In current disease management models for multiple sclerosis (MS), symptoms are treated separately, by multiple specialists, despite the fact that many symptoms interact and exacerbate one another. Impairments in bladder function, ambulation, and mood (BAM) are a common and often debilitating triad of symptoms with compounded detrimental effect.
Assess the feasibility of CoachMS: a novel closed-loop, remote, interdisciplinary symptom management platform that integrates specific behavioral approaches to encourage patient self-management.
We enrolled 21 participants from the University of California, San Francisco MS Center with clinician- or self-reported symptoms in at least 2 of the 3 BAM domains. To quantitatively measure BAM symptoms, participants were given a Fitbit Flex2 to wear for the duration of the study and assessed with weekly, online surveys. At 2 weeks, together with the study team, individual goals were set for each participant. A simple 1:1 randomization allocated participants to either Coach or control groups. The CoachMS group received targeted interventions throughout the remainder of the study if they failed to meet their individual BAM goals, or displayed worsening. The control group was monitored without intervention. Our primary outcome was feasibility; secondary outcomes included proportion of recommended treatments pursued, and changes in BAM symptom severity.
12 participants (55%) completed the study. These participants demonstrated excellent adherence to study protocol and reported satisfaction with the pilot platform. Coach participants demonstrated greater follow-through with clinical recommendations from the 2-week goal setting stage than controls (OR 9.33, 95% CI (0.89, 97.62)). As a cohort, a trend towards improvement in each BAM symptom was noted although the CoachMS and control groups did not differ. One control participant, reporting suicidality in the weekly questionnaires but not to her primary clinicians, was urgently evaluated per protocol, and hospitalized.
The CoachMS platform, a closed-loop system for managing MS symptoms, was feasible; retention can be further optimized with lower questionnaire burden. Reminders and contact from study team improved recommendation follow-though in the Coach group, particularly for outside referrals. The CoachMS protocol could represent a viable, accessible and cost-effective tool to monitor and treat MS symptoms in near real-time; a larger trial is planned.