Role of Smartphone Applications in the Assessment and Management of Fatigue in Patients with Multiple Sclerosis: A Scoping Review
Abstract
:1. Introduction
2. Materials and Methods
- Search, identify, and synthesise research on mobile applications for the assessment and management of fatigue in PwMS.
- Categorize the areas of assessment and/or intervention in psychological/cognitive and motor/functions.
- Describe ability of mobile applications to reduce fatigue.
- Describe users’ satisfaction and usability.
- Provide clinicians with a practical overview of the use of mHT in the assessment and management of fatigue in PwMS, highlighting the mobile applications that currently seem to be the most promising for this purpose.
2.1. Search Strategy
2.2. Study Inclusion/Exclusion Criteria
2.3. Study Selection
3. Results
3.1. Classification of Mobile Applications
3.2. Degree of Patient Satisfaction and Usability Evaluation Methods
3.2.1. Questionnaires
3.2.2. Task Completion
3.2.3. Heuristic Evaluation
3.2.4. Think-Aloud and Questionnaire
3.2.5. Survey and Interview
3.3. Feasibility, Reliability, and Fatigue-Related Results
3.3.1. Feasibility Results
3.3.2. Reliability Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Unique Identifying Number | Title | Author | Year of Publication | Study Design | Country | Journal | Sample Size | Type of MS | Avarage Duration of Illness | EDSS |
---|---|---|---|---|---|---|---|---|---|---|
1 | Design considerations for a multiple sclerosis fatigue mobile app MS Energize: A pragmatic iterative approach using usability testing and resonance checks | van Kessel, K; et al. [27] | 2021 | Observational | United Kingdom (UK), New Zealand (NZ) | INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH | 11 patients (7 females; mean age, 47.25; range, 40–54 | N/A | 11 years | N/A |
2 | Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study | Palotai, M; et al. [18] | 2021 | Observational | United States (USA), Hungary (HU) | JMIR MHEALTH AND UHEALTH | 64 patients (54 females; mean age, 52) | 58 RRMS; 5 SPMS; 1 CIS | 20 years | 2.1 |
3 | More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design | Giunti, G; et al. [31] | 2018 | Research Through Design | Spain, Finland | JMIR MHEALTH AND UHEALTH | N/A | N/A | N/A | <4.5 |
4 | A Novel Digital Care Management Platform to Monitor Clinical and Subclinical Disease Activity in Multiple Sclerosis | Van Hecke, W; et al. [25] | 2021 | Observational | Belgium, United Kingdom | BRAIN SCIENCES | feasibility study: 45 patients (36 females; mean age, 45.6) | 25 RRMS; 7 SPMS; 5 PPMS; 8 unknown | Range, 3–20 years | N/A |
5 | Evaluating the Utility of Smartphone-Based Sensor Assessments in Persons With Multiple Sclerosis in the Real-World Using an App (elevateMS): Observational, Prospective Pilot Digital Health Study | Pratap, A; et al. [22] | 2020 | Observational (Prospective and cross-sectional) | United States (USA) | JMIR MHEALTH AND UHEALTH | 629 subjects (259 females). 495 pwMS (232 females, mean age, self-referred 45.20—clinic-referred 48.93); 134 healthy controls (mean age, 39.34) | 423 RRMS; 30 SPMS; 40 PPMS; 2 unknown | Range, 11.14–14.29 years | N/A |
6 | Testing Feasibility of a Mobile Application to Monitor Fatigue in People With Multiple Sclerosis | Newland, P; et al. [16] | 2019 | Observational | United States (USA) | JOURNAL OF NEUROSCIENCE NURSING | 32 patients (26 females; mean age, 49) | 30 RRMS; 2 SPMS | 11.2 years | 3 |
7 | Smartphone-Based Tapping Frequency as a Surrogate for Perceived Fatigue. An in-the-Wild Feasibility Study in Multiple Sclerosis Patients | Barrios, L; et.al. [17] | 2021 | Observational | Switzerland, United States (USA) | MULTIPLE SCLEROSIS JOURNAL | 35 patients (20 females; mean age, 36.77; range, 21–53) | N/A | N/A | 2.31 (range, 0–6) |
8 | Electronic visual analogue scales for pain, fatigue, anxiety and quality of life in people with multiple sclerosis using smartphone and tablet: a reliability and feasibility study | Kos, D; et al. [24] | 2017 | Observational | Belgium | CLINICAL REHABILITATION | 52 patients (34 females; mean age, 49.1); 52 healthy controls (36 females; mean age, 47.5); range, 20–70 | N/A | N/A | N/A |
9 | MS Energize: Field trial of an app for self-management of fatigue for people with multiple sclerosis | Babbage, DR; et al. [26] | 2019 | Observational | New Zealand (NZ), United Kingdom (UK) | INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH | 11 patients (6 females; mean age, 49; range, 41–59) | N/A | 9 years | N/A |
