Development of START, a novel multimedia-based symptom appraisal tool for autoimmune rheumatic diseases.

Summary

START is a theory-informed, multimedia symptom appraisal tool for autoimmune rheumatic diseases that distilled 59 manifestations to 19 items via expert consensus and patient cognitive interviews. In a pilot with 145 ARD cases, 133 non-ARD patients, and 155 healthy controls, START achieved 86.2% sensitivity, 80.9% specificity, and good test-retest reliability (0.789).

Key Findings

• Expert consensus reduced 59 manifestations to 19 items with content validity.
• Pilot testing showed sensitivity 86.2% and specificity 80.9% for detecting any ARDs.
• Test-retest reliability was acceptable (0.789), and multimedia visuals improved comprehension.
• Development followed a social cognitive theory-based framework with expert and patient input.

Clinical Implications

START could serve as a frontline digital triage aid to flag suspected ARDs for earlier specialist referral, potentially improving outcomes through timelier diagnosis. It should complement, not replace, clinician assessment and requires external validation in diverse populations.

Limitations

• Single-stage pilot; lacks external validation across regions and care levels
• Diagnostic accuracy may vary in primary care and non-English or low-literacy settings

Future Directions

Conduct multicenter external validation, assess performance in primary care and diverse languages, evaluate impact on referral times and outcomes, and integrate with EHR/AI-based decision support.