Mobile-phone-based e-diary derived patient reported outcomes: Association with clinical disease activity, psychological status and quality of life of patients with multiple sclerosis

Use of mobile technology for reporting the pharmacovigilance of vaccines in Panama

Objective

Monitoring adverse reactions is essential to confirm vaccine safety profiles. Studies using electronic tools for data collection may reach a broader audience, improving data efficiency and integrity, reducing study costs and simplifying data collection compared with nonelectronic methods. This study aimed to validate electronic versus paper diaries for reporting postimmunization reactions in Panama.

Methods

An experimental design was conducted with three groups (children, pregnant women, and older adults). Groups were divided into one subgroup using paper diary and one using electronic diary. Diary assignments were subsequently reversed in children group, which parents completed. Symptoms and reporting frequency were collected in 2020 and 2021. Information reported in paper diaries was entered into an electronic case report form and reconciled. Users' adherence, differences between reported symptom frequency and users' acceptability of diaries were evaluated.

Results

A total of 180 participants were included: 79 children, 21 pregnant women, 80 older adults. Children group showed greater adherence to both diaries. No significant differences were found in response times in the electronic diary between groups. More symptoms were reported in the electronic diary. The experience of using diaries, no matter which one, was similar.

Conclusions

Results indicate young people adapt better to technological tools than older adults, suggesting tools should be adjusted according to the user's age. Furthermore, electronic applications for reporting postimmunization reactions offer suitable pharmacovigilance alternatives, providing real-time information, and requiring fewer staff, leading to improved health outcomes, patient compliance, and data for research and public health analysis, supporting global vaccine development.

Measuring Disease Progression in Multiple Sclerosis Clinical Drug Trials and Impact on Future Patient Care

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system characterised by inflammation, demyelination and neurodegeneration. Although several drugs are approved for MS, their efficacy in progressive disease is modest. Addressing disease progression as a treatment goal in MS is challenging due to several factors. These include a lack of complete understanding of the pathophysiological mechanisms driving MS and the absence of sensitive markers of disease progression in the short-term of clinical trials. MS usually begins at a young age and lasts for decades, whereas clinical research often spans only 1-3 years. Additionally, there is no unifying definition of disease progression. Several drugs are currently being investigated for progressive MS. In addition to new medications, the rise of new technologies and of adaptive trial designs is enabling larger and more integrated data collection. Remote assessments and decentralised clinical trials are becoming feasible. These will allow more efficient and large studies at a lower cost and with less burden on study participants. As new drugs are developed and research evolves, we anticipate a concurrent change in patient care at various levels in the foreseeable future. We conducted a narrative review to discuss the challenges of accurately measuring disease progression in contemporary MS drug trials, some new research trends and their implications for patient care.

Impact of connected health on the psychological wellbeing and quality of life of people with multiple sclerosis and their caregivers: A systematic review

Background

Connected health (CH) interventions may improve psychological wellbeing and quality of life (QoL) in caregivers and people with multiple sclerosis (MS); however, this impact has not been rigorously evaluated. This systematic review aims to synthesize the literature assessing CH technology's impact on psychological wellbeing and/or QoL of people with MS (PwMS) and/or their caregivers.

Methods

This systematic review's protocol is registered with International Prospective Register of Systematic Reviews (PROSPERO) with identification number CRD42023402434. CINAHL, Web of Science, PubMed, Embase, and PsycINFO databases were searched with terms relating to (a) CH; (b) MS; (c) psychological wellbeing/QoL; and (d) caregivers/people with MS. Of 2821 screened articles, 47 met the eligibility criteria, with just three including MS caregivers.

Results

Heterogenous interventions supporting self-management (n = 20 studies), education (n = 17 studies), psychological (n = 14 studies) or physical (n = 9 studies) rehabilitation and peer support (n = 5 studies) were found. CH technologies had mixed effectiveness in improving psychological and QoL outcomes, with results potentially impacted by technology type, intervention and target group. The study's findings have limited generalizability to improve access across sub-national locations, with no studies disaggregating between urban and rural residence and the majority conducted in the USA and Western Europe.

Conclusion

CH technologies show promise in improving psychological wellbeing and QoL among PwMS and their caregivers. However, this necessitates further study comparing connected health and MS subtypes to improve reproducibility and effectiveness.

The MindKind Consortium. MindKind: A mixed-methods protocol for the feasibility of global digital mental health studies in young people

Background: While an estimated 14-20% of young adults experience mental health conditions worldwide, the best strategies for prevention and management are not fully understood. The ubiquity of smartphone use among young people makes them excellent candidates for collecting data about lived experiences and their relationships to mental health. However, not much is known about the factors affecting young peoples’ willingness to share information about their mental health.

Objective: We aim to understand the data governance and engagement strategies influencing young peoples’ (aged 16-24) participation in app-based studies of mental health. We hypothesize that willingness to participate in research is influenced by involvement  in how their data is collected, shared, and used.

