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Evaluating more naturalistic outcome measures: A 1-year smartphone study in multiple sclerosis.

Bove R, White CC, Giovannoni G, Glanz B, Golubchikov V, Hujol J, Jennings C, Langdon D, Lee M, Legedza A, Paskavitz J, Prasad S, Richert J, Robbins A, Roberts S, Weiner H, Ramachandran R, Botfield M, De Jager PL - Neurol Neuroimmunol Neuroinflamm (2015)

Bottom Line: Among patients with MS, low scores on PROs relating to mental and visual function were associated with dropout (p < 0.05).Finally, averaging repeated measures over the study yielded the most robust correlation matrix of the different outcome measures.A smartphone platform may therefore enable large-scale naturalistic studies of patients with MS or other neurologic diseases.

View Article: PubMed Central - PubMed

Affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.

ABSTRACT

Objective: In this cohort of individuals with and without multiple sclerosis (MS), we illustrate some of the novel approaches that smartphones provide to monitor patients with chronic neurologic disorders in their natural setting.

Methods: Thirty-eight participant pairs (MS and cohabitant) aged 18-55 years participated in the study. Each participant received an Android HTC Sensation 4G smartphone containing a custom application suite of 19 tests capturing participant performance and patient-reported outcomes (PROs). Over 1 year, participants were prompted daily to complete one assigned test.

Results: A total of 22 patients with MS and 17 cohabitants completed the entire study. Among patients with MS, low scores on PROs relating to mental and visual function were associated with dropout (p < 0.05). We illustrate several novel features of a smartphone platform. First, fluctuations in MS outcomes (e.g., fatigue) were assessed against an individual's ambient environment by linking responses to meteorological data. Second, both response accuracy and speed for the Ishihara color vision test were captured, highlighting the benefits of both active and passive data collection. Third, a new trait, a person-specific learning curve in neuropsychological testing, was identified using spline analysis. Finally, averaging repeated measures over the study yielded the most robust correlation matrix of the different outcome measures.

Conclusions: We report the feasibility of, and barriers to, deploying a smartphone platform to gather useful passive and active performance data at high frequency in an unstructured manner in the field. A smartphone platform may therefore enable large-scale naturalistic studies of patients with MS or other neurologic diseases.

No MeSH data available.


Related in: MedlinePlus

Longitudinal performance of 2 MS–cohabitant participant pairs on Ishihara color testingBoth response speed and response accuracy are provided for both members of 2 participant pairs (patient with multiple sclerosis [MS] in red and cohabitant in blue) for all Ishihara tests that they completed. (A) The responses of pair 61 when their right eye is queried. Both participants demonstrate a similar response time when their right eye is tested, but there appears to be a deficit in accuracy in the MS patient's right eye. (B) The response of pair 25 when their left eye is queried. The patient with MS has much slower response time than the cohabitant, but both individuals demonstrate similar accuracy.
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Figure 3: Longitudinal performance of 2 MS–cohabitant participant pairs on Ishihara color testingBoth response speed and response accuracy are provided for both members of 2 participant pairs (patient with multiple sclerosis [MS] in red and cohabitant in blue) for all Ishihara tests that they completed. (A) The responses of pair 61 when their right eye is queried. Both participants demonstrate a similar response time when their right eye is tested, but there appears to be a deficit in accuracy in the MS patient's right eye. (B) The response of pair 25 when their left eye is queried. The patient with MS has much slower response time than the cohabitant, but both individuals demonstrate similar accuracy.

Mentions: We selected the Ishihara color plate test of visual function to illustrate the smartphone's ability to collect both active (accuracy) and passive (speed of completion) measures of individual performance (appendix e-1 and figure e-1). As expected, mean accuracy over all trials was lower in patients with MS (88%, n = 38) than in cohabitants (93%, n = 38). In all participants, impaired color vision in either eye was correlated with perceived visual deficits on the IVIS (r = −0.35, p < 0.01), offering some face validity to this measure. In addition to accuracy, however, response speed captured a different deficit among some patients with MS. For example, in one pair, the patient with MS displays a similar response speed to his or her cohabitant but much lower accuracy across the study duration (figure 3A), whereas in another pair (figure 3B), the patient with MS displays a delay in response compared to his or her cohabitant but comparable accuracy. These observations illustrate the manner in which the smartphone can provide a richer perspective on an individual's neurologic performance and its fluctuation over time.


