iPad App Offers Promising New Way to Evaluate and Monitor MS Symptoms

Clinicians can use the MSPT, an iPad-based neurological performance test that simulates and extends the Multiple Sclerosis Functional Composite, to measure motor and visual function in patients with multiple sclerosis.

Copenhagen, Denmark — October 4, 2013 – An iPad- based approach for collecting MS disability data, the MSPT, was explained here on Friday that offers a potential new way to monitor multiple sclerosis. In a small validation cohort, MSPT generated performance scores were highly reproducible and associated with scores from standard technician-administered test for MS. The MSPT has the advantage of giving the potential opportunity for self-administration in an outpatient setting. Additionally, because the test is computer-based, test performance can be directly entered into clinical trial or patient databases and can be analyzed by traditional or new methods.

Richard Rudick, MD, of the Cleveland Clinic Foundation and colleagues developed this novel method for monitoring MS symptoms that was outlined in a poster presented on October 4 during the Clinical Assessment Tools session of the 29th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the 18th Annual Conference of Rehabilitation in MS.

Rudick said he is “very enthusiastic about the MSPT because the validation was so strong and because we badly need innovation in the MS space... traditional neurologist-reported outcomes for MS do not adequately quantify neurological or neuropsychological performance.”

A team headed by Rudick capitalized on advances in computer and information technology to design an innovative distance health program for defining and monitoring disability in patients with MS. This program, the MSPT, is an iPad-based neurological performance test that was designed to simulate and extend the Multiple Sclerosis Functional Composite (MSFC).

This study aimed to demonstrate the reproducibility of MSPT components and to compare evaluations made using these components to standard technician-administered measures in identifying MS patients from healthy control subjects. Standard measures included the 25 Foot Walk (25FW), 9-Hole Peg Test (9HPT), Low Contrast Visual Acuity (LCVA), and Symbol Digit Modalities Test (SDMT). The team used the iPad3 to develop the MSPT app. Software programs were developed to capture patients’ movements while interacting with the screen and data from the onboard accelerometer and gyroscope were used to quantify that patients’ balance and gait.

To validate the MSPT, 7 subjects with MS were recruited from the Mellen Center; their mean age was 52.5 (standard deviation +/- 6.3 years). The majority (60%) was female and the mean disease duration was 15.3 (+/- 9.2) years. Relapsing MS was recorded in 66% of patients. The 5 healthy controls were younger, the mean age was 36.5 +/- 16.8 years and 50% were women.

The team reported excellent test-retest reproducibility for iPad-based testing, yielding Concordance Correlation Coefficients (CC) between 0.81 and 0.99. Agreement between iPad and technician-administered tests was also demonstrated with Pearson CC between 0.74 and 0.97. The 25FW, 9HPT, and LCVA scores were all worse for MS patients compared with healthy controls by both iPad evaluation and technician-administered testing.

There was disagreement between the iPad and technician-administered cognition testing; iPad processing speed test scores were worse for the MS group but technician-administered Symbol Digit Modalities Test (SMDT) scores did not distinguish between subject with MS and healthy controls.

“With careful programming the iPad can be a portable and affordable data collection tool for reliable, quantitative measurement of motor and visual function and I believe that this technology can be extended to other neurologic or types of disabling chronic conditions, such as arthritis,” said Ruddick.

Study funding was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ USA