10 | A Smartphone-based Application for Self-Management in Multiple Sclerosis | Mokhberdezfuli, M; et al. [29] | 2021 | Observational | Iran | JOURNAL OF HEALTHCARE ENGINEERING | 60 patients (49 females; mean age, 36.8; range, 31–40); 6 healthy subjects | N/A | N/A | N/A |
11 | Identifying and Quantifying Neurological Disability via Smartphone | Boukhvalova, AK; et al. [21] | 2018 | Observational (prospective and cross-sectional) | United States (USA) | FRONTIERS IN NEUROLOGY | prospectives participants: 16 patients (10 females; mean age, 60.97); 15 healthy subjects | 1 RRMS; 5 SPMS; 10 PPMS | 21.48 | 5.31 |
12 | WalkWithMe: Personalized Goal Setting and Coaching for Walking in People with Multiple Sclerosis | Geurts, E; et al. [23] | 2019 | Observational, Case series | Belgium | ACM UMAP ‘19: PROCEEDINGS OF THE 27TH ACM CONFERENCE ON USER MODELING, ADAPTATION AND PERSONALIZATION | 13 patients (all females; mean age, 45) | All RRMS | N/A | N/A |
13 | Real-world keystroke dynamics are a potentially valid biomarker for clinical disability in multiple sclerosis | Lam, KH; et al. [30] | 2021 | Observational | Netherlands | MULTIPLE SCLEROSIS JOURNAL | 85 patients (64 females; mean age, 46.4); 18 healthy subjects | 51 RRMS; 25 SPMS; 9 PPMS | 11.3 years | 3.5 (range, 1.5–7) |
14 | Evaluating more naturalistic outcome measures A 1-year smartphone study in multiple sclerosis | Bove, R; et al. [19] | 2015 | Observational | United States (USA) | NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION | 38 patients (28 females; mean age, 35.1); 38 healthy subjects | 25 RRMS; 5 SPMS; 1 PPMS; 2 CIS; 5 unknown | 7.8 years | 2.3 |
15 | A Rapid Tapping Task on Commodity Smartphones to Assess Motor Fatigability | Barrios, L; et al. [28] | 2020 | Observational | Switzerland | PROCEEDINGS OF THE 2020 CHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS (CHI’20) | 20 patients (11 females; mean age, 43.1; range, 20–62); 35 healthy subjects | N/A | N/A | 3 (range, 0–8) |
16 | Development and Validation of the FSIQ-RMS: A New Patient-Reported Questionnaire to Assess Symptoms and Impacts of Fatigue in Relapsing Multiple Sclerosis | Hudgens, S; et al. [20] | 2019 | Observational | United States (USA) | VALUE IN HEALTH | 10 patients (7 females; mean age, 42.1; range, 27–54) | 8 RRMS; 2 SPMS | N/A | 3.2 (range, 0–6) |
Unique Identifying Number | Application Name | Online Stores | Time | Language | App Decription | Assessment | Management |
---|---|---|---|---|---|---|---|
1 | MS Energize | iOS | N/A | English | App content included general information about MS fatigue, factors that may influence MS fatigue and a section on planning for the future. Each of the seven main modules contained 2–4 subsections, within which were levels of topic relevant education (‘Learn’), an interactive task to engage with (‘Interact’) and an opportunity to apply what was learned by developing an action plan (‘Apply’). The app also provided visual summaries for users and encouragement on their progress and achievements. | Yes | Yes |
2 | N/A | Android | 2 weeks | N/A | The mobile application features three modules: (1) A series of one-time questionnaires, (2) Visual Analogue Scales (VAS) for self-reporting of fatigue, depression, anxiety, and pain levels, (3) A sleep diary (SLD) containing a series of questions regarding perceived duration and quality of sleep, as well as the same VAS described above. Reminder functions were implemented into the mobile application. | Yes | No |
3 | More Stamina | N/A | N/A | English | More Stamina acts as a to-do list where users can input the tasks they want to accomplish that day in a simple manner. A person’s overall energy is represented through a progress bar composed of Stamina Credits. Users start their day with 100 points or Stamina Credits and assign a certain amount of them to activities for that day. More Stamina also has a user profile feature that collects and aggregates information about the user’s condition. Surveys, questionnaires, and other assessment tools such as the FSS and CFS are optionally available for completion. | Yes | Yes |
4 | iCompanion | Android; iOS | N/A | Italian, Dutch, English, German, French and Spanish | Using the iCompanion app, PwMS can keep a diary, log symptoms, and perform test for body functions, cognitive functions and fatigue based on PROs. In addition, PwMS can add treatment information and set reminders on when to take or perform their treatment, as well as learn about topics related to MS. | Yes | Yes |
