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Geßner A, Hartmann M, Vágó A, Trentzsch K, Schriefer D, Mehrholz J, Ziemssen T. Sensitive Identification of Asymmetries and Neuromuscular Deficits in Lower Limb Function in Early Multiple Sclerosis. Neurorehabil Neural Repair 2024; 38:570-581. [PMID: 38613335 PMCID: PMC11308279 DOI: 10.1177/15459683241245964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND In the early stages of multiple sclerosis (MS), there are no objective sensitive functional assessments to identify and quantify early subclinical neuromuscular deficits and lower limb strength asymmetries during complex movements. Single-countermovement jumps (SLCMJ), a maximum single leg vertical jump, on a force plate allow functional evaluation of unilateral lower limb performance in performance diagnostics and could therefore provide early results on asymmetries in MS. OBJECTIVE Objective evaluation of early lower limb neuromuscular deficits and asymmetries in people with multiple sclerosis (pwMS) using SLCMJ on a force plate. METHODS A study was conducted with pwMS (N = 126) and healthy controls (N = 97). All participants performed 3 maximal SLCMJs on a force plate. Temporal, kinetic, and power jump parameters were collected. The Expanded Disability Status Scale (EDSS) was performed on all participants. A repeated measures analysis of covariance (ANCOVA) with age, Body-Mass-Index, and gender as covariates was used. RESULTS PwMS with normal muscle strength according to the manual muscle tests showed significantly reduced SLCMJ performance compared to HC. In both groups, jumping performance differed significantly between the dominant and non-dominant leg, with higher effect size for pwMS. A significant interaction effect between leg dominance and group was found for propulsive time, where the pwMS showed an even higher difference between the dominant and non-dominant leg compared to HC. Furthermore, there was a significant small correlation between leg asymmetries and EDSS in pwMS. CONCLUSION The study shows that the SLCMJ on a force plate is suitable for the early detection of subclinical lower limb neuromuscular deficits and strength asymmetries in MS.
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Affiliation(s)
- Anne Geßner
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maximilian Hartmann
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Anikó Vágó
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katrin Trentzsch
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Dirk Schriefer
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jan Mehrholz
- SRH University of Applied Sciences, Gera, Germany
- Public Health, TU Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Kanzler CM, Armand T, Simovic L, Sylvester R, Domnik N, Eilfort AM, Rohner C, Gassert R, Gonzenbach R, Lambercy O. Influence of virtual reality and task complexity on digital health metrics assessing upper limb function. J Neuroeng Rehabil 2024; 21:125. [PMID: 39068424 PMCID: PMC11282591 DOI: 10.1186/s12984-024-01413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Technology-based assessments using 2D virtual reality (VR) environments and goal-directed instrumented tasks can deliver digital health metrics describing upper limb sensorimotor function that are expected to provide sensitive endpoints for clinical studies. Open questions remain about the influence of the VR environment and task complexity on such metrics and their clinimetric properties. METHODS We aim to investigate the influence of VR and task complexity on the clinimetric properties of digital health metrics describing upper limb function. We relied on the Virtual Peg Insertion Test (VPIT), a haptic VR-based assessment with a virtual manipulation task. To evaluate the influence of VR and task complexity, we designed two novel tasks derived from the VPIT, the VPIT-2H (VR environment with reduced task complexity) and the PPIT (physical task with reduced task complexity). These were administered in an observational longitudinal study with 27 able-bodied participants and 31 participants with multiple sclerosis (pwMS, VPIT and PPIT only) and the value of kinematic and kinetic metrics, their clinimetric properties, and the usability of the assessment tasks were compared. RESULTS Intra-participant variability strongly increased with increasing task complexity (coefficient of variation + 56%) and was higher in the VR compared to the physical environment (+ 27%). Surprisingly, this did not translate into significant differences in the metrics' measurement error and test-retest reliability across task conditions (p > 0.05). Responsiveness to longitudinal changes in pwMS was even significantly higher (effect size + 0.35, p < 0.05) for the VR task with high task complexity compared to the physical instrumented task with low task complexity. Increased inter-participant variability might have compensated for the increased intra-participant variability to maintain good clinimetric properties. No significant influence of task condition on concurrent validity was present in pwMS. Lastly, pwMS rated the PPIT with higher usability than the VPIT (System Usability Scale + 7.5, p < 0.05). CONCLUSION The metrics of both the VR haptic- and physical task-based instrumented assessments showed adequate clinimetric properties. The VR haptic-based assessment may be superior when longitudinally assessing pwMS due to its increased responsiveness. The physical instrumented task may be advantageous for regular clinical use due to its higher usability. These findings highlight that both assessments should be further validated for their ideal use-cases.
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Affiliation(s)
- Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore.
| | - Tom Armand
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Leonardo Simovic
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | - Nadine Domnik
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Antonia M Eilfort
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Carola Rohner
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
| | | | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Campus for Research Excellence And Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
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Molenaar PCG, Noteboom S, van Nederpelt DR, Krijnen EA, Jelgerhuis JR, Lam KH, Druijff-van de Woestijne GB, Meijer KA, van Oirschot P, de Jong BA, Brouwer I, Jasperse B, de Groot V, Uitdehaag BMJ, Schoonheim MM, Strijbis EMM, Killestein J. Digital outcome measures are associated with brain atrophy in patients with multiple sclerosis. J Neurol 2024:10.1007/s00415-024-12516-9. [PMID: 39008036 DOI: 10.1007/s00415-024-12516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Digital monitoring of people with multiple sclerosis (PwMS) using smartphone-based monitoring tools is a promising method to assess disease activity and progression. OBJECTIVE To study cross-sectional and longitudinal associations between active and passive digital monitoring parameters and MRI volume measures in PwMS. METHODS In this prospective study, 92 PwMS were included. Clinical tests [Expanded Disability Status Scale (EDSS), Timed 25 Foot Walk test (T25FW), 9-Hole Peg Test (NHPT), and Symbol Digit Modalities Test (SDMT)] and structural MRI scans were performed at baseline (M0) and 12-month follow-up (M12). Active monitoring included the smartphone-based Symbol Digit Modalities Test (sSDMT) and 2 Minute Walk Test (s2MWT), while passive monitoring was based on smartphone keystroke dynamics (KD). Linear regression analyses were used to determine cross-sectional and longitudinal relations between digital and clinical outcomes and brain volumes, with age, disease duration and sex as covariates. RESULTS In PwMS, both sSDMT and SDMT were associated with thalamic volumes and lesion volumes. KD were related to brain, ventricular, thalamic and lesion volumes. No relations were found between s2MWT and MRI volumes. NHPT scores were associated with lesion volumes only, while EDSS and T25FW were not related to MRI. No longitudinal associations were found for any of the outcome measures between M0 and M12. CONCLUSION Our results show clear cross-sectional correlations between digital biomarkers and brain volumes in PwMS, which were not all present for conventional clinical outcomes, supporting the potential added value of digital monitoring tools.