Methods: Here, we describe the MindKind Study, which employs mixed methods to understand the feasibility of global, smartphone-based studies of youth mental health. A pilot 12-week app-based substudy will query participants’ willingness to engage with remote mental health studies. Participants will be randomized into one of four different data governance models designed to understand their preferences, as well as the acceptability of models that allow them more or less control over how their data are accessed and used. Enrolees will receive one of two different engagement strategies. A companion qualitative study will employ a deliberative democracy approach to examine the preferences, concerns and expectations of young people, with respect to remote mental health research. We also detail our engagement with young people as co-researchers in this study. This pilot study is being conducted in India, South Africa and the United Kingdom.

Conclusions: This study is expected to generate new insights into the feasibility of, and best practices for, remote smartphone-based studies of mental health in youth and represents an important step toward understanding which approaches could help people better manage their mental health.

Electronic Health Diary Campaigns to Complement Longitudinal Assessments in Persons With Multiple Sclerosis: Nested Observational Study (Preprint)

Background

Electronic health diaries hold promise in complementing standardized surveys in prospective health studies but are fraught with numerous methodological challenges.

Objective

The study aimed to investigate participant characteristics and other factors associated with response to an electronic health diary campaign in persons with multiple sclerosis, identify recurrent topics in free-text diary entries, and assess the added value of structured diary entries with regard to current symptoms and medication intake when compared with survey-collected information.

Methods

Data were collected by the Swiss Multiple Sclerosis Registry during a nested electronic health diary campaign and during a regular semiannual Swiss Multiple Sclerosis Registry follow-up survey serving as comparator. The characteristics of campaign participants were descriptively compared with those of nonparticipants. Diary content was analyzed using the Linguistic Inquiry and Word Count 2015 software (Pennebaker Conglomerates, Inc) and descriptive keyword analyses. The similarities between structured diary data and follow-up survey data on health-related quality of life, symptoms, and medication intake were examined using the Jaccard index.

Results

Campaign participants (n=134; diary entries: n=815) were more often women, were not working full time, did not have a higher education degree, had a more advanced gait impairment, and were on average 5 years older (median age 52.5, IQR 43.25-59.75 years) than eligible nonparticipants (median age 47, IQR 38-55 years; n=524). Diary free-text entries (n=632; participants: n=100) most often contained references to the following standard Linguistic Inquiry and Word Count word categories: negative emotion (193/632, 30.5%), body parts or body functioning (191/632, 30.2%), health (94/632, 14.9%), or work (67/632, 10.6%). Analogously, the most frequently mentioned keywords (diary entries: n=526; participants: n=93) were “good,” “day,” and “work.” Similarities between diary data and follow-up survey data, collected 14 months apart (median), were high for health-related quality of life and stable for slow-changing symptoms such as fatigue or gait disorder. Similarities were also comparatively high for drugs requiring a regular application, including interferon beta-1a (Avonex) and glatiramer acetate (Copaxone), and for modern oral therapies such as fingolimod (Gilenya) and teriflunomide (Aubagio).

Conclusions

Diary campaign participation seemed dependent on time availability and symptom burden and was enhanced by reminder emails. Electronic health diaries are a meaningful complement to regular structured surveys and can provide more detailed information regarding medication use and symptoms. However, they should ideally be embedded into promotional activities or tied to concrete research study tasks to enhance regular and long-term participation.

MindKind: A mixed-methods protocol for the feasibility of global digital mental health studies in young people

Background: While an estimated 14-20% of young adults experience mental health conditions worldwide, the best strategies for prevention and management are not fully understood. The ubiquity of smartphone use among young people makes them excellent candidates for collecting data about lived experiences and their relationships to mental health. However, not much is known about the factors affecting young peoples’ willingness to share information about their mental health. Objective: We aim to understand the data governance and engagement strategies influencing young peoples’ (aged 16-24) participation in app-based studies of mental health. We hypothesize that the willingness to participate in research is impacted by their ability to be involved in how their data is collected, shared, and used. Methods: Here, we describe the MindKind Study, which employs mixed methods to understand the feasibility of global, smartphone-based studies of youth mental health. A pilot 12-week app-based substudy will query participants’ willingness to engage with remote mental health studies. Participants will be randomized into one of four different data governance models designed to understand their preferences, as well as the acceptability of models that allow them more or less control over how their data are accessed and used. Enrolees will receive one of two different engagement strategies. A companion qualitative study will employ a deliberative democracy approach to examine the preferences, concerns and expectations of young people, with respect to remote mental health research. We also detail our engagement with young people as co-researchers in this study. This pilot study is being conducted in India, South Africa and the United Kingdom. Conclusions: This study is expected to generate new insights into the feasibility of, and best practices for, remote smartphone-based studies of mental health in youth and represents an important step toward understanding which approaches could help people better manage their mental health.