Development and Implementation of an Educational Video That Instructs Patients with Rheumatoid Arthritis for Self-Assessment of Disease Activity: Methodology of the AUTO-DAS in Middle Eastern Arab Countries Study - European Medical Journal

Development and Implementation of an Educational Video That Instructs Patients with Rheumatoid Arthritis for Self-Assessment of Disease Activity: Methodology of the AUTO-DAS in Middle Eastern Arab Countries Study

2 Mins
*Nelly Ziade,1 Ghada Abi Karam,1 Amani Daher,1 Mohammad Abu Jbara,2 Alla Ayko,3 Elie Alam,4 Thurayya Arayssi,5 Humeira Badsha,6 Samar el Emadi,7 Hussein Halabi,8 Ghita Harifi,6 Bhavna Khan,9 Lina el Kibbi,10 Manal al Mashaleh,11 Abdel Fattah Masri,12 Bassel Masri,13 Jeanine Menassa,14 Mira Merashli,12 Georges Merheb,15 Jamil Messaykeh,16 Kamel Mroue',17 Sahar Saad,18 Nelly Salloum,19 Imad Uthman,12 Bassel el-Zorkany20

The authors have declared no conflicts of interest.


The authors would like to acknowledge Prof Maxime Dougados, Cochin Hospital, France, and the National Rheumatoid Arthritis Society, Maidenhead, UK for providing access to the video used with patients in France and the UK, respectively, and granting us authorisation to use these videos as a reference to create our own educational video.

EMJ Rheumatol. ;5[1]:49-51. Abstract Review No. AR4.
Disease Activity Score (DAS), patient education, patient-reported outcomes, rheumatoid arthritis (RA), self-assessment

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


The treat-to-target concept has revolutionised rheumatoid arthritis (RA) management and prognosis.1 Using a specific treatment target, such as Disease Activity Score (DAS)-28, and involving patients in their disease management can help to improve disease prognosis. The objective of this study was to develop and implement an educational video that instructs patients with RA how to carry out a self-assessment of disease activity using DAS-28.


Step 1: Identify the Unmet Needs in Rheumatoid Arthritis Evaluation and Plan the Study

Rheumatologists from some Middle Eastern Arab countries (MEAC) were invited to participate in this study. The protocol draft was presented during regional meetings to identify the unmet needs in RA patients and to finalise the study protocol. International experts and societies were contacted to access pre-existing educational material.

Step 2: Adapt the Protocol and Produce the Educational Material

Different material sources2-5 were synthesised and translated into Arabic through a professional translation service, and specific medical terms were translated by the rheumatologists themselves. The Arabic text and English subtitles were validated by the rheumatologists through multiple email rounds. The simplified leaflet was developed in both Arabic and English languages. The educational video was shot by a professional team with a real patient and a rheumatologist on set. The voiceover was recorded with the presence of one of the medical team members in the studio.

Step 3: Validate the Educational Material

The final products (leaflet, text, subtitles, and video) were validated by the rheumatologists through email rounds. The material was tested on RA patients to assess comprehension and acceptability. Obstacles were noted at the various study levels.


A total of 23 rheumatologists from 7 MEAC participated in the study. A one-page educational leaflet was developed in both Arabic and English languages. An educational video presenting the treat-to-target concept and the basics of DAS performance in a simple way was produced with a voiceover in the Arabic language with English subtitles.6 Obstacles experienced at the rheumatologist, patient, cultural, and logistical levels were identified (Table 1) and the potential solutions were addressed by the study team. The solutions will be applied in the future steps of the Auto-DAS MEAC study.

Table 1: Obstacles faced during the conception and implementation of the educational tool for rheumatoid arthritis patient empowerment for self-assessment at the different levels: rheumatologist, patient, cultural, and logistical.
DAS: Disease Activity Score; IRB: Institutional Review Board.


Collaboration between several countries sharing the same language and similar cultural backgrounds and unmet needs was possible and allowed for the production of an educational material aimed at the empowerment of RA patients for the self-assessment of their disease activity. Obstacles to applying self-assessment were identified, and potential solutions will be applied to the future steps of the Auto-DAS MEAC study. The video will serve for future studies in Arabic-speaking countries and will be available for clinical use according to the rheumatologist’s clinical judgment.

Discussions with experts during the abstract display at the European League Against Rheumatism (EULAR) Congress in Amsterdam, Netherlands, yielded additional comments about the obstacles identified in Table 1, mainly surrounding the use of DAS as a proper treatment target. Several suggestions were made about the proper tool to adopt, which will be highly useful for the future steps of the study.

Smolen JS et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3-15. Gossec L et al. Is the self-assessment of disease activity (auto-DAS28) by patients a feasible and acceptable measure over the long term in rheumatoid arthritis? Three-year follow-up of a nurse-led program in 771 patients with establish RA [Abstract]. Arthritis Rheumatol. 2016;75(Suppl 2). Sordet C et al. Comparison of self assessment of disease activity to Das28 in rheumatoid arthritis: Data from the randomized “Roc” trial. [Abstract]. Ann Rheum Dis. 2016;75(Suppl 2):408. National Rheumatoid Arthritis Society. Know your DAS: App (Mobile and Tablet). Rheumatoid Arthritis Management Tool. 2016. Available at: Last accessed: 18 June 2018. DAS28. 2018. Available at: Last accessed: 18 June 2018. Khasha G. YouTube. AUTO-DAS Middle Eastern Arab Countries. 2018. Available at: Last accessed: 18 June 2018.

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