Evaluating more naturalistic outcome measures: A 1-year smartphone study in multiple sclerosis.

Bove R, White CC, Giovannoni G, Glanz B, Golubchikov V, Hujol J, Jennings C, Langdon D, Lee M, Legedza A, Paskavitz J, Prasad S, Richert J, Robbins A, Roberts S, Weiner H, Ramachandran R, Botfield M, De Jager PL - Neurol Neuroimmunol Neuroinflamm (2015)

Longitudinal performance of 2 MS–cohabitant participant pairs on Ishihara color testingBoth response speed and response accuracy are provided for both members of 2 participant pairs (patient with multiple sclerosis [MS] in red and cohabitant in blue) for all Ishihara tests that they completed. (A) The responses of pair 61 when their right eye is queried. Both participants demonstrate a similar response time when their right eye is tested, but there appears to be a deficit in accuracy in the MS patient's right eye. (B) The response of pair 25 when their left eye is queried. The patient with MS has much slower response time than the cohabitant, but both individuals demonstrate similar accuracy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608760&req=5

Figure 3: Longitudinal performance of 2 MS–cohabitant participant pairs on Ishihara color testingBoth response speed and response accuracy are provided for both members of 2 participant pairs (patient with multiple sclerosis [MS] in red and cohabitant in blue) for all Ishihara tests that they completed. (A) The responses of pair 61 when their right eye is queried. Both participants demonstrate a similar response time when their right eye is tested, but there appears to be a deficit in accuracy in the MS patient's right eye. (B) The response of pair 25 when their left eye is queried. The patient with MS has much slower response time than the cohabitant, but both individuals demonstrate similar accuracy.
Mentions: We selected the Ishihara color plate test of visual function to illustrate the smartphone's ability to collect both active (accuracy) and passive (speed of completion) measures of individual performance (appendix e-1 and figure e-1). As expected, mean accuracy over all trials was lower in patients with MS (88%, n = 38) than in cohabitants (93%, n = 38). In all participants, impaired color vision in either eye was correlated with perceived visual deficits on the IVIS (r = −0.35, p < 0.01), offering some face validity to this measure. In addition to accuracy, however, response speed captured a different deficit among some patients with MS. For example, in one pair, the patient with MS displays a similar response speed to his or her cohabitant but much lower accuracy across the study duration (figure 3A), whereas in another pair (figure 3B), the patient with MS displays a delay in response compared to his or her cohabitant but comparable accuracy. These observations illustrate the manner in which the smartphone can provide a richer perspective on an individual's neurologic performance and its fluctuation over time.

Bottom Line: Among patients with MS, low scores on PROs relating to mental and visual function were associated with dropout (p < 0.05).Finally, averaging repeated measures over the study yielded the most robust correlation matrix of the different outcome measures.A smartphone platform may therefore enable large-scale naturalistic studies of patients with MS or other neurologic diseases.

View Article: PubMed Central - PubMed

Affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.

ABSTRACT

Objective: In this cohort of individuals with and without multiple sclerosis (MS), we illustrate some of the novel approaches that smartphones provide to monitor patients with chronic neurologic disorders in their natural setting.

Methods: Thirty-eight participant pairs (MS and cohabitant) aged 18-55 years participated in the study. Each participant received an Android HTC Sensation 4G smartphone containing a custom application suite of 19 tests capturing participant performance and patient-reported outcomes (PROs). Over 1 year, participants were prompted daily to complete one assigned test.

Results: A total of 22 patients with MS and 17 cohabitants completed the entire study. Among patients with MS, low scores on PROs relating to mental and visual function were associated with dropout (p < 0.05). We illustrate several novel features of a smartphone platform. First, fluctuations in MS outcomes (e.g., fatigue) were assessed against an individual's ambient environment by linking responses to meteorological data. Second, both response accuracy and speed for the Ishihara color vision test were captured, highlighting the benefits of both active and passive data collection. Third, a new trait, a person-specific learning curve in neuropsychological testing, was identified using spline analysis. Finally, averaging repeated measures over the study yielded the most robust correlation matrix of the different outcome measures.

Conclusions: We report the feasibility of, and barriers to, deploying a smartphone platform to gather useful passive and active performance data at high frequency in an unstructured manner in the field. A smartphone platform may therefore enable large-scale naturalistic studies of patients with MS or other neurologic diseases.

No MeSH data available.


Related in: MedlinePlus