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We examined whether digital self-management engagement was associated with their long-term trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This retrospective cohort included 3513 adults using a certified digital self-management application. Patients were grouped by completion of 0, 1\u20132, or \u22653 structured self-management plans. Longitudinal models with patient-level cluster-robust standard errors estimated post-baseline change trajectories. Sensitivity analyses addressed differential attrition, measured confounding, and reverse causality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2895 patients with baseline PtGADA, 1026 (35.4%) contributed post-baseline observations. Patients completing \u22653 plans had more favourable PtGADA, pain, and RAPID3 trajectories than zero-plan patients (group-effect\n                      <jats:italic>p<\/jats:italic>\n                      =6.2\u00d710\n                      <jats:sup>\u22125<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      =0.0055, and\n                      <jats:italic>p<\/jats:italic>\n                      =0.0044, respectively), without diverging slopes. At weeks 12\u201348, PtGADA improved by 11.1\u201312.1 points and pain by 7.2\u20137.3 points in the high-engagement group. After attrition weighting, PtGADA remained significant, RAPID3 retained a significant joint group effect, and pain was no longer significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher engagement was most robustly associated with more favourable long-term PtGADA trajectories; support for pain was directionally similar but statistically more limited, and RAPID3 findings were the least consistent of the three outcomes. These results describe an engagement-associated phenotype rather than a causal treatment effect and support its evaluation as a potential marker of sustained digital engagement in future prospective stratification studies.<\/jats:p>\n                    <jats:p>\n                      <jats:table-wrap>\n                        <jats:table>\n                          <jats:tbody>\n                            <jats:tr>\n                              <jats:td align=\"left\" colspan=\"2\">\n                                <jats:bold>Key Points<\/jats:bold>\n                                \u2022\n                                <jats:italic>In this real-world cohort of 3513 patients with inflammatory arthritis, higher digital self-management engagement was most robustly associated with more favourable PtGADA trajectories; the association with pain was directionally similar but less robust, while RAPID3 findings were less consistent.<\/jats:italic>\n                                \u2022\n                                <jats:italic>Engagement-group trajectories were approximately parallel, and the findings remained directionally consistent in analyses examining sensitivity to differential follow-up, measured baseline differences, and reverse-causality concerns, although statistical significance varied by outcome and landmark.<\/jats:italic>\n                                \u2022\n                                <jats:italic>The engagement-outcome association was directionally consistent across multiple sensitivity analyses addressing measured confounding and differential follow-up, although temporal exposure assignment could not be established and residual reverse-causality bias cannot be excluded.<\/jats:italic>\n                                \u2022\n                                <jats:italic>Digital self-management engagement, operationalised by action-plan completion, represents a potential marker of sustained digital engagement for future prospective stratification studies, rather than a validated tool for baseline risk stratification.<\/jats:italic>\n                              <\/jats:td>\n                            <\/jats:tr>\n                          <\/jats:tbody>\n                        <\/jats:table>\n                      <\/jats:table-wrap>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10067-026-08425-z","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:14:12Z","timestamp":1790666052000},"page":"6999-7013","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital self-management engagement and long-term patient-reported outcome trajectories in inflammatory arthritis: a real-world retrospective cohort 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Midaia GmbH developed the mobile application used in this study but did not finance the study. DY, JL, DK, LP, OI, TK, and SV declare that they have no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"ChatGPT-5.5 (OpenAI) was used between March and May 2026 for language polishing and drafting non-substantive manuscript text. ChatGPT-5.6 Sol was additionally used during manuscript revision in August 2026 for language editing and drafting non-substantive responses to reviewer comments. No AI tool was credited as an author. All AI-suggested text was critically reviewed, revised, and approved by the authors, who take full responsibility for the final manuscript. No patient-level identifiable data were provided to AI tools. Statistical analyses were performed using R version 4.5.1 (R Foundation for Statistical Computing, Vienna, Austria), and figures were generated using Python 3.10 (pandas, matplotlib). AI tools were not used to perform statistical estimation.","order":2,"name":"Ethics","label":"Artificial intelligence (AI)-assisted tools disclosure","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and Good Clinical Practice guidelines and was approved by the Local Ethics Committee of Medical Center Medical Clinic Blagomed LLC (protocol no. 107\/5, dated 13 Aug 2022).","order":3,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Digital informed consent was obtained from all patients before the study started.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"This specific dataset and analysis have not been previously presented or published. Related analyses of earlier, smaller subsets of the same underlying patient population have been reported previously and are identified in the manuscript.","order":5,"name":"Ethics","label":"Prior presentation and abstract publication","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The corresponding author, Stefan Vordenb\u00e4umen, meets the reimbursement requirements of Heinrich Heine University D\u00fcsseldorf, which has an agreement that can cover article processing charges with Springer Nature.","order":6,"name":"Ethics","label":"Open access publishing note","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}