The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review

Abstract

Despite recent advances in multiple sclerosis (MS) care, many patients only infrequently access health care services, or are unable to access them easily, for reasons such as mobility restrictions, travel costs, consultation and treatment time constraints, and a lack of locally available MS expert services. Advances in mobile communications have led to the introduction of electronic health (eHealth) technologies, which are helping to improve both access to and the quality of health care services. As the Internet is now readily accessible through smart mobile devices, most people can take advantage of eHealth apps. The development of digital applications and remote communication technologies for patients with MS has increased rapidly in recent years. These apps are intended to complement traditional in-clinic approaches and can bring significant benefits to both patients with MS and health care providers (HCPs). For patients, such eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. These apps also help patients to participate actively in self-management, for example, by tracking adherence to treatment, changes in bladder and bowel habits, and activity and mood. For HCPs, MS eHealth solutions can simplify the multidisciplinary approaches needed to tailor MS management strategies to individual patients; facilitate remote monitoring of patient symptoms, adverse events, and outcomes; enable the efficient use of limited resources and clinic time; and potentially allow more timely intervention than is possible with scheduled face-to-face visits. These benefits are important because MS is a long-term, multifaceted chronic condition that requires ongoing monitoring, assessment, and management. We identified in the literature 28 eHealth solutions for patients with MS that fall within the four categories of screening and assessment, disease monitoring and self-management, treatment and rehabilitation, and advice and education. We review each solution, focusing on any clinical evidence supporting their use from prospective trials (including ASSESS MS, Deprexis, MSdialog, and the Multiple Sclerosis Performance Test) and consider the opportunities, barriers to adoption, and potential pitfalls of eHealth technologies in routine health care.

Keywords: communication; eHealth; multiple sclerosis; technology; telehealth; telemedicine; telerehabilitation.

Figure 1

Electronic health (eHealth) technologies and health care. HCP: health care professional.

Figure 2

Overview of electronic health (eHealth) technologies applied in multiple sclerosis. CSI: Cognitive Stability Index; GEMS: Guidelines for Exercise in Multiple Sclerosis; HAT: Home Automated Telemanagement; MCCO: Mellen Center Care Online; MS: multiple sclerosis; MS-HAT: Multiple Sclerosis—specific version of Home Automated Telemanagement; MSDS3D: Multiple Sclerosis Documentation System: Three-Dimensional; MSPT: Multiple Sclerosis Performance Test; MSRS-R, Multiple Sclerosis Rating Scale-Revised; TaDiMuS: Tablet-based Data capture in Multiple Sclerosis; MAPSS-MS: Memory, Attention and Problem-Solving Skills for Persons with Multiple Sclerosis; ST: specific training; and tDCS: transcranial direct current stimulation.