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Affiliation(s)
- Pam C G Molenaar
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc Polikliniek Neurologie, Attn. MS Center Amsterdam, P. O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Samantha Noteboom
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - David R van Nederpelt
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Eva A Krijnen
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Julia R Jelgerhuis
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Ka-Hoo Lam
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc Polikliniek Neurologie, Attn. MS Center Amsterdam, P. O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | | | | | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc Polikliniek Neurologie, Attn. MS Center Amsterdam, P. O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Iman Brouwer
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Bas Jasperse
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Vincent de Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc Polikliniek Neurologie, Attn. MS Center Amsterdam, P. O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Eva M M Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc Polikliniek Neurologie, Attn. MS Center Amsterdam, P. O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc Polikliniek Neurologie, Attn. MS Center Amsterdam, P. O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Haghayegh F, Norouziazad A, Haghani E, Feygin AA, Rahimi RH, Ghavamabadi HA, Sadighbayan D, Madhoun F, Papagelis M, Felfeli T, Salahandish R. Revolutionary Point-of-Care Wearable Diagnostics for Early Disease Detection and Biomarker Discovery through Intelligent Technologies. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400595. [PMID: 38958517 DOI: 10.1002/advs.202400595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/19/2024] [Indexed: 07/04/2024]
Abstract
Early-stage disease detection, particularly in Point-Of-Care (POC) wearable formats, assumes pivotal role in advancing healthcare services and precision-medicine. Public benefits of early detection extend beyond cost-effectively promoting healthcare outcomes, to also include reducing the risk of comorbid diseases. Technological advancements enabling POC biomarker recognition empower discovery of new markers for various health conditions. Integration of POC wearables for biomarker detection with intelligent frameworks represents ground-breaking innovations enabling automation of operations, conducting advanced large-scale data analysis, generating predictive models, and facilitating remote and guided clinical decision-making. These advancements substantially alleviate socioeconomic burdens, creating a paradigm shift in diagnostics, and revolutionizing medical assessments and technology development. This review explores critical topics and recent progress in development of 1) POC systems and wearable solutions for early disease detection and physiological monitoring, as well as 2) discussing current trends in adoption of smart technologies within clinical settings and in developing biological assays, and ultimately 3) exploring utilities of POC systems and smart platforms for biomarker discovery. Additionally, the review explores technology translation from research labs to broader applications. It also addresses associated risks, biases, and challenges of widespread Artificial Intelligence (AI) integration in diagnostics systems, while systematically outlining potential prospects, current challenges, and opportunities.
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Affiliation(s)
- Fatemeh Haghayegh
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Alireza Norouziazad
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Elnaz Haghani
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Ariel Avraham Feygin
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Reza Hamed Rahimi
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Hamidreza Akbari Ghavamabadi
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Deniz Sadighbayan
- Department of Biology, Faculty of Science, York University, Toronto, ON, M3J 1P3, Canada
| | - Faress Madhoun
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Manos Papagelis
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, M5T 3A9, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, M5T 3M6, Canada
| | - Razieh Salahandish
- Laboratory of Advanced Biotechnologies for Health Assessments (Lab-HA), Biomedical Engineering Program, Lassonde School of Engineering, York University, Toronto, M3J 1P3, Canada
- Department of Electrical Engineering and Computer Science (EECS), Lassonde School of Engineering, York University, Toronto, ON, M3J 1P3, Canada
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de Jong DJ, Strijbis EM, Killestein J. Information from ecological momentary assessments lead to over-medicalization: Commentary. Mult Scler 2024; 30:972-973. [PMID: 38751217 PMCID: PMC11290015 DOI: 10.1177/13524585241253081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Affiliation(s)
- Daan J de Jong
- MS Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Eva M Strijbis
- MS Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
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Tea F, Groh AMR, Lacey C, Fakolade A. A scoping review assessing the usability of digital health technologies targeting people with multiple sclerosis. NPJ Digit Med 2024; 7:168. [PMID: 38918483 PMCID: PMC11199563 DOI: 10.1038/s41746-024-01162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
Digital health technologies (DHTs) have become progressively more integrated into the healthcare of people with multiple sclerosis (MS). To ensure that DHTs meet end-users' needs, it is essential to assess their usability. The objective of this study was to determine how DHTs targeting people with MS incorporate usability characteristics into their design and/or evaluation. We conducted a scoping review of DHT studies in MS published from 2010 to the present using PubMed, Web of Science, OVID Medline, CINAHL, Embase, and medRxiv. Covidence was used to facilitate the review. We included articles that focused on people with MS and/or their caregivers, studied DHTs (including mhealth, telehealth, and wearables), and employed quantitative, qualitative, or mixed methods designs. Thirty-two studies that assessed usability were included, which represents a minority of studies (26%) that assessed DHTs in MS. The most common DHT was mobile applications (n = 23, 70%). Overall, studies were highly heterogeneous with respect to what usability principles were considered and how usability was assessed. These findings suggest that there is a major gap in the application of standardized usability assessments to DHTs in MS. Improvements in the standardization of usability assessments will have implications for the future of digital health care for people with MS.
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Affiliation(s)
- Fiona Tea
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Adam M R Groh
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC, Canada
| | - Colleen Lacey
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
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Seo D, So JM, Kim J, Jung H, Jang I, Kim H, Kang DW, Lim YM, Choi J, Lee EJ. Digital symbol-digit modalities test with modified flexible protocols in patients with CNS demyelinating diseases. Sci Rep 2024; 14:14649. [PMID: 38918552 PMCID: PMC11199480 DOI: 10.1038/s41598-024-65486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
Cognitive impairment (CI) is prevalent in central nervous system demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). We developed a novel tablet-based modified digital Symbol Digit Modalities Test (MD-SDMT) with adjustable protocols that feature alternating symbol-digit combinations in each trial, lasting one or two minutes. We assessed 144 patients (99 with MS and 45 with NMOSD) using both MD-SDMT protocols and the traditional paper-based SDMT. We also gathered participants' feedback through a questionnaire regarding their preferences and perceived reliability. The results showed strong correlations between MD-SDMT and paper-based SDMT scores (Pearsons correlation: 0.88 for 2 min; 0.85 for 1 min, both p < 0.001). Among the 120 respondents, the majority preferred the digitalized SDMT (55% for the 2 min, 39% for the 1 min) over the paper-based version (6%), with the 2 min MD-SDMT reported as the most reliable test. Notably, patients with NMOSD and older individuals exhibited a preference for the paper-based test, as compared to those with MS and younger patients. In summary, even with short test durations, the digitalized SDMT effectively evaluates cognitive function in MS and NMOSD patients, and is generally preferred over the paper-based method, although preferences may vary with patient characteristics.
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Affiliation(s)
- Dayoung Seo
- AMIST, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Jeong Min So
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Jiyon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Heejae Jung
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Inhye Jang
- AMIST, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Jaesoon Choi
- Biomedical Engineering, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
| | - Eun-Jae Lee
- AMIST, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea.
- Translational Biomedical Research Group, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea.
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8
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Daniore P, Nittas V, Haag C, Bernard J, Gonzenbach R, von Wyl V. From wearable sensor data to digital biomarker development: ten lessons learned and a framework proposal. NPJ Digit Med 2024; 7:161. [PMID: 38890529 PMCID: PMC11189504 DOI: 10.1038/s41746-024-01151-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Wearable sensor technologies are becoming increasingly relevant in health research, particularly in the context of chronic disease management. They generate real-time health data that can be translated into digital biomarkers, which can provide insights into our health and well-being. Scientific methods to collect, interpret, analyze, and translate health data from wearables to digital biomarkers vary, and systematic approaches to guide these processes are currently lacking. This paper is based on an observational, longitudinal cohort study, BarKA-MS, which collected wearable sensor data on the physical rehabilitation of people living with multiple sclerosis (MS). Based on our experience with BarKA-MS, we provide and discuss ten lessons we learned in relation to digital biomarker development across key study phases. We then summarize these lessons into a guiding framework (DACIA) that aims to informs the use of wearable sensor data for digital biomarker development and chronic disease management for future research and teaching.
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Vasileios Nittas
- Department of Behavioral and Social Sciences, Brown University, Providence, USA
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jürgen Bernard
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Department of Computer Science, University of Zurich, Zurich, Switzerland
| | | | - Viktor von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland.