5 | ElevateMS | Apple App Store | 12 weeks | N/A | ElevateMS primarily targeted collection of real-world data from participants with MS. This included self-reported measures of symptoms and health via optional “check-in” surveys, and independent assessments of motor function via sensor-based active functional tests. Local weather data were collected every time an assessment was performed. | Yes | No |
6 | FatigueApp.com | N/A | N/A | English | The FatigueApp collect data to correlate fatigue measures with other symptoms and quality of life. The 12-item World Health Organization Disability Assessment Schedule 2.011 is used to report quality of life. The 10-cm visual analog scale is used to assess pain severity. The PROMIS Fatigue Scale Short Form was used to measure MS-related fatigue severity and the PROMIS Cognitive Abilities and Cognitive Concerns scale to assess perceived cognitive dysfunction. | Yes | No |
7 | N/A | Android | 2-week | N/A | The app proposed a rapid tapping task on a smartphone as an inexpensive approach to assessing motor fatigability. Participants performed the tapping task with their dominant hand during each day. The app also sent daily notifications to the patients to remind them to complete the tapping tasks as well as to complete the FSS questionnaire once per week directly in the app. | Yes | No |
8 | Electronic VAS | Android | N/A | N/A | Participants completed electronic visual analogue scales on a smartphone, where fifteen statements covering the domains of fatigue, anxiety, pain and quality of life. | Yes | No |
9 | MS Energize | iOS iPhone | 5–6 weeks | English | The app covers MS fatigue, how to use energy effectively, how behavior, thoughts and emotions interact and impact on MS fatigue, as well as the potential effects of bodily and environmental factors. MS Energize provides education, interactive tasks, and supports application of the principles into a user’s day-to-day life. | Yes | Yes |
10 | N/A | Android | N/A | N/A | The app includes a Patient’s Panel with educational content related to MS, patient medical record, patient health status, contacting a physician, and MS care centers. Patients could enter his/her personal and clinical data to create a medical record. A patient could also send messages to his/her physician and receive a response. The app also includes a Physician’s Panel. | Yes | Yes |
11 | Tapping Test; Balloon Popping Test | Android | 9 weeks | N/A | In the tapping test, users had to tap as quickly as possible over a 10 s duration and the final score is the average of two attempts. The balloon popping test expands neurological functions necessary for test completion from pure motoric, to motoric, visual, and cognitive. The primary goal for this test is to touch as many randomly generated dark blue circles (balloons) moving across the screen in succession over the 26-s test duration as possible. | Yes | No |
12 | WalkWithMe | Android | 10 weeks | N/A | WalkWithMe is an application that supports pwMS to achieve a self-set goal for walking over a period of 10 weeks. The application provides also audio feedback and a virtual coach, to assist the user in performing walking activities towards the target goal. Users can also log certain factors, such as fatigue, weather conditions, and surface. | Yes | Yes |
13 | Neurokeys keyboard App | Android; iOS | 2 weeks | N/A | Neurokeys measures health status through regular typing on the smartphone. During regular typing, keyboard interactions of interest were logged and timestamped in the background and general typing characteristics were obtained. | Yes | No |
14 | N/A | Android | 1 year | N/A | The application consists on a suite of 19 tests, designed to assess participant performance (color vision, attention, dexterity, and cognition), and elicit patient-reported outcomes (PROs; fatigue, mood, and QoL). | Yes | No |
15 | N/A | Any | N/A | N/A | Participants performed a rapid alternating tap on the smartphone screen to assess motor fatigability. Participants were asked to perform the tapping task as fast as possible without stopping until the app indicated completion. | Yes | No |
16 | FSIQ-RMS (e-Diary) | Android | N/A | English and other 45 translations | The FSIQ-RMS is a new PRO instrument to assess fatigue symptoms relevant to patients within the spectrum of RMS and the relevant impact of these symptoms on patients’ lives. | Yes | No |
