April 15, 2024

Floodlight smartphone app helps monitor MS, but compliance is poor

A smartphone app called Floodlight Open can help track functional areas in people with multiple sclerosis (MS), but more work is needed to improve patients’ adherence to using the app in a real-world setting, according to a new study. study.

Researchers tested the use of Floodlight Open among more than 1,000 MS patients (and another more than 1,000 healthy people) to determine its feasibility for monitoring various functional domains or areas of function, such as cognition, the ability to walk, known as gait , and the hand and motor skills. skills.

While people with MS were more likely to persistently use the smartphone app compared to those without the neurodegenerative disease, a notable proportion of patients quickly stopped using it. Overall, more than a third of study participants (both MS patients and healthy people) did not use the app after the first week.

“These findings inform the future development and evolution of digital health technologies in MS clinical care,” the researchers wrote, adding that “finding effective strategies to improve the long-term engagement of people with MS remains a challenge.” an important and open challenge”.

The study, “Using Smartphone-Based Remote Multiple Sclerosis Assessments in Floodlight Open, a Global, Prospective, Open Access Study”, was published in Scientific Reports. It was funded by Roche, which created the Floodlight app.

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High Patient Engagement Observed with Smartphone App in Controlled Clinical Trial

Smartphone applications have emerged as an easy and cost-effective way to frequently collect clinical information from people suffering from chronic diseases such as MS.

Floodlight Open employs a variety of smartphone sensor-based tests to remotely measure functional domains commonly affected in MS, including cognition, hand and motor function, gait, and postural stability. A proof-of-concept study demonstrated that the app could reliably assess these domains in MS patients, with performance that correlated well with standard clinical tests.

Use of the app was also associated with high patient engagement and satisfaction over a six-month period during the clinical trial. However, the factors that influence adherence to the application outside of a controlled clinical study and, therefore, that influence its usefulness in the real world remain to be investigated.

Therefore, the Floodlight Open study was designed to better understand smartphone app use in a global study population of people with and without MS in a naturalistic setting. To better mimic a real-world setting, enrollment and participation were completely self-contained, without clinical visits or medical supervision, and without a set study duration.

This study analysis focused on 1,350 people with self-reported MS and 1,133 people without MS.

These trial participants regularly completed a fixed sequence of active functional tests up to once a day. Some other tests and patient-reported outcomes were performed independently of that sequence, and overall mobility data was collected passively using smartphone sensors.

Overall, people with MS persistently used the smartphone app more than people without the disease. MS patients were found to use it consistently for an average of 5.6 weeks, meaning they completed at least one active test in the fixed sequence per week. In contrast, in people without MS, the app was used persistently for an average of 2.3 weeks.

Persistence outside the context of a supervised trial remains one of the most significant obstacles in the adoption of remote digital health technological tools.

In both groups, persistence in the passively collected mobility test was greater. Patients with MS provided data at least one day per week for an average of 9.8 weeks, while those in the control group (the healthy participants) did so for an average of 6.3 weeks.

Still, more than a third of all study participants (38% total) stopped participating after the first week of using the app.

“Persistence outside the context of a supervised trial remains one of the most significant barriers to the adoption of remote digital health technology tools,” the researchers wrote.

Importantly, persistence was greater among MS patients who used the app beyond the first week of the study, extending to a mean of 10.3 weeks for active testing and 16.3 weeks for passive blood pressure monitoring. mobility.

According to the researchers, app persistence generally decreased slowly over time, which is in line with previous studies on digital assessment tools.

Participants also often took breaks for weeks or months from the smartphone app before using it again. Furthermore, it was found that many patients started the fixed sequence of active tests, but did not complete it in the same session.

“This observation suggests that there may be benefits to performing different tests independently of each other at a time that is convenient for the user, rather than performing them in a fixed sequence,” the researchers noted.

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Older age and MS disease status linked to greater use of Floodlight Open

Self-reported MS disease status and older age were associated with greater persistence with the Floodlight Open app. MS patients in Denmark, who were using the app as part of a supervised clinical study, also showed greater persistence compared to people in all other countries, where app use was not clinically monitored.

Overall, participants with MS performed worse on active functional tests compared to healthy people, confirming Floodlight’s ability to distinguish disease status from MS.

In all, the researchers noted that while the study finds Floodlight Open viable, there is a need to optimize “the perceived value of the effort” for users to better promote adherence to the digital tool.

According to the scientists, linking app use directly to clinical care is one way to improve willingness to participate. The ability to review app data with their doctor could offer participants a tangible and motivating benefit.

As such, support from healthcare providers and researchers will be critical to widespread adoption of these digital tools, the team concluded.

Data from the Floodlight Open study have been made available to researchers around the world, who can use the information to further study the use of digital assessment tools in MS.

“Future work could include further exploration of the user experience to increase persistence, further refinement and validation of specific tests for use as disease monitoring tools in clinical care, and integration of the app into clinical studies and clinical care of MS,” the team concluded.

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