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Digital Innovation in Multiple Sclerosis Management

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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (20 October 2021) | Viewed by 64440

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Special Issue Editors

Prof. Dr. Tjalf Ziemssen

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Guest Editor

Centre of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, 01069 Dresden, Germany
Interests: multiple sclerosis; digital health; mechanism of action of immunomodulation; autonomic nervous system
Special Issues, Collections and Topics in MDPI journals

Mr. Rocco Haase

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Guest Editor

MS Centre Dresden, Centre of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
Interests: ehealth; multiple sclerosis; patient-reported outcomes; data science; psychometrics; heart-rate variability

Special Issue Information

Dear Colleagues,

Multiple sclerosis (MS) is one of the world’s most common neurologic diseases, causing most non-traumatic neurologic disability in young adults. MS is a lifelong unpredictable disability which can affect the different functional systems of the central nervous system (CNS), with symptoms such as fatigue, visual disturbances, altered sensation, and motor difficulties with mobility.

Therefore, the chronic, heterogenic, and multifocal “disease of a thousand faces” requires a complex, ubiquitous, differentiated, and adaptive monitoring and treatment strategy. This strategy should be personalized and tailored to the individual needs and disease course of the patient and be continuously. Due to innovation in technology, a new type of patient has been created, the e-patient, characterized by the use of electronic communication tools and commitment to participate in their own care. The extent to which the world of digital health has changed during the COVID-19 pandemic has been widely recognized. Remote medicine has become part of the new normal for patients and clinicians, introducing innovative care delivery models that are likely to endure even if the pendulum swings back to some degree in a post-COVID age.

The development of digital applications and remote communication technologies for patients with multiple sclerosis has increased rapidly in recent years. For patients, eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. For HCPs, eHealth technology may facilitate the assessment of clinical disability, analysis of lab and imaging data, and remote monitoring of patient symptoms, adverse events, and outcomes. It may allow time optimization and more timely intervention than is possible with scheduled face-to-face visits. The way we measure the impact of MS on daily life has remained relatively unchanged for decades, and is heavily reliant on clinic visits that may only occur once or twice each year.

These benefits are important because multiple sclerosis requires ongoing monitoring, assessment, and management. In this Special Issue, screening and assessment, disease monitoring and self-management, treatment and rehabilitation, and advice and education using digital tools should be included. This Special Issue welcomes submissions in the form of original research articles, reviews, case reports, short article types, and others. The aim of this Special Issue is to cover the state of knowledge and expertise in the field of eHealth technology applied to multiple sclerosis, from clinical evaluation to patient education.

Prof. Dr. Tjalf Ziemssen
Mr. Rocco Haase
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

digital tools
multiple sclerosis
digital management

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Published Papers (13 papers)

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Editorial

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3 pages, 183 KiB

Open AccessEditorial

Digital Innovation in Multiple Sclerosis Management

by Tjalf Ziemssen and Rocco Haase

Brain Sci. 2022, 12(1), 40; https://doi.org/10.3390/brainsci12010040 - 29 Dec 2021

Cited by 5 | Viewed by 2742

Abstract

The development of digital applications and remote communication technologies for people with multiple sclerosis (pwMS) has increased rapidly in recent years [...] Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

Research

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19 pages, 3049 KiB

Open AccessArticle

Health Economic Impact of Software-Assisted Brain MRI on Therapeutic Decision-Making and Outcomes of Relapsing-Remitting Multiple Sclerosis Patients—A Microsimulation Study

by Diana M. Sima, Giovanni Esposito, Wim Van Hecke, Annemie Ribbens, Guy Nagels and Dirk Smeets

Brain Sci. 2021, 11(12), 1570; https://doi.org/10.3390/brainsci11121570 - 27 Nov 2021

