Reliability and Acceptance of a Smartphone-Based Remote Monitoring App (dreaMS) for People with MS – Results of a Feasibility Study
Tim Woelfle1,2, Silvan Pless1,2, Andrea Wiencierz3, Óscar Reyes Pupo4, Ludwig Kappos1, Johannes Lorscheider1,2, Yvonne Naegelin1,2
1Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), 2Neurology, University Hospital Basel, 3Department for Clinical Research, University of Basel, Hospital, 4Healios AG
Objective:
To assess reliability and meaningfulness of tests applied through a smartphone application (dreaMS) in people with MS (PwMS).
Background:
There is an unmet need for reliable and sensitive measures for monitoring PwMS along their long-term disease trajectory.
Design/Methods:

The dreaMS app uses built-in sensors of the user’s smartphone and includes eleven tests to be taken by participants at home, measuring performance in 4 domains: mobility (postural stability, sitting down/standing up, walking, climbing stairs), dexterity, cognition (mobile version of the Single Digit Modalities Test), and vision (visual acuity, low contrast vision).

Inclusion criteria of this feasibility study (NCT04413032) were age 18-70 and EDSS ≤ 6.5 for PwMS. Study duration was six weeks per participant. Primary outcomes were test-retest reliability of the extracted test features as measured by the intraclass correlation (ICC≥0.6) or the median coefficient of variation (mCV˂0.2). Acceptance and meaningfulness for PwMS were self-evaluated on a 5-point Likert scale.

Results:
We included 31 PwMS (mean age 43.4±12.0 years; 21 females (68%); median Expanded Disability Status Scale score 3.0, range 1.0-6.0) and 31 age- and sex-matched healthy volunteers. All 11 tests allowed extraction of at least one test feature meeting the preset reliability criteria, resulting in the selection of 72 out of 133 features (54%). Participants’ mean assessments on a 5-point Likert scale were: 4.1 for overall impression, 3.8 for willingness of future use, and 4.4 regarding the perceived relevance for PwMS.
Conclusions:
Smartphone-based remote monitoring of neurologic functions with the dreaMS app proved to be technically feasible and produced a set of reliable test features for all tested domains. The app-based tests were well-accepted and perceived meaningful by PwMS. Validation of the best-performing measures in long-term studies with >400 participants and systematic cross-sectional and longitudinal comparison with state-of-the-art established clinical and paraclinical reference outcomes has been initiated.