Informing the development of a mobile application for the physical activity guidelines in multiple sclerosis: a qualitative, pluralistic approach

Identifying and Validating Data Elements and Main Characteristics of a Teleconsultation and Televisit System for Patients with Multiple Sclerosis in Iran

Background: Patients with multiple sclerosis (MS) face barriers and disparities in accessing care for evaluation and treatment. Given the unmet needs and barriers to access to care, teleservices (e.g., teleconsultation and televisit) could support these patients by providing reliable information, offering specialty care and managing symptoms. The objective of this work was to identify and validate the data elements and main characteristics required for the design and implementation of a teleconsultation and televisit system for patients with MS. Methods: This descriptive, cross-sectional, multicenter study was completed through three main stages in 2023-2024. Various methods, including literature review, focus group discussion, and the Delphi technique, were employed to identify the data elements. A review of the literature was carried on electronic databases to detect the elements for the system. A focus group was established to review, add, or delete the data elements obtained from searching the literature. The Delphi technique was employed to achieve consensus and validate the preliminary system design. Results: A total of 97 data elements were classified into seven distinct categories, including patients' demographic information, physicians' demographic information, clinical information, teleconsultation, televisit, statistics/reports generation, and other system capabilities. Overall, 104 data elements were approved by the specialists for inclusion in the system. Conclusions: In this research, the necessary data elements for the design and implementation of a teleconsultation and televisit system for patients with MS were suggested. System developers and decision makers can utilize these data elements to recognize the specific information required in the system while initiating the design process for various systems for patients with MS.

Mobile Applications to Support Multiple Sclerosis Communities: The Post-COVID-19 Scenario

Introduction: The increase in the use of mobile apps since the COVID-19 pandemic, even among people with multiple sclerosis (PwMS) and health care providers (HCPs), has enabled access to reliable information, symptoms monitoring and management, and social connections. The pandemic has undoubtedly contributed to the acceleration of the "digital revolution." But how far has it progressed for the MS communities? Methods: Italian Google Play and App Store were queried, selecting MS-specific apps in English or Italian language and usable by a wide public. Results: Fifty-four (n = 54) MS-specific apps were identified; most were PwMS-oriented (83%), free of charge (94%), and in English language (76%). The 45 PwMS-oriented apps focused on increasing MS knowledge (71%), tracking symptoms (33%), and promoting networking with peers or HCPs (38%). The 13 HCPs-oriented tools addressed education and updates on MS (62%), disease assessment and management (54%), and research (15%). Google Search tool was also queried to find non-MS-specific apps to fulfill some unmet domains (as sleep, pain, sexual or mental health). Twenty-four additional apps were listed to provide a valuable contribution. Conclusion: The "digital revolution" led to increasingly customized tools for PwMS, especially as m-health or social-networking apps. However, apps to support other specific MS-relevant domains, appealing HCPs-oriented apps, and specific mobile tools for MS caregivers are still lacking. The absence of data assessing the usability and quality of MS apps in ecologically contexts leads to not reliable conclusions about potential benefits. A strong dialogue between MS communities and the digital industry is encouraged to fill this gap.

Exploring the Major Barriers to Physical Activity in Persons With Multiple Sclerosis: Observational Longitudinal Study

BACKGROUND

Physical activity (PA) represents a low-cost and readily available means of mitigating multiple sclerosis (MS) symptoms and alleviating the disease course. Nevertheless, persons with MS engage in lower levels of PA than the general population.

OBJECTIVE

This study aims to enhance the understanding of the barriers to PA engagement in persons with MS and to evaluate the applicability of the Barriers to Health Promoting Activities for Disabled Persons (BHADP) scale for assessing barriers to PA in persons with MS, by comparing the BHADP score with self-reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life, as well as sensor-measured PA.

METHODS

Study participants (n=45; median age 46, IQR 40-51 years; median Expanded Disability Status Scale score 4.5, IQR 3.5-6) were recruited among persons with MS attending inpatient neurorehabilitation. They wore a Fitbit Inspire HR (Fitbit Inc) throughout their stay at the rehabilitation clinic (phase 1; 2-4 wk) and for the 4 following weeks at home (phase 2; 4 wk). Sensor-based step counts and cumulative minutes in moderate to vigorous PA were computed for the last 7 days at the clinic and at home. On the basis of PA during the last 7 end-of-study days, we grouped the study participants as active (≥10,000 steps/d) and less active (<10,000 steps/d) to explore PA barriers compared with PA level. PA barriers were repeatedly assessed through the BHADP scale. We described the relevance of the 18 barriers of the BHADP scale assessed at the end of the study and quantified their correlations with the Spearman correlation test. We evaluated the associations of the BHADP score with end-of-study reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life with multivariable regression models. We performed separate regression analyses to examine the association of the BHADP score with different sensor-measured outcomes of PA.

RESULTS

The less active group reported higher scores for the BHADP items Feeling what I do doesn't help, No one to help me, and Lack of support from family/friends. The BHADP items Not interested in PA and Impairment were positively correlated. The BHADP score was positively associated with measures of fatigue and depression and negatively associated with self-efficacy and health-related quality of life. The BHADP score showed an inverse relationship with the level of PA measured but not when dichotomized according to the recommended PA level thresholds.

CONCLUSIONS

The BHADP scale is a valid and well-adapted tool for persons with MS because it reflects common MS symptoms such as fatigue and depression, as well as self-efficacy and health-related quality of life. Moreover, decreases in PA levels are often related to increases in specific barriers in the lives of persons with MS and should hence be addressed jointly in health care management.

Mobile apps used for people living with multiple sclerosis: A scoping review

BACKGROUND

Multiple Sclerosis (MS) is a chronic neurodegenerative disorder. People living with MS (plwMS) require long-term, multidisciplinary care in both clinical and community settings. MS-specific mHealth interventions have advanced in the form of clinical treatments, rehabilitation, disease monitoring and self-management of disease. However, mHealth interventions for plwMS appear to have limited proof of clinical efficacy. As native mobile apps target specific mobile operating systems, they tend to have better interactive designs leveraging platform-specific guidelines. Thus, to improve such efficacy, it is pivotal to explore the design characteristics of native mobile apps used for plwMS.

OBJECTIVES

This study aimed to explore the design characteristics of native mobile apps used for adults living with MS in academic settings.

METHODS

A scoping review of studies was conducted. A literature search was performed through PubMed, CINAHL, MEDLINE and Cochrane Library. Per native mobile apps, characteristics, persuasive technology elements and evaluations were summarized.

RESULTS

A total of 14 native mobile apps were identified and 43% of the identified apps were used for data collection (n=6). Approximately 70% of the included apps involved users (plwMS) whilst developing (n=10). A total of three apps utilized embedded sensors. Videos or photos were used for physical activity interventions (n=2) and gamification principles were applied for cognitive and/or motor rehabilitation interventions (n=3). Behavior change theories were integrated into the design of the apps for fatigue management and physical activity. Regarding persuasive technology, the design principles of primary support were applied across all identified apps. The elements of dialogue support and social support were the least applied. The methods for evaluating the identified apps were varied.

CONCLUSION

The findings suggest that the identified apps were in the early stages of development and had a user-centered design. By applying the persuasive systems design model, interaction design qualities and features of the identified mobile apps in academic settings were systematically evaluated at a deeper level. Identifying the digital functionality and interface design of mobile apps for plwMS will help researchers to better understand interactive design and how to incorporate these concepts in mHealth interventions for improvement of clinical efficacy.