- Digital Society Initiative, University of Zurich, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
- Swiss School of Public Health (SSPH+), Zurich, Switzerland.
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Demuth S, Ed-Driouch C, Dumas C, Laplaud D, Edan G, Vince N, De Sèze J, Gourraud PA. Scoping review of clinical decision support systems for multiple sclerosis management: Leveraging information technology and massive health data. Eur J Neurol 2024:e16363. [PMID: 38860844 DOI: 10.1111/ene.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system, with numerous therapeutic options, but a lack of biomarkers to support a mechanistic approach to precision medicine. A computational approach to precision medicine could proceed from clinical decision support systems (CDSSs). They are digital tools aiming to empower physicians through the clinical applications of information technology and massive data. However, the process of their clinical development is still maturing; we aimed to review it in the field of MS. METHODS For this scoping review, we screened systematically the PubMed database. We identified 24 articles reporting 14 CDSS projects and compared their technical and software development aspects. RESULTS The projects position themselves in various contexts of usage with various algorithmic approaches: expert systems, CDSSs based on similar patients' data visualization, and model-based CDSSs implementing mathematical predictive models. So far, no project has completed its clinical development up to certification for clinical use with global release. Some CDSSs have been replaced at subsequent project iterations. The most advanced projects did not necessarily report every step of clinical development in a dedicated article (proof of concept, offline validation, refined prototype, live clinical evaluation, comparative prospective evaluation). They seek different software distribution options to integrate into health care: internal usage, "peer-to-peer," and marketing distribution. CONCLUSIONS This review illustrates the potential of clinical applications of information technology and massive data to support MS management and helps clarify the roadmap for future projects as a multidisciplinary and multistep process.
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Affiliation(s)
- Stanislas Demuth
- INSERM CIC 1434, Clinical Investigation Center, University Hospital of Strasbourg, Strasbourg, France
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
| | - Chadia Ed-Driouch
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
- Département Automatique, Productique et Informatique, IMT Atlantique, CNRS, LS2N, UMR CNRS 6004, Nantes, France
| | - Cédric Dumas
- Département Automatique, Productique et Informatique, IMT Atlantique, CNRS, LS2N, UMR CNRS 6004, Nantes, France
| | - David Laplaud
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
- Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Gilles Edan
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Nicolas Vince
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
| | - Jérôme De Sèze
- INSERM CIC 1434, Clinical Investigation Center, University Hospital of Strasbourg, Strasbourg, France
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre-Antoine Gourraud
- INSERM, CR2TI-Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
- Data Clinic, Department of Public Health, University Hospital of Nantes, Nantes, France
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10
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Carvalho Macruz FBD, Dias ALMP, Andrade CS, Nucci MP, Rimkus CDM, Lucato LT, Rocha AJD, Kitamura FC. The new era of artificial intelligence in neuroradiology: current research and promising tools. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-12. [PMID: 38565188 PMCID: PMC10987255 DOI: 10.1055/s-0044-1779486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024]
Abstract
Radiology has a number of characteristics that make it an especially suitable medical discipline for early artificial intelligence (AI) adoption. These include having a well-established digital workflow, standardized protocols for image storage, and numerous well-defined interpretive activities. The more than 200 commercial radiologic AI-based products recently approved by the Food and Drug Administration (FDA) to assist radiologists in a number of narrow image-analysis tasks such as image enhancement, workflow triage, and quantification, corroborate this observation. However, in order to leverage AI to boost efficacy and efficiency, and to overcome substantial obstacles to widespread successful clinical use of these products, radiologists should become familiarized with the emerging applications in their particular areas of expertise. In light of this, in this article we survey the existing literature on the application of AI-based techniques in neuroradiology, focusing on conditions such as vascular diseases, epilepsy, and demyelinating and neurodegenerative conditions. We also introduce some of the algorithms behind the applications, briefly discuss a few of the challenges of generalization in the use of AI models in neuroradiology, and skate over the most relevant commercially available solutions adopted in clinical practice. If well designed, AI algorithms have the potential to radically improve radiology, strengthening image analysis, enhancing the value of quantitative imaging techniques, and mitigating diagnostic errors.
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Affiliation(s)
- Fabíola Bezerra de Carvalho Macruz
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Radiologia e Oncologia, Seção de Neurorradiologia, Faculdade de Medicina, São Paulo SP, Brazil.
- Rede D'Or São Luiz, Departamento de Radiologia e Diagnóstico por Imagem, São Paulo SP, Brazil.
- Universidade de São Paulo, Laboratório de Investigação Médica em Ressonância Magnética (LIM 44), São Paulo SP, Brazil.
- Academia Nacional de Medicina, Rio de Janeiro RJ, Brazil.
| | | | | | - Mariana Penteado Nucci
- Universidade de São Paulo, Laboratório de Investigação Médica em Ressonância Magnética (LIM 44), São Paulo SP, Brazil.
| | - Carolina de Medeiros Rimkus
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Radiologia e Oncologia, Seção de Neurorradiologia, Faculdade de Medicina, São Paulo SP, Brazil.
- Rede D'Or São Luiz, Departamento de Radiologia e Diagnóstico por Imagem, São Paulo SP, Brazil.
- Universidade de São Paulo, Laboratório de Investigação Médica em Ressonância Magnética (LIM 44), São Paulo SP, Brazil.
| | - Leandro Tavares Lucato
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Radiologia e Oncologia, Seção de Neurorradiologia, Faculdade de Medicina, São Paulo SP, Brazil.
- Diagnósticos da América SA, São Paulo SP, Brazil.
| | | | - Felipe Campos Kitamura
- Diagnósticos da América SA, São Paulo SP, Brazil.
- Universidade Federal de São Paulo, São Paulo SP, Brazil.
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11
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Oh J, Giacomini PS, Yong VW, Costello F, Blanchette F, Freedman MS. From progression to progress: The future of multiple sclerosis. J Cent Nerv Syst Dis 2024; 16:11795735241249693. [PMID: 38711957 PMCID: PMC11072059 DOI: 10.1177/11795735241249693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Significant advances have been made in the diagnosis and treatment of multiple sclerosis in recent years yet challenges remain. The current classification of MS phenotypes according to disease activity and progression, for example, does not adequately reflect the underlying pathophysiological mechanisms that may be acting in an individual with MS at different time points. Thus, there is a need for clinicians to transition to a management approach based on the underlying pathophysiological mechanisms that drive disability in MS. A Canadian expert panel convened in January 2023 to discuss priorities for clinical discovery and scientific exploration that would help advance the field. Five key areas of focus included: identifying a mechanism-based disease classification system; developing biomarkers (imaging, fluid, digital) to identify pathologic processes; implementing a data-driven approach to integrate genetic/environmental risk factors, clinical findings, imaging and biomarker data, and patient-reported outcomes to better characterize the many factors associated with disability progression; utilizing precision-based treatment strategies to target different disease processes; and potentially preventing disease through Epstein-Barr virus (EBV) vaccination, counselling about environmental risk factors (e.g. obesity, exercise, vitamin D/sun exposure, smoking) and other measures. Many of the tools needed to meet these needs are currently available. Further work is required to validate emerging biomarkers and tailor treatment strategies to the needs of individual patients. The hope is that a more complete view of the individual's pathobiology will enable clinicians to usher in an era of truly personalized medicine, in which more informed treatment decisions throughout the disease course achieve better long-term outcomes.
