Reliability and acceptance of dreaMS, a software application for people with multiple sclerosis: a feasibility study

Abstract

Background There is an unmet need for reliable and sensitive measures for better monitoring people with multiple sclerosis (PwMS) to detect disease progression early and adapt therapeutic measures accordingly. Objective To assess reliability of extracted features and meaningfulness of 11 tests applied through a smartphone application (“dreaMS”). Methods PwMS (age 18–70 and EDSS ≤ 6.5) and matched healthy volunteers (HV) were asked to perform tests installed on their smartphone once or twice weekly for 5 weeks. Primary outcomes were test–retest reliability of test features (target: intraclass correlation [ICC] ≥ 0.6 or median coefficient of variation [mCV] < 0.2) and reported meaningfulness of the tests by PwMS. Meaningfulness was self-assessed for each test on a 5-point Likert scale (target: mean score of > 3) and by a structured interview. ClinicalTrials.gov Identifier: NCT04413032. Results We included 31 PwMS (21 [68%] female, mean age 43.4 ± 12.0 years, median EDSS 3.0 [range 1.0–6.0]) and 31 age- and sex-matched healthy volunteers. Out of 133 features extracted from 11 tests, 89 met the preset reliability criteria. All 11 tests were perceived as highly meaningful to PwMS. Conclusion The dreaMS app reliably assessed features reflecting key functional domains meaningful to PwMS. More studies with longer follow-up are needed to prove validity of these measures as digital biomarkers in PwMS.

Harmonizing Definitions for Progression Independent of Relapse Activity in Multiple Sclerosis

“…However, a number of issues remain: (1) PIRA may frequently remain undetected due to the low granularity of our clinical measures. Therefore, in addition to the composite clinical determinants such as 9HPT, T25FWT, and SDMT, future studies should implement comprehensive digital measures including active tasks, passive monitoring, and patient-reported outcomes . (2) The relationship between PIRA and true PIRA, pure PIRA, or PIRMA should be further elucidated using conventional and advanced imaging techniques of the brain and spinal cord to extend our understanding of the relation of subclinical (focal) inflammation and clinical PIRA.…”

Assessment of cognitive performance in multiple sclerosis using smartphone-based training games: a feasibility study

“…Since this was a sub study of the dreaMS feasibility study, the sample size, schedule, and prevalence of cognitive impairment were not specifically set up for the assessment of cognitive games [ 19 ]. The wide range of age and disability grades allowed by the inclusion criteria may have contributed to higher variability of the results and thus have reduced the power of the analysis.…”

“…The tasks included in the dreaMS app cover five different functional domains: dexterity, walking ability, balance, cognition, and vision. Additionally, the app includes patient-reported outcome measures (PROs) for fatigue, walking ability, general symptoms, and quality of life [ 19 ]. As part of a study to investigate the technical feasibility, reliability, and acceptance of the dreaMS app (NCT04413032), we integrated 10 adaptive cognitive training games from the commercially available brain training app Peak [ 20 ] in the dreaMS app via deep link.…”

Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

“…Hence, such apps help them personalize and tailor their treatments based on the patient's needs, phenotype, and disease stage. In this context, several mobile apps have been developed for remote monitoring multiple sclerosis [105][106][107][108] . The apps provide a set of tasks to evaluate different function systems affected by the disease.…”

“…Dexterity was covered with pinching and drawing shape tasks 105 , finger-tapping 106 and a screen-to-nose test 108 . Balance and walking were rated with timed distance walking [105][106][107][108] and sit-stand transitions 108 . Tasks were correlated with the results of their clinical counterparts, such for example, the SDMT for cognition 105 and 9HPT for dexterity 108 .…”