title: Pixel or Paper? Validation of a Mobile Technology for Collecting Patient-Reported Outcomes in Rheumatoid Arthritis.
abstract: BACKGROUND
  In the management of chronic disease, new models for telemonitoring of patients combined with the choice of electronic patient-reported outcomes (ePRO) are being encouraged, with a clear improvement of both patients' and parents' quality of life. An Italian study demonstrated that ePRO were welcome in patients with rheumatoid arthritis (RA), with excellent matching data.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the level of agreement between electronic and paper-and-pencil questionnaire responses.
  
  
  METHODS
  This is an observational prospective study. Patients were randomly assigned to first complete the questionnaire by paper and pencil and then by tablet or in the opposite order. The questionnaire consisted of 3 independent self-assessment visual rating scales (Visual Analog Scale, Global Health score, Patient Global Assessment of Disease Activity) commonly used in different adult patients, including those with rheumatic diseases.
  
  
  RESULTS
  A total of 185 consecutive RA patients were admitted to hospital and were enrolled and completed the questionnaire both on paper and on electronic versions. For all the evaluated items, the intrarater degree of agreement between 2 approaches was found to be excellent (intraclass correlation coefficient>0.75, P<.001).
  
  
  CONCLUSIONS
  An electronic questionnaire is uploaded in a dedicated Web-based tool that could implement a telemonitoring system aimed at improving the follow-up of RA patients. High intrarater reliability between paper and electronic methods of data collection encourage the use of a new digital app with consequent benefit for the overall health care system.
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Oscar Massimiliano
authors.identifier: http://orcid.org/0000-0002-9986-4030
authors.initials: OM
authors.lastname: Epis
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Cinzia
authors.identifier: http://orcid.org/0000-0001-7611-5005
authors.initials: C
authors.lastname: Casu
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Laura
authors.identifier: http://orcid.org/0000-0001-5611-227X
authors.initials: L
authors.lastname: Belloli
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Emanuela
authors.identifier: http://orcid.org/0000-0001-6107-6787
authors.initials: E
authors.lastname: Schito
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Davide
authors.identifier: http://orcid.org/0000-0002-9610-129X
authors.initials: D
authors.lastname: Filippini
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Marina
authors.identifier: http://orcid.org/0000-0001-6913-0493
authors.initials: M
authors.lastname: Muscarà
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Maria Giovanna
authors.identifier: http://orcid.org/0000-0002-9654-7646
authors.initials: MG
authors.lastname: Gentile
authors.affiliation: Hippocrates Sintech Srl, Genova, Italy.
authors.forename: Paula Carina
authors.identifier: http://orcid.org/0000-0002-2341-7488
authors.initials: PC
authors.lastname: Perez Cagnone
authors.affiliation: Hippocrates Sintech Srl, Genova, Italy.
authors.forename: Chiara
authors.identifier: http://orcid.org/0000-0002-7370-4565
authors.initials: C
authors.lastname: Venerelli
authors.affiliation: Hippocrates Sintech Srl, Genova, Italy.
authors.forename: Massimo
authors.identifier: http://orcid.org/0000-0002-2976-7219
authors.initials: M
authors.lastname: Sonnati
authors.affiliation: Hippocrates Research Srl, Genova, Italy.
authors.forename: Irene
authors.identifier: http://orcid.org/0000-0002-5460-2977
authors.initials: I
authors.lastname: Schiavetti
authors.affiliation: Rheumatology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: Eleonora
authors.identifier: http://orcid.org/0000-0003-2332-5310
authors.initials: E
authors.lastname: Bruschi
keywords: PROs; electronic device; monitoring; paper; questionnaire; rheumatoid arthritis; tablet; validation