DALLAS—A multiple sclerosis (MS) performance test administered by a patient using an iPad-based app is superior to an MS performance test administered by a technician, according to research presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. The study could prompt changes in the way that data are collected and interpreted for the purposes of clinical trials and disease management, according to Richard Rudick, MD, Vice President of Development Sciences at Biogen Idec in Cambridge, Massachusetts.

The research suggests that unfiltered, accurate patient data could be transferred in real time to the cloud, where it would be available for immediate viewing and for future study. This method of data storage would give clinicians new ways to “collect, display, aggregate, and analyze neurologic performance,” said Dr. Rudick.

iPad Test Distinguished Patients From Controls
Dr. Rudick and his colleagues developed the app-based MS performance test (MSPT) to simulate the technician-based test in all respects. The app-based test comprises a walking speed test, a manual dexterity test, a low-contrast visual acuity test, and a processing speed test. These items approximate the traditional, technician-administered timed 25-foot walk test, the nine-hole peg test, the Sloan low-contrast visual acuity test, and the Symbol Digit Modalities Test.

The cross-sectional validation study matched 49 healthy controls with 51 patients according to age, sex, and education. Roughly three-quarters of the study arm had relapsing MS, and a quarter had the progressive form of the disease.

Participants were tested at a single site with each modality. Tests occurred once in the morning and once in the afternoon. The test and retest results were consistent and correlative, according to Dr. Rudick. “They were highly reliable, whether the technician did it, or the iPad,” he said. Because data for all aspects of each test were comparable, Dr. Rudick concluded that the tests were measuring the same things.

The most important question was how well the app-based test distinguished patients with MS from controls, compared with the technician-based test, according to Dr. Rudick. “In virtually every case, except for the visual [test], the iPad actually does a little bit better than the technician in distinguishing the MS patients from the healthy controls,” he said.

In addition, scores on both tests were highly similar. For the timed 25-foot walk test administered by the technician, the mean score in the MS group was 7, and the mean score for the walking speed test in the MS group was 7.26. In the healthy controls group, the mean score for the technician-given test was 4.24. That group’s mean score for the self-given walking speed test was 4.27.

Technicians Are Still Necessary
Patient-reported outcomes were also consistent with both forms of the tests. In general, however, patient-reported cognitive impairment does not correlate with the results of neurocognitive testing. “What does seem to correlate with patients reporting cognitive impairment is if they are depressed. Then the depression score matches the patient-reported cognitive impairment better than the actual cognitive test score does,” said Dr. Rudick.

Many physician assistants, registered nurses, and physicians may be ready to embrace this app-based technology, but it may not be appropriate for some patients, such as those who walk with difficulty. “You still need a technician to instruct and encourage patients,” said Neil Jouvenat, a physician assistant at the University of Nebraska Medical Center in Omaha. “If the iPad were to instruct a patient to ‘get up now, strap this to your back, and walk 25 feet,’ they won’t because they don’t really think they can. There is a fine line between someone who can walk a certain distance and someone who can’t.” The technician can help in those situations, he added.

The Technology May Aid Clinical Trials
The app holds promise for individuals who would have been excluded from clinical trials in the past, such as patients who live in rural areas. In addition, the collection of normative data from healthy adults will mean that clinical interpretations of MSPT scores will have broader utility in MS patients and groups, and the technology can be adapted to yield additional data such as specific measurements for balance and speed.

Technology such as this has the power to “revolutionize” disease management, particularly if information is collected in a central database that is accessible to any clinician or researcher, said Patricia Coyle, MD, Professor of Psychiatry and Neurology and Director of the MS Comprehensive Care Center at Stony Brook University in New York. “There are only so many MS patients, and we don’t have a good idea of their disease activity. They’re not tracked. No one’s trying to pull that data together,” she said. But having these data “potentially would mean revolutionizing” the field.

—Whitney McKnight

Could an iPad App Change How MS Is Managed and Treated?