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Affiliation(s)
- Jiwon Oh
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - V. Wee Yong
- University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | - Fiona Costello
- University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | | | - Mark S. Freedman
- Department of Medicine¸ University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, QC, Canada
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12
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Voigt I, Fischer S, Proschmann U, Konofalska U, Richter P, Schlieter H, Berger T, Meuth SG, Hartung HP, Akgün K, Ziemssen T. Consensus quality indicators for monitoring multiple sclerosis. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100891. [PMID: 38585674 PMCID: PMC10998202 DOI: 10.1016/j.lanepe.2024.100891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
Multiple sclerosis (MS) as a chronic, degenerative autoimmune disease of the central nervous system has a longitudinal and heterogeneous course with increasing treatment options and risk profiles requiring constant monitoring of a growing number of parameters. Despite treatment guidelines, there is a lack of strategic and individualised monitoring pathways, including respective quality indicators (QIs). To address this, we systematically developed transparent, traceable, and measurable QIs for MS monitoring. Through literature review, expert discussions, and consensus-building, existing QIs were identified and refined. In a two-stage online Delphi process involving MS specialists (on average 53 years old and with 25 years of professional experience), the QIs were evaluated for content, clarity, and intelligibility, resulting in a set of 24 QIs and checklists to assess the quality of care. The final QIs provide a structured approach to document, monitor, and enhance the quality of care for people with MS across their treatment journey.
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Affiliation(s)
- Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Stefanie Fischer
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Undine Proschmann
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Urszula Konofalska
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Peggy Richter
- Research Group Digital Health, Faculty of Business and Economics, TUD Dresden University of Technology, Dresden 01062, Germany
| | - Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, TUD Dresden University of Technology, Dresden 01062, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, Düsseldorf 40225, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, Düsseldorf 40225, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
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13
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Sonkaya ZZ, Özturk B, Sonkaya R, Taskiran E, Karadas Ö. Using Objective Speech Analysis Techniques for the Clinical Diagnosis and Assessment of Speech Disorders in Patients with Multiple Sclerosis. Brain Sci 2024; 14:384. [PMID: 38672033 PMCID: PMC11047916 DOI: 10.3390/brainsci14040384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is one of the chronic and neurodegenerative diseases of the central nervous system (CNS). It generally affects motor, sensory, cerebellar, cognitive, and language functions. It is thought that identifying MS speech disorders using quantitative methods will make a significant contribution to physicians in the diagnosis and follow-up of MS patients. In this study, it was aimed to investigate the speech disorders of MS via objective speech analysis techniques. The study was conducted on 20 patients diagnosed with MS according to McDonald's 2017 criteria and 20 healthy volunteers without any speech or voice pathology. Speech data obtained from patients and healthy individuals were analyzed with the PRAAT speech analysis program, and classification algorithms were tested to determine the most effective classifier in separating specific speech features of MS disease. As a result of the study, the K-nearest neighbor algorithm (K-NN) was found to be the most successful classifier (95%) in distinguishing pathological sounds which were seen in MS patients from those in healthy individuals. The findings obtained in our study can be considered as preliminary data to determine the voice characteristics of MS patients.
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Affiliation(s)
- Zeynep Z. Sonkaya
- Department of Experimental Linguistics, Ankara University, 06590 Ankara, Turkey
| | - Bilgin Özturk
- Department of Neurology, Gülhane Medicine Faculty, Health Science University, 06010 Ankara, Turkey; (B.Ö.); (R.S.); (Ö.K.)
| | - Rıza Sonkaya
- Department of Neurology, Gülhane Medicine Faculty, Health Science University, 06010 Ankara, Turkey; (B.Ö.); (R.S.); (Ö.K.)
| | - Esra Taskiran
- Department of Neurology, Antalya Training and Research Hospital, 07100 Antalya, Turkey;
| | - Ömer Karadas
- Department of Neurology, Gülhane Medicine Faculty, Health Science University, 06010 Ankara, Turkey; (B.Ö.); (R.S.); (Ö.K.)
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14
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Papukchieva S, Kahn M, Eberl M, Friedrich B, Joschko N, Ziemssen T. Data on Ocrelizumab Treatment Collected by MS Patients in Germany Using Brisa App. J Pers Med 2024; 14:409. [PMID: 38673036 PMCID: PMC11051290 DOI: 10.3390/jpm14040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND With a rising number of multiple sclerosis (MS) cases and increasing pressure on health systems, digital companion apps like Brisa, designed specifically for people with MS, can play an important role in the patient journey. These apps enable the collection of real-time longitudinal data that are critical to our understanding of the pathophysiology and progression of MS. METHODS This retrospective, descriptive analysis consists of data from Brisa users who registered between 6 August 2021 and 8 September 2022. Of the unique users, 37.7% (n = 1593) fulfilled the inclusion criteria including information about medication and demographics and tracked one or more symptoms and/or patient-reported outcomes. Users were classified as moderate-efficacy treatment users, high-efficacy treatment users and ocrelizumab users, and the reporting frequency and scores of symptoms and patient-reported outcomes were analyzed. RESULTS The largest cohort of Brisa users (405) reported treatment with ocrelizumab and were mostly diagnosed 2-5 years before the survey. The most reported MS symptoms were similar between OUs (ocrelizumab users), HETUs (high-efficacy treatment users) and METUs (moderate-efficacy treatment users). OUs on average reported symptoms and answered questionnaires more frequently. Baseline scores between HETUs and OUs were similar, whereas baseline scores of METUs were slightly lower in comparison. In a further analysis of OUs, disability scores increased with age; users aged 26-45 years had higher pain scores than 18-25-year-olds. No significant differences were found in quality of life, bowel control and vision between age groups. CONCLUSION These findings show that the characteristics of the Brisa cohort are similar to the results of other studies and registries and can provide a representative overview of everyday disease management. Thereby, these results can bridge the gap between clinical research and real patient experience, but they also raise new questions, such as how often the hard-and-early therapy approach is already used and whether baseline characteristics and reasons for choosing a particular treatment contribute to the different outcomes over time. Answering these questions requires further research and analysis.
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Affiliation(s)
| | - Maria Kahn
- Temedica GmbH, 80687 Munich, Germany; (S.P.)
| | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, 01307 Dresden, Germany
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15
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Macias Alonso AK, Hirt J, Woelfle T, Janiaud P, Hemkens LG. Definitions of digital biomarkers: a systematic mapping of the biomedical literature. BMJ Health Care Inform 2024; 31:e100914. [PMID: 38589213 PMCID: PMC11015196 DOI: 10.1136/bmjhci-2023-100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Technological devices such as smartphones, wearables and virtual assistants enable health data collection, serving as digital alternatives to conventional biomarkers. We aimed to provide a systematic overview of emerging literature on 'digital biomarkers,' covering definitions, features and citations in biomedical research. METHODS We analysed all articles in PubMed that used 'digital biomarker(s)' in title or abstract, considering any study involving humans and any review, editorial, perspective or opinion-based articles up to 8 March 2023. We systematically extracted characteristics of publications and research studies, and any definitions and features of 'digital biomarkers' mentioned. We described the most influential literature on digital biomarkers and their definitions using thematic categorisations of definitions considering the Food and Drug Administration Biomarkers, EndpointS and other Tools framework (ie, data type, data collection method, purpose of biomarker), analysing structural similarity of definitions by performing text and citation analyses. RESULTS We identified 415 articles using 'digital biomarker' between 2014 and 2023 (median 2021). The majority (283 articles; 68%) were primary research. Notably, 287 articles (69%) did not provide a definition of digital biomarkers. Among the 128 articles with definitions, there were 127 different ones. Of these, 78 considered data collection, 56 data type, 50 purpose and 23 included all three components. Those 128 articles with a definition had a median of 6 citations, with the top 10 each presenting distinct definitions. CONCLUSIONS The definitions of digital biomarkers vary significantly, indicating a lack of consensus in this emerging field. Our overview highlights key defining characteristics, which could guide the development of a more harmonised accepted definition.