Cited by 9 | Viewed by 4767

Abstract

Aim: To develop a microsimulation model to assess the potential health economic impact of software-assisted MRI in detecting disease activity or progression in relapsing-remitting multiple sclerosis (RRMS) patients. Methods: We develop a simulated decision analytical model based on a hypothetical cohort of RRMS patients to compare a baseline decision-making strategy in which only clinical evolution (relapses and disability progression) factors are used for therapy decisions in MS follow-up, with decision-making strategies involving MRI. In this context, we include comparisons with a visual radiologic assessment of lesion evolution, software-assisted lesion detection, and software-assisted brain volume loss estimation. The model simulates clinical (EDSS transitions, number of relapses) and subclinical (new lesions and brain volume loss) disease progression and activity, modulated by the efficacy profiles of different disease-modifying therapies (DMTs). The simulated decision-making process includes the possibility to escalate from a low efficacy DMT to a high efficacy DMT or to switch between high efficacy DMTs when disease activity is detected. We also consider potential error factors that may occur during decision making, such as incomplete detection of new lesions, or inexact computation of brain volume loss. Finally, differences between strategies in terms of the time spent on treatment while having undetected disease progression/activity, the impact on the patient’s quality of life, and costs associated with health status from a US perspective, are reported. Results: The average time with undetected disease progression while on low efficacy treatment is shortened significantly when using MRI, from around 3 years based on clinical criteria alone, to 2 when adding visual examination of MRI, and down to only 1 year with assistive software. Hence, faster escalation to a high efficacy DMT can be performed when MRI software is added to the radiological reading, which has positive effects in terms of health outcomes. The incremental utility shows average gains of 0.23 to 0.37 QALYs over 10 and 15 years, respectively, when using software-assisted MRI compared to clinical parameters only. Due to long-term health benefits, the average annual costs associated with health status are lower by $1500–$2200 per patient when employing MRI and assistive software. Conclusions: The health economic burden of MS is high. Using assistive MRI software to detect and quantify lesions and/or brain atrophy has a significant impact on the detection of disease activity, treatment decisions, health outcomes, utilities, and costs in patients with MS. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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15 pages, 3647 KiB

Open AccessArticle

Automated Analysis of the Two-Minute Walk Test in Clinical Practice Using Accelerometer Data

by Katrin Trentzsch, Benjamin Melzer, Heidi Stölzer-Hutsch, Rocco Haase, Paul Bartscht, Paul Meyer and Tjalf Ziemssen

Brain Sci. 2021, 11(11), 1507; https://doi.org/10.3390/brainsci11111507 - 13 Nov 2021

Cited by 4 | Viewed by 2602

Abstract

One of the core problems for people with multiple sclerosis (pwMS) is the impairment of their ability to walk, which can be severely restrictive in everyday life. Therefore, monitoring of ambulatory function is of great importance to be able to effectively counteract disease progression. An extensive gait analysis, such as the Dresden protocol for multidimensional walking assessment, covers several facets of walking impairment including a 2-min walk test, in which the distance taken by the patient in two minutes is measured by an odometer. Using this approach, it is questionable how precise the measuring methods are at recording the distance traveled. In this project, we investigate whether the current measurement can be replaced by a digital measurement method based on accelerometers (six Opal sensors from the Mobility Lab system) that are attached to the patient’s body. We developed two algorithms using these data and compared the validity of these approaches using the results from 2-min walk tests from 562 pwMS that were collected with a gold-standard odometer. In 48.4% of pwMS, we detected an average relative measurement error of less than 5%, while results from 25.8% of the pwMS showed a relative measurement error of up to 10%. The algorithm had difficulties correctly calculating the walking distances in another 25.8% of pwMS; these results showed a measurement error of more than 20%. A main reason for this moderate performance was the variety of pathologically altered gait patterns in pwMS that may complicate the step detection. Overall, both algorithms achieved favorable levels of agreement (r = 0.884 and r = 0.980) with the odometer. Finally, we present suggestions for improvement of the measurement system to be implemented in the future. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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13 pages, 1920 KiB

Open AccessArticle

The Potential Impact of Digital Biomarkers in Multiple Sclerosis in The Netherlands: An Early Health Technology Assessment of MS Sherpa

by Sonja Cloosterman, Inez Wijnands, Simone Huygens, Valérie Wester, Ka-Hoo Lam, Eva Strijbis, Bram den Teuling and Matthijs Versteegh

