The Interactive Web-Based Program MSmonitor for Self-Management and Multidisciplinary Care in Persons With Multiple Sclerosis: Quasi-Experimental Study of Short-Term Effects on Patient Empowerment

Abstract

Background: Empowerment helps persons with a chronic disease to self-manage their condition and increase their autonomy and participation. MSmonitor (Curavista bv) is an interactive Web-based program for self-management and multidisciplinary care in multiple sclerosis (MS). It includes, among others, short questionnaires on fatigue (Modified Fatigue Impact Scale-5 [MFIS-5]) and health-related quality of life (HRQoL, Leeds Multiple Sclerosis Quality of Life [LMSQoL]); long questionnaires on disabilities, perception of disabilities (Multiple Sclerosis Impact Profile), and HRQoL (Multiple Sclerosis Quality of Life-54); a Medication and Adherence Inventory and an Activity Diary. The combination MFIS-5, LMSQoL, and Medication and Adherence Inventory constitutes the Quick Scan.

Objective: This study aimed to investigate the short-term effects of MSmonitor on empowerment in patients with MS.

Methods: We conducted a quasi-experimental study in a general hospital. Of the 180 patients with MS, 125 were eligible, 30 used MSmonitor, and 21 participated in the study (mean age 45.4 years, SD 10.2 years). A total of 24 eligible patients who did not use MSmonitor constituted the control group (mean age 49.3 years, SD 11.4 years). At baseline and at 4 months, we assessed self-efficacy (Multiple Sclerosis Self-Efficacy Scale [MSSES]), participation and autonomy (Impact on Participation and Autonomy [IPA] questionnaire), and self-management (Partners In Health [PIH] questionnaire). Differences between time points and groups were tested with paired t tests and χ² tests.

Results: In the MSmonitor group, follow-up values remained unchanged for MSSES control (P=.19), MSSES function (P=.62), IPA limitations (P=.26), IPA problems (P=.40), PIH recognition and management of symptoms (P=.52), PIH adherence to treatment (P=.80), and PIH coping (P=.73), whereas the PIH knowledge score had improved (mean 27.8, SD 1.7 vs mean 28.7, SD 2.0; P=.02). The overall utilization rate of the program components was 83% and that of the Quick Scan was 95%. In the control group, all outcomes had remained unchanged.

Conclusions: The results suggest that for first-time users of the MSmonitor program and their health care providers, it may not be justified to expect a short-term improvement in empowerment in terms of self-efficacy, self-management, autonomy, or participation. Furthermore, a lack of effect on empowerment is not because of nonusage of the program components.

Keywords: eHealth; empowerment; internet-based communication; internet-based intervention; multiple sclerosis; personal autonomy; self-efficacy; self-management; social participation.

Figure 1

Screenshot of graphic presentation of Multiple Sclerosis Impact Profile (MSIP) disability scores in the domains muscle and movement, excretion and reproductive functions, mental functions, basic movement activities, activities of daily living, environmental factors, participation in life situations, and the symptoms fatigue, pain, speech, and vision (lower numbers). Upper numbers represent the maximum of the score range. Higher scores indicate a worse condition. Right bars give the actual score, left bars the previous score.

Figure 2

Screenshot of graphic presentation of changes over time in MFIS-5 and LMSQoL scores. The MFIS-5 score (higher is worse) is converted into a fitness (fitheid) score (higher is better) to match the direction of the LMSQoL score. Scores are converted into percentages (0%, minimum score; 100%, maximum score). MFIS-5: Modified Fatigue Impact Scale-5 items; LMSQoL: Leeds Multiple Sclerosis Quality of Life.

Figure 3

Study Flow Chart.