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Affiliation(s)
- Ana Karen Macias Alonso
- Department of Applied Natural Sciences, Technische Hochschule Lübeck, Lübeck, Germany
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Julian Hirt
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Health, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
| | - Tim Woelfle
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and MS Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Perrine Janiaud
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lars G Hemkens
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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16
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Papukchieva S, Stratil AS, Kahn M, Neß NH, Hollnagel-Schmitz M, Gerencser V, Rustemeier J, Eberl M, Friedrich B, Ziemssen T. Shifting from the treat-to-target to the early highly effective treatment approach in patients with multiple sclerosis - real-world evidence from Germany. Ther Adv Neurol Disord 2024; 17:17562864241237857. [PMID: 38525488 PMCID: PMC10960977 DOI: 10.1177/17562864241237857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Background While evidence highlights the effectiveness of initiating disease-modifying therapy with a high-efficacy medication for multiple sclerosis (MS) patients with poor prognostic factors, it remains unclear whether this approach has been adopted by a broad range of MS providers in Germany yet. Objective To assess the adoption of the early highly effective treatment (EHT) compared to the treat-to-target treatment approach with the option of escalating treatment efficacy over time in Germany based on real-world evidence data. Design Patient-level pharmacy dispensing data from the Permea platform were analysed from 2020 to 2022. Methods In total, 29,529 therapy beginners (>18 years) were included to analyse shifts in treatment approaches over time and switching behaviour. Medication classification adhered to the German Society of Neurology guidelines and designated fumarates, glatiramer acetate, teriflunomide and interferons as low-efficacy category 1 medications; cladribine and S1P-modulators as medium-efficacy category 2 medications; and alemtuzumab, natalizumab, ocrelizumab, ofatumumab and rituximab (off-label) as high-efficacy category 3 medications. Results Our results show that 70.0% of patients redeemed their first prescription for category 1 medication, 16.3% for category 2 and 13.7% for category 3 medications. The proportion of prescriptions filled shifted from 2020 to 2022 with a decrease of 14.7% for category 1 drugs and an increase of 12.5% for category 3 drugs. 93.2% of patients stayed on their initially prescribed medication category. 3.2% of category 1 and 3.7% of category 2 therapy beginners escalated to category 3 medication. 3.4% of category 3 medication users de-escalated their treatment to category 1 or category 2. Conclusion While most individuals started their treatment according to the treat-to-target approach and remained on their initially prescribed medication category, there has been a steadily increasing shift towards the EHT approach since 2020. These insights demonstrate that, while not officially recommended by German guidelines, MS providers increasingly adopt the EHT approach.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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17
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Masanneck L, Pawlitzki MG, Meuth SG. [Digital medicine in neurological research-Between hype and evidence]. DER NERVENARZT 2024; 95:230-235. [PMID: 38095660 DOI: 10.1007/s00115-023-01581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND The rapid advancement of digital medicine and health technologies in neurology offers both significant potential and challenges. This article outlines fundamental aspects of digital medicine related to neurological research and highlights application examples of digital technologies in neurological research. AIM To provide a comprehensive overview of current digital developments in neurology and their impact on neurological research. MATERIAL AND METHODS In this narrative review articles from various sources and references related to digital medicine and health technologies in neurology were compiled and analyzed. RESULTS AND DISCUSSION The data presented indicate that digital health technologies and digital therapeutics have the potential to decisively shape neurological care and research; however, it is emphasized that a critical evaluation and evidence-based approach to these technologies are essential to determine their actual value in neurology.
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Affiliation(s)
- Lars Masanneck
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
- Hasso-Plattner-Institut, Potsdam, Deutschland.
| | - Marc G Pawlitzki
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Sven G Meuth
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
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18
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Tahedl M, Wiltgen T, Voon CC, Berthele A, Kirschke JS, Hemmer B, Mühlau M, Zimmer C, Wiestler B. Cortical Thin Patch Fraction Reflects Disease Burden in MS: The Mosaic Approach. AJNR Am J Neuroradiol 2023; 45:82-89. [PMID: 38164526 PMCID: PMC10756581 DOI: 10.3174/ajnr.a8064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE GM pathology plays an essential role in MS disability progression, emphasizing the importance of neuroradiologic biomarkers to capture the heterogeneity of cortical disease burden. This study aimed to assess the validity of a patch-wise, individual interpretation of cortical thickness data to identify GM pathology, the "mosaic approach," which was previously suggested as a biomarker for assessing and localizing atrophy. MATERIALS AND METHODS We investigated the mosaic approach in a cohort of 501 patients with MS with respect to 89 internal and 651 external controls. The resulting metric of the mosaic approach is the so-called thin patch fraction, which is an estimate of overall cortical disease burden per patient. We evaluated the mosaic approach with respect to the following: 1) discrimination between patients with MS and controls, 2) classification between different MS phenotypes, and 3) association with established biomarkers reflecting MS disease burden, using general linear modeling. RESULTS The thin patch fraction varied significantly between patients with MS and healthy controls and discriminated among MS phenotypes. Furthermore, the thin patch fraction was associated with disease burden, including the Expanded Disability Status Scale, cognitive and fatigue scores, and lesion volume. CONCLUSIONS This study demonstrates the validity of the mosaic approach as a neuroradiologic biomarker in MS. The output of the mosaic approach, namely the thin patch fraction, is a candidate biomarker for assessing and localizing cortical GM pathology. The mosaic approach can furthermore enhance the development of a personalized cortical MS biomarker, given that the thin patch fraction provides a feature on which artificial intelligence methods can be trained. Most important, we showed the validity of the mosaic approach when referencing data with respect to external control MR imaging repositories.
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Affiliation(s)
- Marlene Tahedl
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Cui Ci Voon
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (B.H.), Munich, Germany
| | - Mark Mühlau
- Department of Neurology (T.W., C.C.V., A.B., B.H., M.M.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany
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19
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Heesen C, Berger T, Riemann-Lorenz K, Krause N, Friede T, Pöttgen J, Meyer B, Lühmann D. Mobile health interventions in multiple sclerosis: A systematic review. Mult Scler 2023; 29:1709-1720. [PMID: 37897326 PMCID: PMC10687804 DOI: 10.1177/13524585231201089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) might be particularly well suited to benefit from digital health applications because they are, on average, younger and less severely disabled than patients with many other chronic diseases. Many digital health applications for pwMS have been developed. OBJECTIVES Analysis of the evidence of digital health applications to improve health outcomes from a patient perspective. METHODS A systematic review was performed on all randomized controlled trials (RCTs) that have studied mobile health interventions for pwMS, that is, which can be applied with a smartphone, tablet, or laptop to improve patient-reported outcomes. RESULTS Of the 1127 articles identified in the literature search, 13 RCTs fit the inclusion criteria. Two trials studied messaging systems, two depression interventions, one addressed MS fatigue, five cognition, and three mobility issues, of which two focused on spasticity management. One trial aimed to enhance physical activity. Most were pilot studies that cannot yield definitive conclusions regarding efficacy. One depression intervention and one fatigue intervention showed significant results across several outcomes. CONCLUSION Several mobile self-guided digital health applications for pwMS have been tested in RCTs, and two interventions targeting depression and fatigue have demonstrated significant effects. Challenges remain regarding implementation into routine care.