Brain Sci. 2021, 11(10), 1305; https://doi.org/10.3390/brainsci11101305 - 30 Sep 2021

Cited by 5 | Viewed by 4375

Abstract

(1) Background: Monitoring of Multiple Sclerosis (MS) with eHealth interventions or digital biomarkers provides added value to the current care path. Evidence in the literature is currently scarce. MS sherpa is an eHealth intervention with digital biomarkers, aimed at monitoring symptom progression and disease activity. To show the added value of digital biomarker–based eHealth interventions to the MS care path, an early Health Technology Assessment (eHTA) was performed, with MS sherpa as an example, to assess the potential impact on treatment switches. (2) Methods: The eHTA was performed according to the Dutch guidelines for health economic evaluations. A decision analytic MS model was used to estimate the costs and benefits of MS standard care with and without use of MS sherpa, expressed in incremental cost-effectiveness ratios (ICERs) from both societal and health care perspectives. The efficacy of MS sherpa on early detection of active disease and the initiation of a treatment switch were modeled for a range of assumed efficacy (5%, 10%, 15%, 20%). (3) Results: From a societal perspective, for the efficacy of 15% or 20%, MS sherpa became dominant, which means cost-saving compared to the standard of care. MS sherpa is cost-effective in the 5% and 10% scenarios (ICERs EUR 14,535 and EUR 4069, respectively). From the health care perspective, all scenarios were cost-effective. Sensitivity analysis showed that increasing the efficacy of MS sherpa in detecting active disease early leading to treatment switches be the most impactful factor in the MS model. (4) Conclusions: The results indicate the potential of eHealth interventions to be cost-effective or even cost-saving in the MS care path. As such, digital biomarker–based eHealth interventions, like MS sherpa, are promising cost-effective solutions in optimizing MS disease management for people with MS, by detecting active disease early and helping neurologists in decisions on treatment switch. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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25 pages, 5787 KiB

Open AccessArticle

A Novel Digital Care Management Platform to Monitor Clinical and Subclinical Disease Activity in Multiple Sclerosis

by Wim Van Hecke, Lars Costers, Annabel Descamps, Annemie Ribbens, Guy Nagels, Dirk Smeets and Diana M. Sima

Brain Sci. 2021, 11(9), 1171; https://doi.org/10.3390/brainsci11091171 - 3 Sep 2021

Cited by 19 | Viewed by 6786

Abstract

In multiple sclerosis (MS), the early detection of disease activity or progression is key to inform treatment changes and could be supported by digital tools. We present a novel CE-marked and FDA-cleared digital care management platform consisting of (1) a patient phone/web application and healthcare professional portal (icompanion) including validated symptom, disability, cognition, and fatigue patient-reported outcomes; and (2) clinical brain magnetic resonance imaging (MRI) quantifications (icobrain ms). We validate both tools using their ability to detect (sub)clinical disease activity (known-groups validity) and real-world data insights. Surveys showed that 95.6% of people with MS (PwMS) were interested in using an MS app, and 98.2% were interested in knowing about MRI changes. The icompanion measures of disability (p < 0.001) and symptoms (p = 0.005) and icobrain ms MRI parameters were sensitive to (sub)clinical differences between MS subtypes. icobrain ms also decreased intra- and inter-rater lesion count variability and increased sensitivity for detecting disease activity/progression from 24% to 76% compared to standard radiological reading. This evidence shows PwMS’ interest, the digital care platform’s potential to improve the detection of (sub)clinical disease activity and care management, and the feasibility of linking different digital tools into one overarching MS care pathway. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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13 pages, 2477 KiB

Open AccessArticle

Innovation in Digital Education: Lessons Learned from the Multiple Sclerosis Management Master’s Program

by Isabel Voigt, Christine Stadelmann, Sven G. Meuth, Richard H. W. Funk, Franziska Ramisch, Joachim Niemeier and Tjalf Ziemssen

Brain Sci. 2021, 11(8), 1110; https://doi.org/10.3390/brainsci11081110 - 23 Aug 2021

