671 - Strike a Pose: The Role of Photographic Range of Motion (ROM) Images in Detection, Monitoring, and Documentation of Fasciitis and Sclerosis Associated with Chronic Graft-Versus-Host Disease (cGVHD)

Abstract

Topic Significance & Study Purpose/Background/Rationale: Fasciitis and sclerosis, complications of cGVHD, can lead to limited range of joint motion, which can greatly impact mobility and quality of life. While early intervention can delay or halt the progression of fasciitis and sclerosis, advanced disease can be irreversible. Digital pictures can be used to detect subtle changes in ROM, which can facilitate prompt treatment and monitoring. At our institution, we developed a process for capturing photographic range of motion images of patients and importing them into their electronic medical record (EMR). These images are used to establish a baseline assessment, detect subtle changes in ROM over time prompting referral to the multidisciplinary cGVHD program, and evaluate response to cGVHD treatment. Methods, Intervention, & Analysis: Baseline photographic ROM images are obtained by the transplant nurse case manager for each patient at about 6 months after allogeneic hematopoietic cell transplant as part of a standardized cGVHD assessment. The images consist of four poses to assess ROM in the shoulders, elbows, wrists, and ankles (Carpenter, Blood, 2011). The images are captured via an application on an electronic tablet, which directly imports the photographs into the patient's EMR. These photographs are loaded into the physician progress note in EMR and can be recalled for future comparison. Use of the electronic tablet promotes portability, while use of the application ensures photographs are not stored on the device, maintaining patient confidentiality. If cGVHD is detected and treatment is initiated, the imaging series is repeated every 3 months to assess response. Findings & Interpretation: Photographic ROM images were piloted during 6-month cGVHD assessments. Images could be easily obtained and imported. Further guidelines were developed for subsequent monitoring at designated time points to assess response to cGVHD therapies. Subtle changes in ROM were detected by comparing the images at different time points. Placing the images in the EMR facilitated sharing information with the multidisciplinary team and with external providers. Discussion & Implications: Portable electronic tablets can be used to capture and import ROM images to EMR. These images facilitate monitoring of subtle changes in ROM and can guide therapy of sclerotic cGVHD. Efforts are underway to modify the EMR software so that multiple photographs from different time points can be compared side by side to better track subtle changes in ROM.