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Affiliation(s)
- Christoph Heesen
- Clinical and Rehabilitative MS Research, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology, University of Bern, Bern, Switzerland
| | - Karin Riemann-Lorenz
- Clinical and Rehabilitative MS Research, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center, Hamburg, Germany
| | - Nicole Krause
- Clinical and Rehabilitative MS Research, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center, Hamburg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jana Pöttgen
- Clinical and Rehabilitative MS Research, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center, Hamburg, Germany
| | | | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Guardado S, Mylonopoulou V, Rivera-Romero O, Patt N, Bansi J, Giunti G. An Exploratory Study on the Utility of Patient-Generated Health Data as a Tool for Health Care Professionals in Multiple Sclerosis Care. Methods Inf Med 2023; 62:165-173. [PMID: 37748719 PMCID: PMC10878743 DOI: 10.1055/s-0043-1775718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Patient-generated health data (PGHD) are data collected through technologies such as mobile devices and health apps. The integration of PGHD into health care workflows can support the care of chronic conditions such as multiple sclerosis (MS). Patients are often willing to share data with health care professionals (HCPs) in their care team; however, the benefits of PGHD can be limited if HCPs do not find it useful, leading patients to discontinue data tracking and sharing eventually. Therefore, understanding the usefulness of mobile health (mHealth) solutions, which provide PGHD and serve as enablers of the HCPs' involvement in participatory care, could motivate them to continue using these technologies. OBJECTIVE The objective of this study is to explore the perceived utility of different types of PGHD from mHealth solutions which could serve as tools for HCPs to support participatory care in MS. METHOD A mixed-methods approach was used, combining qualitative research and participatory design. This study includes three sequential phases: data collection, assessment of PGHD utility, and design of data visualizations. In the first phase, 16 HCPs were interviewed. The second and third phases were carried out through participatory workshops, where PGHD types were conceptualized in terms of utility. RESULTS The study found that HCPs are optimistic about PGHD in MS care. The most useful types of PGHD for HCPs in MS care are patients' habits, lifestyles, and fatigue-inducing activities. Although these subjective data seem more useful for HCPs, it is more challenging to visualize them in a useful and actionable way. CONCLUSION HCPs are optimistic about mHealth and PGHD as tools to further understand their patients' needs and support care in MS. HCPs from different disciplines have different perceptions of what types of PGHD are useful; however, subjective types of PGHD seem potentially more useful for MS care.
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Affiliation(s)
- Sharon Guardado
- Empirical Software Engineering (M3S) Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Vasiliki Mylonopoulou
- Division of Human-Computer Interaction, Department Of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Octavio Rivera-Romero
- Department of Electronic Technology, Universidad de Sevilla, Seville, Spain
- Instituto de Investigación en Informática, Universidad de Sevilla, Seville, Spain
- SABIEN Group, ITACA Institute, Universitat Politécnica de Valéncia, Valencia, Spain
| | - Nadine Patt
- Department of Neurology, Kliniken Valens, Rehabilitationszentrum Valens, Valens, Switzerland
| | - Jens Bansi
- Department of Neurology, Kliniken Valens, Rehabilitationszentrum Valens, Valens, Switzerland
| | - Guido Giunti
- Empirical Software Engineering (M3S) Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
- Health Sciences and Technology Unit, Faculty of Medicine, University of Oulu, Finland
- Applied Ergonomics and Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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21
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dos Passos GR, Adoni T, Mendes MF, Sato DK. Reshaping neuroimmunology: diagnosis and treatment in the era of precision medicine. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1125-1133. [PMID: 38157878 PMCID: PMC10756840 DOI: 10.1055/s-0043-1777752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Precision medicine has revolutionized the field of neuroimmunology, with innovative approaches that characterize diseases based on their biology, deeper understanding of the factors leading to heterogeneity within the same disease, development of targeted therapies, and strategies to tailor therapies to each patient. This review explores the impact of precision medicine on various neuroimmunological conditions, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), optic neuritis, autoimmune encephalitis, and immune-mediated neuropathies. We discuss advances in disease subtyping, recognition of novel entities, promising biomarkers, and the development of more selective monoclonal antibodies and cutting-edge synthetic cell-based immunotherapies in neuroimmunological disorders. In addition, we analyze the challenges related to affordability and equity in the implementation of these emerging technologies, especially in situations with limited resources.
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Affiliation(s)
- Giordani Rodrigues dos Passos
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina e Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.
| | - Tarso Adoni
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
| | | | - Douglas Kazutoshi Sato
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina e Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.
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22
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Mirmosayyeb O, Yazdan Panah M, Mokary Y, Ghaffary EM, Ghoshouni H, Zivadinov R, Weinstock-Guttman B, Jakimovski D. Optical coherence tomography (OCT) measurements and disability in multiple sclerosis (MS): A systematic review and meta-analysis. J Neurol Sci 2023; 454:120847. [PMID: 37924591 DOI: 10.1016/j.jns.2023.120847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Studies have demonstrated that people with multiple sclerosis (pwMS) experience visual impairments and neurodegenerative retinal processes. The disability progression in pwMS may be associated with retinal changes assessed with optical coherence tomography (OCT). This meta-analysis aims at synthesizing the correlations between OCT measurements of disability in pwMS. METHODS We systematically searched four databases (PubMed/MEDLINE, Embase, Scopus, and Web of Science) from inception to November 2022, then conducted a meta-analysis using a random effects model to determine the pooled correlation coefficient(r) between OCT measurements and disability scales by R version 4.2.3 with the meta version 6.2-1 package. RESULTS From 3129 studies, 100 studies were included. Among 9051 pwMS, the female-to-male ratio was 3.15:1, with a mean age of 39.57 ± 6.07 years. The mean disease duration and Expanded Disability Status Scale (EDSS) were 8.5 ± 3.7 and 2.7 ± 1.1, respectively. Among the pooled subgroup analyses, macular ganglion cell inner plexiform layer (mGCIPL) in patients with relapsing-remitting (pwRRMS) and peripapillary retinal nerve fiber layer (pRNFL) in patients with progressive MS (pwPMS) had strong correlations with EDSS, r = -0.33 (95% CI: -0.45 to -0.20, I2 = 45%, z-score = -4.86, p < 0.001) and r = -0.20 (95% CI:-0.58 to 0.26, I2 = 76%, z-score = -0.85, p = 0.395), respectively. According to subgroup analysis on pwMS without optic neuritis (ON) history, the largest correlation was seen between EDSS and macular ganglion cell complex (mGCC): r = -0.39 (95% CI: -0.70 to 0.04, I2 = 79%, z-score = -1.79, p = 0.073). CONCLUSION OCT measurements are correlated with disability in pwMS, and they can complement the comprehensive neurological visit as an additional paraclinical test.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mohammad Yazdan Panah
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Ghoshouni
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA.
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23
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Doghish AS, Elazazy O, Mohamed HH, Mansour RM, Ghanem A, Faraag AHI, Elballal MS, Elrebehy MA, Elesawy AE, Abdel Mageed SS, Mohammed OA, Nassar YA, Abulsoud AI, Raouf AA, Abdel-Reheim MA, Rashad AA, Elawady AS, Elsisi AM, Alsalme A, Ali MA. The role of miRNAs in multiple sclerosis pathogenesis, diagnosis, and therapeutic resistance. Pathol Res Pract 2023; 251:154880. [PMID: 37832353 DOI: 10.1016/j.prp.2023.154880] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
In recent years, microRNAs (miRNAs) have gained increased attention from researchers around the globe. Although it is twenty nucleotides long, it can modulate several gene targets simultaneously. Their mal expression is a signature of various pathologies, and they provide the foundation to elucidate the molecular mechanisms of each pathology. Among the debilitating central nervous system (CNS) disorders with a growing prevalence globally is the multiple sclerosis (MS). Moreover, the diagnosis of MS is challenging due to the lack of disease-specific biomarkers, and the diagnosis mainly depends on ruling out other disabilities. MS could adversely affect patients' lives through its progression, and only symptomatic treatments are available as therapeutic options, but an exact cure is yet unavailable. Consequently, this review hopes to further the study of the biological features of miRNAs in MS and explore their potential as a therapeutic target.
