><biomarker><body movement><care access><clinical exam><clinical examination><computer vision><consultation><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><cost effective><developmental><disability><drug/agent><early detection><feasibility testing><follow up><follow-up><followed up><followup><functional status><handheld mobile device><hands><health assessment><health service access><health services availability><iPhone><improved><indexing><inflamed joint><inflamed synovial tissue><inflamed synovium><internet based platform><internet platform><intervention therapy><joint damage><joint inflammation><joint injury><joint swelling><joint trauma><laptop><mobile device><new marker><new technology><novel><novel biomarker><novel marker><novel technologies><older adult><older adulthood><online app><pain assay><pain reduction><pandemic><pandemic disease><pathway><patient oriented outcomes><range of motion><reduce pain><remote assessment><remote evaluation><remote monitoring><response><response to therapy><response to treatment><rheumatic arthritis><rheumatologist><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><smart phone><smartphone><synovial inflammation><telehealth><therapeutic effectiveness><therapeutic response><therapy response><treatment access><treatment response><treatment responsiveness><urgent care><usability><video call><video calling><video chat><video phone call><visual function><web app><web application><web based app><web based application><web based platform><web based system><web enabled platform><web platform><young adult><young adulthood>