Is mHealth a Useful Tool for Self-Assessment and Rehabilitation of People with Multiple Sclerosis? A Systematic Review

Exploring concordance between face-to-face and tele-assessment of upper limb functionality in people with multiple sclerosis

BACKGROUND

People with multiple sclerosis (PwMS) experience fatigue, pain, and sensory-motor disturbances that limit fundamental daily activities. The development of techniques for remotely assessing upper limb functionality is crucial for advancing telemedicine as an integral part of the continuum of care for PwMS.

OBJECTIVE

To assess the agreement between face-to-face assessment and tele-assessment of upper limb functionality in PwMS.

METHOD

A descriptive study was conducted to investigate the concordance. Participants were evaluated twice: once physically and once remotely. Upper limb functionality (Manual Ability Measure), upper limb extremity muscle strength and endurance (30-second Arm Curl Test), and range of motion (Range of Movement) were assessed.

RESULTS

A total of 42 PwMS were included in this study. The participants were included in a face-to-face assessment and tele-assessment of upper limb functionality. Concordance between both methods for upper limb extremity muscle strength and endurance, manual dexterity, motor speed, precision, and range of motion was assessed as high. Moreover, most confidence intervals were narrow and excluded 0.8.

CONCLUSION

Tele-assessment of upper limb functionality showed high concordance with face-to-face assessment in PwMS. Tele-assessment of upper limb functionality through a video call system could serve as a complementary or alternative method to meet the increasing demand for monitoring multiple sclerosis disease progression.

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.

Protocol for a pragmatic randomised controlled feasibility study of MS WorkSmart: an online intervention for Australians with MS who are employed

INTRODUCTION

Multiple sclerosis (MS) causes a wide variety of symptoms. Loss of income due to sickness and early retirement comprise one-third of the total cost of MS in Australia. An intervention that maximises work productivity and keeps people with MS in the workforce for longer could provide a large societal cost saving and improve quality of life. The aim is to test the feasibility of delivering and evaluating a 10-week digitally delivered intervention called 'MS WorkSmart'. Findings will provide insights into participant profiles and address key methodological and procedural uncertainties (recruitment, retention, intervention adherence and engagement, and selection of primary outcome) in preparation for a subsequent definitive trial.

METHODS AND ANALYSIS

A parallel-arm randomised controlled feasibility study, comparing those randomised to receive the MS WorkSmart package plus usual care (n=20) to those receiving usual care only (n=20). Australians with MS, aged 18-60 years, who are employed, and self-report work instability will be recruited from the Australian MS Longitudinal Study. Online surveys, at baseline and 1-month postintervention, will include MS-related work productivity loss and risk of job loss, MS work behaviour self-efficacy, health-related quality of life, fatigue severity, MS symptom impact on work, intention to retire due to MS, MS-related work difficulties, and awareness and readiness for change at work. Qualitative feedback will be obtained via a semistructured survey following the intervention (for participants) and via interviews (coaches). Analyses will be primarily descriptive and focus on the feasibility and acceptability of the intervention and study procedures. Progression criteria will guide decisions around whether to progress to a full trial.

ETHICS AND DISSEMINATION

The study has been approved by the University of Tasmania Human Research Ethics Committee (H0024544). Findings will be disseminated via publication in peer-reviewed journals, conference presentations and community presentations.

TRIAL REGISTRATION NUMBER

ACTRN12622000826741.

Tablet app-based dexterity training in multiple sclerosis (TAD-MS): a randomized controlled trial

PURPOSE

Mobile health applications (mHealth apps) may lead to health benefits. In recent years, the use of apps in multiple sclerosis (MS) has increased. Apps to train and improve dexterity in MS are scarce. This study investigated the effectiveness of a tablet app-based home-based training to improve dexterity in individuals with MS.

MATERIALS AND METHODS

In a randomized controlled trial, two standardized 4-week home-based interventions focussing on different aspects of dexterity and upper limb function were compared. Assessments were done at baseline, post-intervention and 12-week follow-up. The primary endpoint was the Arm Function in Multiple Sclerosis Questionnaire, a dexterity-related measure of patient-reported activities of daily living. Secondary endpoints were dexterous function, grip strength and health-related quality of life.

RESULTS

Forty-eight individuals were randomly assigned to a tablet app-based program (n = 26) or a control strengthening exercise program (n = 22). No significant differences were found for the primary endpoint (p = 0.35). Some significant differences in favour of the app-group were found in fine coordinated finger movements and strength. No significant differences were found at the 12-week follow-up for all endpoints. Adherence in both groups was above 90%.

CONCLUSIONS

App-based training was not superior compared to a control strengthening exercise program concerning the arm- and hand function from the participant's perspective. However, app-based training was found to be effective in improving specific dimensions (finger movements and strength), and can easily be applied at home. Therefore, individuals living with MS with impaired dexterity should consider app-based training.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov NCT03369470.

The electronic medical record management systems may improve monitoring and control of disease activity in patients with ankylosing spondylitis

To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. The number of annual outpatient visits increased after ASDAS assessment (4.0 (4.0, 7.0) vs. 4.0 (4.0, 8.0), p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (6.4 (8.5, 11.2) vs. 6.3 (8.3, 10.8) min, p = 0.073), especially among patients whose with an inactive disease activity was < 1.3 (ASDAS C-reactive protein (CRP) 6.7 (8.8, 11.1) vs. 6.1 (8.0, 10.3) min, p = 0.033; ASDAS erythrocyte sedimentation rate (ESR) 6.4 (8.7, 11.1) vs. 6.1 (8.1, 10.0) min, p = 0.027). Among patients who received at least three ASDAS assessments, the third ASDAS-CRP tended to be lower than the first (1.5 (0.9, 2.1) vs. 1.4 (0.8, 1.9), p = 0.058). The use of an EMRMS increased the frequency of ambulatory visits among AS patients with high and very high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS.

Mobile health solutions: An opportunity for rehabilitation in low- and middle income countries?

Mobile health (mHealth) development has advanced rapidly, indicating promise as an effective patient intervention. mHealth has many potential benefits that could help the treatment of patients, and the development of rehabilitation in low- and middle-income countries (LMICs). mHealth is a low-cost option that does not need rapid access to healthcare clinics or employees. It increases the feasibility and rationality of clinical treatment expectations in comparison to the conventional clinical model of management by promoting patient adherence to the treatment plan. mHealth can also serve as a basis for formulating treatment plans and partially compensate for the shortcomings of the traditional model. In addition, mHealth can help achieve universal rehabilitation service coverage by overcoming geographical barriers, thereby increasing the number of ways patients can benefit from the rehabilitation service, and by providing rehabilitation to individuals in remote areas and communities with insufficient healthcare services. However, despite these positive potential aspects, there is currently only a very limited number of studies performed in LMICs using mHealth. In this study, we first reviewed the current evidence supporting the use of mHealth in rehabilitation to identify the countries where studies have been carried out. Then, we identify the current limitations of the implementation of such mHealth solutions and propose a 10-point action plan, focusing on the macro (e.g., policymakers), meso (e.g., technology and healthcare institutions), and micro (e.g., patients and relatives) levels to ease the use, validation, and implementation in LMICs and thus participate in the development and recognition of public health and rehabilitation in these countries.