Cited by 3 | Viewed by 3812

Abstract

Since 2020, the master’s program “Multiple Sclerosis Management” has been running at Dresden International University, offering structured training to become a multiple sclerosis specialist. Due to the COVID-19 pandemic, many planned teaching formats had to be changed to online teaching. The subject of this paper was the investigation of a cloud-based digital hub and student evaluation of the program. Authors analyzed use cases of computer-supported collaborative learning and student evaluation of courses and modules using the Gioia method and descriptive statistics. The use of a cloud-based digital hub as a central data platform proved to be highly successful for learning and teaching, as well as for close interaction between lecturers and students. Students rated the courses very positively in terms of content, knowledge transfer and interaction. The implementation of the master’s program was successful despite the challenges of the COVID-19 pandemic. The resulting extensive use of digital tools demonstrates the “new normal” of future learning, with even more emphasis on successful online formats that also increase interaction between lecturers and students in particular. At the same time, there will continue to be tailored face-to-face events to specifically increase learning success. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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12 pages, 266 KiB

Open AccessArticle

Profiles of eHealth Adoption in Persons with Multiple Sclerosis and Their Caregivers

by Rocco Haase, Isabel Voigt, Maria Scholz, Hannes Schlieter, Martin Benedict, Marcel Susky, Anja Dillenseger and Tjalf Ziemssen

Brain Sci. 2021, 11(8), 1087; https://doi.org/10.3390/brainsci11081087 - 19 Aug 2021

Cited by 13 | Viewed by 3321

Abstract

(1) Background: Persons with multiple sclerosis (pwMS) are often characterized as ideal adopters of new digital healthcare trends, but it is worth thinking about whether and which pwMS will be targeted and served by a particular eHealth service like a patient portal. With our study, we wanted to explore needs and barriers for subgroups of pwMS and their caregivers when interacting with eHealth services in care and daily living. (2) Methods: This study comprises results from two surveys: one collecting data from pwMS and their relatives (as informal caregivers) and another one providing information on the opinions and attitudes of healthcare professionals (HCPs). Data were analyzed descriptively and via generalized linear models. (3) Results: 185 pwMS, 25 informal caregivers, and 24 HCPs in the field of MS participated. Nine out of ten pwMS used information technology on a daily base. Individual impairments like in vision and cognition resulted in individual needs like the desire to actively monitor their disease course or communicate with their physician in person. HCPs reported that a complete medication overview, additional medication information, overview of future visits and a reminder of medication intake would be very helpful eHealth features for pwMS, while they themselves preferred features organizing and enriching future visits. (4) Conclusions: A closer look at the various profiles of eHealth adoption in pwMS and their caregivers indicated that there is a broad and robust enthusiasm across several subgroups that does not exclude anyone in general, but constitutes specific areas of interest. For pwMS, the focus was on eHealth services that connect previously collected information and make them easily accessible and understandable. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

10 pages, 9580 KiB

Open AccessCommunication

An ID-Associated Application to Facilitate Patient-Tailored Management of Multiple Sclerosis

by Michael Lang, Daniela Rau, Lukas Cepek, Fia Cürten, Stefan Ringbauer and Martin Mayr

Brain Sci. 2021, 11(8), 1061; https://doi.org/10.3390/brainsci11081061 - 12 Aug 2021

Cited by 2 | Viewed by 3467

Abstract

Despite improvements in diagnosis and treatment, multiple sclerosis (MS) is the leading neurological cause of disability in young adults. As a chronic disease, MS requires complex and challenging management. In this context, eHealth has gained an increasing relevance. Here, we aim to summarize beneficial features of a mobile app recently implemented in clinical MS routine as well as beyond MS. PatientConcept is a CE-certified, ID-associated multilingual software application allowing patients to record relevant health data without disclosing any identifying data. Patients can voluntarily share their health data with selected physicians. Since its implementation in 2018, about 3000 MS patients have used PatientConcept. Initially developed as a physician–patient communication platform, the app maps risk management plans of all current disease modifying therapies and thereby facilitates adherence to specified monitoring appointments. It also allows continuous monitoring of various PROs (Patient Reported Outcomes), enabling a broad overview of the disease course. In addition, various studies/projects currently assess monitoring, follow-up, diagnostics and telemetric evaluations of patients with other diseases beyond MS. Altogether, PatientConcept offers a broad range of possibilities to support physician–patient communication, implementation of risk management plans and assessment of PROs. It is a promising tool to facilitate patient-tailored management of MS and other chronic diseases. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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Review