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Affiliation(s)
- Ahmed S Doghish
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt; Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, Cairo 11231, Egypt.
| | - Ola Elazazy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Hend H Mohamed
- School of Biotechnology, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt; Biochemistry Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Reda M Mansour
- Zoology and Entomology Department, Faculty of Science, Helwan University, Helwan 11795, Egypt; Biology Department, School of Biotechnology, Badr University in Cairo, Badr City, Cairo 11829, Egypt
| | - Aml Ghanem
- School of Biotechnology, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Ahmed H I Faraag
- School of Biotechnology, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt; Botany and Microbiology Department, Faculty of Science, Helwan University, Helwan 11795, Egypt
| | - Mohammed S Elballal
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mahmoud A Elrebehy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt.
| | - Ahmed E Elesawy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Sherif S Abdel Mageed
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Osama A Mohammed
- Department of Clinical Pharmacology, College of Medicine, University of Bisha, Bisha 61922, Saudi Arabia
| | - Yara A Nassar
- Biology Department, School of Biotechnology, Badr University in Cairo, Badr City, Cairo 11829, Egypt; Department of Botany, Faculty of Science, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed I Abulsoud
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, Cairo 11231, Egypt; Biochemistry Department, Faculty of Pharmacy, Heliopolis University, Cairo 11785, Egypt
| | - Ahmed Amr Raouf
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mustafa Ahmed Abdel-Reheim
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62521, Egypt.
| | - Ahmed A Rashad
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Alaa S Elawady
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Ahmed Mohammed Elsisi
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, Cairo 11231, Egypt; Department of Biochemistry, Faculty of Pharmacy, Sinai University, Al-Arish, Egypt
| | - Ali Alsalme
- Chemistry Department, College of Science, King Saud University, Riyadh 1145, Saudi Arabia
| | - Mohamed A Ali
- School of Biotechnology, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
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Pinarello C, Elmers J, Inojosa H, Beste C, Ziemssen T. Management of multiple sclerosis fatigue in the digital age: from assessment to treatment. Front Neurosci 2023; 17:1231321. [PMID: 37869507 PMCID: PMC10585158 DOI: 10.3389/fnins.2023.1231321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Fatigue is one of the most disabling symptoms of Multiple Sclerosis (MS), affecting more than 80% of patients over the disease course. Nevertheless, it has a multi-faceted and complex nature, making its diagnosis, evaluation, and treatment extremely challenging in clinical practice. In the last years, digital supporting tools have emerged to support the care of people with MS. These include not only smartphone or table-based apps, but also wearable devices or novel techniques such as virtual reality. Furthermore, an additional effective and cost-efficient tool for the therapeutic management of people with fatigue is becoming increasingly available. Virtual reality and e-Health are viable and modern tools to both assess and treat fatigue, with a variety of applications and adaptability to patient needs and disability levels. Most importantly, they can be employed in the patient's home setting and can not only bridge clinic visits but also be complementary to the monitoring and treatment means for those MS patients who live far away from healthcare structures. In this narrative review, we discuss the current knowledge and future perspectives in the digital management of fatigue in MS. These may also serve as sources for research of novel digital biomarkers in the identification of disease activity and progression.
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Affiliation(s)
- Chiara Pinarello
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Julia Elmers
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Hernán Inojosa
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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25
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Machado TM, Berssaneti FT. Literature review of digital twin in healthcare. Heliyon 2023; 9:e19390. [PMID: 37809792 PMCID: PMC10558347 DOI: 10.1016/j.heliyon.2023.e19390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/26/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
This article aims to make a bibliometric literature review using systematic scientific mapping and content analysis of digital twins in healthcare to know the evolution, domain, keywords, content type, and kind and purpose of digital twin's implementation in healthcare, so a consolidation and future improvement of existing knowledge can be made and gaps for new studies can be identified. The increase in publications of digital twins in healthcare is quite recent and it is still concentrated in the domain of technology sources. The subject is majorly concentrated in patient's digital twin group and in precision medicine and aspects, issues and/or policies subgroups, although the publications keywords mirror it only at the group side. Digital twins in healthcare are probably stepping out of the infancy phase. On the other hand, digital twins in hospital group and the device and facilities management subgroups are more mature with all knowledge gathered from the manufacturing sector. There is an absence of some publication's types in general, device and care subgroup and no whole body or hospital digital twin was reported. Based on the presented arguments, guidelines for future research were presented: advance in the creation of general frameworks, in subgroups not as much explored, and in groups and subgroups already explored, but that need more advancement to achieve the main goals of a whole human or hospital digital twin with the main issues resolved.
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Affiliation(s)
- Tatiana Mallet Machado
- Production Engineering Department, Polytechnic School University of São Paulo, Av. Prof. Almeida Prado, Brazil
| | - Fernando Tobal Berssaneti
- Production Engineering Department, Polytechnic School University of São Paulo, Av. Prof. Almeida Prado, Brazil
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26
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Voigt I, Inojosa H, Wenk J, Akgün K, Ziemssen T. Building a monitoring matrix for the management of multiple sclerosis. Autoimmun Rev 2023; 22:103358. [PMID: 37178996 DOI: 10.1016/j.autrev.2023.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Multiple sclerosis (MS) has a longitudinal and heterogeneous course, with an increasing number of therapy options and associated risk profiles, leading to a constant increase in the number of parameters to be monitored. Even though important clinical and subclinical data are being generated, treating neurologists may not always be able to use them adequately for MS management. In contrast to the monitoring of other diseases in different medical fields, no target-based approach for a standardized monitoring in MS has been established yet. Therefore, there is an urgent need for a standardized and structured monitoring as part of MS management that is adaptive, individualized, agile, and multimodal-integrative. We discuss the development of an MS monitoring matrix which can help facilitate data collection over time from different dimensions and perspectives to optimize the treatment of people with MS (pwMS). In doing so, we show how different measurement tools can combined to enhance MS treatment. We propose to apply the concept of patient pathways to disease and intervention monitoring, not losing track of their interrelation. We also discuss the use of artificial intelligence (AI) to improve the quality of processes, outcomes, and patient safety, as well as personalized and patient-centered care. Patient pathways allow us to track the patient's journey over time and can always change (e.g., when there is a switch in therapy). They therefore may assist us in the continuous improvement of monitoring in an iterative process. Improving the monitoring process means improving the care of pwMS.
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Affiliation(s)
- Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hernan Inojosa
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Judith Wenk
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
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27
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Giansanti D. Precision Medicine 2.0: How Digital Health and AI Are Changing the Game. J Pers Med 2023; 13:1057. [PMID: 37511670 PMCID: PMC10381472 DOI: 10.3390/jpm13071057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
In the era of rapid IT developments, the health domain is undergoing a considerable transformation [...].
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28
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Stoumpos AI, Kitsios F, Talias MA. Digital Transformation in Healthcare: Technology Acceptance and Its Applications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3407. [PMID: 36834105 PMCID: PMC9963556 DOI: 10.3390/ijerph20043407] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 05/27/2023]
Abstract
Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.
