Technology-enabled assessments to enhance multiple sclerosis clinical care and research

Abstract

BackgroundComprehensive and efficient assessments are necessary for clinical care and research in chronic diseases. Our objective was to assess the implementation of a technology-enabled tool in MS practice.MethodWe analyzed prospectively collected longitudinal data from routine multiple sclerosis (MS) visits between September 2015 and May 2018. The MS Performance Test, comprising patient-reported outcome measures (PROMs) and neuroperformance tests (NPTs) self-administered using a tablet, was integrated into routine care. Descriptive statistics, Spearman correlations, and linear mixed-effect models were used to examine the implementation process and relationship between patient characteristics and completion of assessments.ResultsA total of 8022 follow-up visits from 4199 patients (median age 49.9 [40.2–58.8] years, 32.1% progressive course, and median disease duration 13.6 [5.9–22.3] years) were analyzed. By the end of integration, the tablet version of the Timed 25-Foot Walk was obtained in 89.0% of patients and the 9-Hole Peg Test in 94.8% compared with 74.2% and 64.3%, respectively before implementation. The greatest increase in data capture occurred in processing speed and low-contrast acuity assessments (0% prior vs 78.4% and 36.7%, respectively, following implementation). Four PROMs were administered in 41%–98% of patients compared with a single depression questionnaire with a previous capture rate of 70.6%. Completion rates and time required to complete each NPT improved with subsequent visits. Younger age and lower disability scores were associated with shorter completion time and higher completion rates.ConclusionsIntegration of technology-enabled data capture in routine clinical practice allows acquisition of comprehensive standardized data for use in patient care and clinical research.

Expanded access to multiple sclerosis teleneurology care following the COVID-19 pandemic

“…In-clinic visits: We included all nonprocedural in-person neurology visits to describe practice patterns for all patients >18 years seen at UCSF during the study period, and at CC those who completed the standardized intake process of neuroperformance testing and patient reported outcomes (approximately 77% of the entire follow-up MS clinical population 15 ). Neurological diagnosis was based on clinical documentation.…”

“…Data for both in-clinic and teleneurology visits were collected and defined as either "pre-COVID19" or "post-COVID19" if completed after 3/15/20, given major statewide closures within both Ohio and California and restricted access to in-clinic care. 13,14 In-clinic visits: We included all nonprocedural inperson neurology visits to describe practice patterns for all patients >18 years seen at UCSF during the study period, and at CC those who completed the standardized intake process of neuroperformance testing and patient reported outcomes (approximately 77% of the entire follow-up MS clinical population 15 ). Neurological diagnosis was based on clinical documentation.…”

The Microsoft HoloLens 2 Provides Accurate Measures of Gait, Turning, and Functional Mobility in Healthy Adults

“…Consistent with the adoption of any new technology in medicine, clinician time and willingness to adapt are likely barriers to its integration into clinical workflows. However, we have demonstrated that the integration of technology into clinical workflows, when properly developed and validated, can improve outcomes and reduce cost [49], as well as decreasing the time physicians spend documenting in the electronic health record [50]. While this project focused on the validation of the HL2 device, other head-mounted AR systems are available.…”

Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms—A Narrative Review

“…The MSPT includes the Processing Speed Test (PST) for cognitive function, the Contrast Sensitivity Test (CST) for visual acuity, the Manual Dexterity Test (MDT) for upper extremity function, a patient history questionnaire, and the Neuro-QoL test [ 113 , 114 ]. In an analysis of 8022 follow-up visits from 4199 patients in which the MSPT was integrated into visits, the tablet-based data collection resulted in more patients completing assessment and in a shorter time frame relative to analog methods, making it easier to incorporate these tests into care in spite of time constraints placed on HCPs [ 115 ]. Digitally administered tools also hold promise for use via telehealth, which has become important during the COVID-19 pandemic; early work seeking to validate remote use of the Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test (CVLT-II) suggests that these tools may be effectively used remotely [ 116 ].…”