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26 pages, 1013 KiB

Open AccessReview

Digital Biomarkers in Multiple Sclerosis

by Anja Dillenseger, Marie Luise Weidemann, Katrin Trentzsch, Hernan Inojosa, Rocco Haase, Dirk Schriefer, Isabel Voigt, Maria Scholz, Katja Akgün and Tjalf Ziemssen

Brain Sci. 2021, 11(11), 1519; https://doi.org/10.3390/brainsci11111519 - 16 Nov 2021

Cited by 61 | Viewed by 9596

Abstract

For incurable diseases, such as multiple sclerosis (MS), the prevention of progression and the preservation of quality of life play a crucial role over the entire therapy period. In MS, patients tend to become ill at a younger age and are so variable in terms of their disease course that there is no standard therapy. Therefore, it is necessary to enable a therapy that is as personalized as possible and to respond promptly to any changes, whether with noticeable symptoms or symptomless. Here, measurable parameters of biological processes can be used, which provide good information with regard to prognostic and diagnostic aspects, disease activity and response to therapy, so-called biomarkers Increasing digitalization and the availability of easy-to-use devices and technology also enable healthcare professionals to use a new class of digital biomarkers—digital health technologies—to explain, influence and/or predict health-related outcomes. The technology and devices from which these digital biomarkers stem are quite broad, and range from wearables that collect patients’ activity during digitalized functional tests (e.g., the Multiple Sclerosis Performance Test, dual-tasking performance and speech) to digitalized diagnostic procedures (e.g., optical coherence tomography) and software-supported magnetic resonance imaging evaluation. These technologies offer a timesaving way to collect valuable data on a regular basis over a long period of time, not only once or twice a year during patients’ routine visit at the clinic. Therefore, they lead to real-life data acquisition, closer patient monitoring and thus a patient dataset useful for precision medicine. Despite the great benefit of such increasing digitalization, for now, the path to implementing digital biomarkers is widely unknown or inconsistent. Challenges around validation, infrastructure, evidence generation, consistent data collection and analysis still persist. In this narrative review, we explore existing and future opportunities to capture clinical digital biomarkers in the care of people with MS, which may lead to a digital twin of the patient. To do this, we searched published papers for existing opportunities to capture clinical digital biomarkers for different functional systems in the context of MS, and also gathered perspectives on digital biomarkers under development or already existing as a research approach. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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13 pages, 1101 KiB

Open AccessReview

Developing a Digital Solution for Remote Assessment in Multiple Sclerosis: From Concept to Software as a Medical Device

by Anneke van der Walt, Helmut Butzkueven, Robert K. Shin, Luciana Midaglia, Luca Capezzuto, Michael Lindemann, Geraint Davies, Lesley M. Butler, Cristina Costantino and Xavier Montalban

Brain Sci. 2021, 11(9), 1247; https://doi.org/10.3390/brainsci11091247 - 21 Sep 2021

Cited by 19 | Viewed by 6173

Abstract

There is increasing interest in the development and deployment of digital solutions to improve patient care and facilitate monitoring in medical practice, e.g., by remote observation of disease symptoms in the patients’ home environment. Digital health solutions today range from non-regulated wellness applications and research-grade exploratory instruments to regulated software as a medical device (SaMD). This paper discusses the considerations and complexities in developing innovative, effective, and validated SaMD for multiple sclerosis (MS). The development of SaMD requires a formalised approach (design control), inclusive of technical verification and analytical validation to ensure reliability. SaMD must be clinically evaluated, characterised for benefit and risk, and must conform to regulatory requirements associated with device classification. Cybersecurity and data privacy are also critical. Careful consideration of patient and provider needs throughout the design and testing process help developers overcome challenges of adoption in medical practice. Here, we explore the development pathway for SaMD in MS, leveraging experiences from the development of Floodlight™ MS, a continually evolving bundled solution of SaMD for remote functional assessment of MS. The development process will be charted while reflecting on common challenges in the digital space, with a view to providing insights for future developers. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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10 pages, 657 KiB