Unique Identifying Number | Degree of Satisfaction | Usability Evaluation Method |
---|---|---|
1 | The usability testing and resonance checks suggested that user experience of MS Energise was mostly positive, and participants provided a number of suggestions for improvements to aspects of content and design. | Think-aloud; Questionnaire SUS |
2 | It is reported good patient compliance with the mobile application based assessments. Patients reported no issues with the usage of the application. | Task completion |
3 | Several major and minor usability problems were discovered during heuristic evaluation. Usability issues were addressed and the latest iteration of the app presented no additional usability issues. | Heuristic evaluation |
4 | From PwMS, 68.9% indicated to intend to start using an MS app like icompanion, and 80.1% intended to start using it daily or weekly. Only one patient (2.2%) indicated to have a negative attitude towards using an app to monitor their disease course. | Survey |
5 | Compliance decreased over time in all cohorts. However, participation in elevateMS was generally consistent. The results demonstrate the feasibility and utility of a decentralized method to gather real-world data about participant’s real-time life experience of MS through the app, as well as the importance of frequent, real-world assessments of MS disease manifestations outside of episodic clinical evaluations. | Task completion |
6 | The phone application showed overall initial feasibility, with only a small proportion of participants demonstrating noncompletion. So, the FatigueApp is a feasible way for collecting real-time symptoms of fatigue in patients with MS. | Task completion |
7 | N/A | N/A |
8 | Feasibility was assessed by questioning self-reported completion accuracy, smartphone or tablet skills, experiences and suggestions for improvement. Some subjects provided suggestions for improvement. | Questionnaire |
9 | Participants provided much positive feedback about MS Energize, and gave it reasonable ratings for usability. Participants rated MS Energize with a median total score of 75 on the SUS (mean score 72.3, range 65 to 90). | SUS; qualitative interview |
10 | The mean values for different sections of the questionnaire were between 6.1 and 9, indicating that the application was evaluated at a “good” level by the users. | QUIS questionnaire |
11 | N/A | N/A |
12 | The results prove that people evaluated WalkWithMe positively. The features were rated as useful, easy to use and understand, and attractive by most participants. All aspects regarding usability were evaluated positively by the participants in the self-made questionnaire. Impact overall received an average score of 3.4 out of 5. | uMARS questionnaire; self-made questionnaire; interview |
13 | N/A | N/A |
14 | N/A | N/A |
15 | N/A | N/A |
16 | In the device-usability questionnaire, all participants reported that it was easy or very easy to learn, use, navigate, read, and see the response choices of the eDiary. In the cognitive interviews, participants confirmed that the symptoms and impacts listed on the FSIQ-RMS were relevant to their experience with RMS. For that, the final FSIQ-RMS is a valid and reliable PRO instrument that has demonstrated content and measurement validity for fatigue-related symptom and impact items. | Questionnaire; Interviews |
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Antonioni, A.; Baroni, A.; Milani, G.; Cordioli, I.; Straudi, S. Role of Smartphone Applications in the Assessment and Management of Fatigue in Patients with Multiple Sclerosis: A Scoping Review. Sclerosis 2024, 2, 42-64. https://doi.org/10.3390/sclerosis2010004
Antonioni A, Baroni A, Milani G, Cordioli I, Straudi S. Role of Smartphone Applications in the Assessment and Management of Fatigue in Patients with Multiple Sclerosis: A Scoping Review. Sclerosis. 2024; 2(1):42-64. https://doi.org/10.3390/sclerosis2010004
Chicago/Turabian StyleAntonioni, Annibale, Andrea Baroni, Giada Milani, Irene Cordioli, and Sofia Straudi. 2024. "Role of Smartphone Applications in the Assessment and Management of Fatigue in Patients with Multiple Sclerosis: A Scoping Review" Sclerosis 2, no. 1: 42-64. https://doi.org/10.3390/sclerosis2010004
APA StyleAntonioni, A., Baroni, A., Milani, G., Cordioli, I., & Straudi, S. (2024). Role of Smartphone Applications in the Assessment and Management of Fatigue in Patients with Multiple Sclerosis: A Scoping Review. Sclerosis, 2(1), 42-64. https://doi.org/10.3390/sclerosis2010004