Open AccessReview

A Mobile App for Measuring Real Time Fatigue in Patients with Multiple Sclerosis: Introducing the Fimo Health App

by Jana Mäcken, Marie Wiegand, Mathias Müller, Alexander Krawinkel and Michael Linnebank

Brain Sci. 2021, 11(9), 1235; https://doi.org/10.3390/brainsci11091235 - 18 Sep 2021

Cited by 5 | Viewed by 4094

Abstract

Although fatigue is one of the most disabling symptoms of MS, its pathogenesis is not well understood yet. This study aims to introduce a new holistic approach to measure fatigue and its influencing factors via a mobile app. Fatigue is measured with different patient-reported outcome measures (Visual Analog Scale, Fatigue Severity Scale) and tests (Symbol Digit Modalities Test). The influencing vital and environmental factors are captured with a smartwatch and phone sensors. Patients can track these factors within the app. To individually counteract their fatigue, a fatigue course, based on the current treatment guidelines, was implemented. The course implies knowledge about fatigue and MS, exercises, energy-conservation management, and cognitive behavioral therapy. Based on the Transtheoretical Model of Behavior Change, the design of the Fimo health app follows the ten strategies of the process of change, which is a proven approach to designing health intervention programs. By monitoring fatigue and individual influencing factors, patients can better understand and manage their fatigue. They can share their data and insights about fatigue and its influencing factors with their doctors. Thus, they can receive individualized therapies and drug plans. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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13 pages, 1780 KiB

Open AccessReview

Electronic Health Interventions in the Case of Multiple Sclerosis: From Theory to Practice

by Maria Scholz, Rocco Haase, Dirk Schriefer, Isabel Voigt and Tjalf Ziemssen

Brain Sci. 2021, 11(2), 180; https://doi.org/10.3390/brainsci11020180 - 2 Feb 2021

Cited by 32 | Viewed by 5492

Abstract

(1) Background: eHealth interventions play a growing role in shaping the future healthcare system. The integration of eHealth interventions can enhance the efficiency and quality of patient management and optimize the course of treatment for chronically ill patients. In this integrative review, we discuss different types of interventions, standards and advantages of quality eHealth approaches especially for people with multiple sclerosis (pwMS). (2) Methods: The electronic databases PubMed, Cochrane and Web of Science were searched to identify potential articles for eHealth interventions in pwMS; based on 62 articles, we consider different ways of implementing health information technology with various designs. (3) Results: There already exist some eHealth interventions for single users with a single-use case, interventions with a social setting, as well as eHealth interventions that integrate various single and social interventions and even those that may be used additionally for complex use cases. A key determinant of consumer acceptance is a high-quality user-centric design for healthcare practitioners and pwMS. In pwMS, the different neurological disabilities should be considered, and particular attention must be paid to the course of the treatment and the safety processes of each treatment option. (4) Conclusion: Depending on the field of application and the respective users, interventions are designed for single, social, integrated or complex use. In order to be accepted by their target group, interventions must be beneficial and easy to use. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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Other

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23 pages, 7474 KiB

Open AccessSystematic Review

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

by Bruno Bonnechère, Aki Rintala, Annemie Spooren, Ilse Lamers and Peter Feys

Brain Sci. 2021, 11(9), 1187; https://doi.org/10.3390/brainsci11091187 - 9 Sep 2021

Cited by 8 | Viewed by 4008

Abstract

The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy, we found a small but significant effect of the use of mHealth for cognitive training (Standardized Mean Difference (SMD) = 0.28 [0.12; 0.45]) and moderate effect for fatigue (SMD = 0.61 [0.47; 0.76]). mHealth is a promising tool in pwMS but more studies are needed to validate these solutions in the other ICF categories. More replications studies are also needed as most of the mHealth have only been assessed in one single study. Full article

(This article belongs to the Special Issue Digital Innovation in Multiple Sclerosis Management)

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