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Affiliation(s)
- Angelos I. Stoumpos
- Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus
| | - Fotis Kitsios
- Department of Applied Informatics, University of Macedonia, 156 Egnatia Street, GR54636 Thessaloniki, Greece
| | - Michael A. Talias
- Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus
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29
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The influence of the COVID-19 pandemic on the prescription of multiple sclerosis medication in Germany. Biomed Pharmacother 2023; 158:114129. [PMID: 36527843 PMCID: PMC9756211 DOI: 10.1016/j.biopha.2022.114129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Real-word evidence from diverse data sources is increasingly important in terms of generating rapid insights to effectively manage patient populations, especially during major public health disruptions such as the ongoing COVID-19 pandemic. Patients with chronic and inflammatory diseases - such as multiple sclerosis (MS) - were reported to experience potentially negative effects due to the use of immunosuppressive drugs in combination with a COVID-19 infection. In this research, we explored the impact of the COVID-19 pandemic on medication use in patients with MS in Germany. METHODS Patient-level pharmacy dispensing data from the Permea platform - covering approximately 44% of all community pharmacy dispensing in Germany - were analysed from 2019 - 2021. Longitudinal use patterns of MS medication and antidepressants and patient demographics were assessed. Daily variation in MS medication use was specifically studied around the dates of the first and second lockdowns in Germany. RESULTS We included data from 539,400 prescriptions which included at least 1 MS drug. The medication data showed a stable level of monthly prescriptions for MS medication at 2.02 ± 0.03 prescriptions per pharmacy during the study period. Although there was a sharp increase in daily prescriptions before the first lockdown (from an average 660.08 ± 137.59 daily prescriptions in the observed period to a maximum dispensing number of 998 daily prescriptions), the overall number of prescriptions remained at pre-pandemic levels (603 ± 90.31 daily prescriptions in 2019). Similar trends were observed for monthly co-prescribed antidepressant use per pharmacy (0.10 ± 0.01 in 2019-0.11 ± 0.02 in 2020). CONCLUSION Throughout the COVID-19 pandemic, the use of MS medications and co-prescribed antidepressants was stable. These insights from real-world data demonstrate the value of evidence-based insights for managing patient care.
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30
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Masanneck L, Räuber S, Schroeter CB, Lehnerer S, Ziemssen T, Ruck T, Meuth SG, Pawlitzki M. Driving time-based identification of gaps in specialised care coverage: An example of neuroinflammatory diseases in Germany. Digit Health 2023; 9:20552076231152989. [PMID: 36762020 PMCID: PMC9903011 DOI: 10.1177/20552076231152989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Due to the growing complexity in monitoring and treatment of many disorders, disease-specific care and research networks offer patients certified healthcare. However, the networks' ability to provide health services close to patients' homes usually remains vague. Digital Health Technologies (DHTs) help to provide better care, especially if implemented in a targeted manner in regions undersupplied by specialised networks. Therefore, we used a car travel time-based isochrone approach to identify care gaps using the example of the neuroinflammation-focused German healthcare and research networks for multiple sclerosis (MS), myasthenia gravis (MG), myositis and immune-mediated neuropathy. Methods Excellence centres were mapped, and isochrones for 30, 60, 90 and 120 minutes were calculated. The resulting geometric figures were aggregated and used to mask the global human settlement population grid 2019 to estimate German inhabitants that can reach centres within the given periods. Results While 96.48% of Germans can drive to an MS-focused centre within one hour, coverage is lower for the rare disease networks for MG (48.3%), myositis (43.1%) and immune-mediated neuropathy (56.7%). Within 120 minutes, more than 80% of Germans can reach a centre of any network. Besides the generally worse covered rural regions such as North-Eastern Germany, the rare disease networks also show network-specific regional underrepresentation. Conclusion An isochrone-based approach helps identify regions where specialised care is hard to reach, which might be especially troublesome in the case of an often disabled patient collective. Patient care could be improved by focusing deployments of disease-specific DHTs on these areas.
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Affiliation(s)
- Lars Masanneck
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany,Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Saskia Räuber
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sophie Lehnerer
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center, Berlin, Germany,Centre for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Digital Health Center, Berlin, Germany
| | - Tjalf Ziemssen
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany,Marc Pawlitzki, Department of Neurology, Heinrich-Heine University Duesseldorf, Moorenstraße 5, D-40225 Duesseldorf, Germany.
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Bonnechère B, Timmermans A, Michiels S. Current Technology Developments Can Improve the Quality of Research and Level of Evidence for Rehabilitation Interventions: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23020875. [PMID: 36679672 PMCID: PMC9866361 DOI: 10.3390/s23020875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 06/01/2023]
Abstract
The current important limitations to the implementation of Evidence-Based Practice (EBP) in the rehabilitation field are related to the validation process of interventions. Indeed, most of the strict guidelines that have been developed for the validation of new drugs (i.e., double or triple blinded, strict control of the doses and intensity) cannot-or can only partially-be applied in rehabilitation. Well-powered, high-quality randomized controlled trials are more difficult to organize in rehabilitation (e.g., longer duration of the intervention in rehabilitation, more difficult to standardize the intervention compared to drug validation studies, limited funding since not sponsored by big pharma companies), which reduces the possibility of conducting systematic reviews and meta-analyses, as currently high levels of evidence are sparse. The current limitations of EBP in rehabilitation are presented in this narrative review, and innovative solutions are suggested, such as technology-supported rehabilitation systems, continuous assessment, pragmatic trials, rehabilitation treatment specification systems, and advanced statistical methods, to tackle the current limitations. The development and implementation of new technologies can increase the quality of research and the level of evidence supporting rehabilitation, provided some adaptations are made to our research methodology.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Sarah Michiels
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, 2650 Edegem, Belgium
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Christ M, Schuh K, Bayas A. Large-scale cross-sectional online survey on patient-neurologist communication, burden of disease assessment and disease monitoring in people with multiple sclerosis. Front Neurol 2023; 13:1093352. [PMID: 36686532 PMCID: PMC9848394 DOI: 10.3389/fneur.2022.1093352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background Management of multiple sclerosis (MS) requires a high level of communication between health care professionals (HCPs) and people with MS (pwMS) including profound investigation and discussion of symptoms to identify therapeutic needs. For treatment decisions, monitoring of disease activity is important, in this respect self-monitoring devices and apps, as well as magnetic resonance imaging are important tools. Methods MS Perspectives is a cross-sectional online survey conducted in Germany which was designed to collect data, among others, on the communication between pwMS and HCPs regarding treatment goals, symptom assessment, usage of devices and apps to self-monitor health functions, as well as to identify patients' attitude toward the role of magnetic resonance imaging (MRI). Between December 2021 and February 2022, 4,555 pwMS completed the survey. Results In total, 63.7% of participants reported that treatment goals have been discussed with their HCPs. Symptoms worsening in the past 12 months independent of relapses was more often reported by pwMS than inquired by HCPs, according to patients' report. Devices or apps for health monitoring were used by less than half of participants. Frequency of MRI controls was much lower in participants with longer compared to shorter disease duration (47.5 vs. 86.3%). The proportion of patients with annual or semiannual scans was highest among pwMS receiving infusion therapy (93.5%), followed by oral medication (82.5%) and injectables (73.4%), and lowest for pwMS without immunotherapy (58.2%). Conclusion MS Perspectives identified a rather low patient involvement regarding treatment goals and symptom assessment in clinical practice. Regarding this and our findings for health self-monitoring and MRI usage, strategies for improving patient-HCP communication and disease monitoring may be considered.
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Affiliation(s)
- Monika Christ
- Department of Neurology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | - Antonios Bayas
- Department of Neurology, Faculty of Medicine, University of Augsburg, Augsburg, Germany,*Correspondence: Antonios Bayas ✉
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Mountford S, Kahn M, Balakrishnan P, Jacyshyn-Owen E, Eberl M, Friedrich B, Joschko N, Ziemssen T. Correlation and differences of patient-reported outcomes vs. Likert-Rating of MS symptoms in a real-world cohort using a digital patient app. Digit Health 2023; 9:20552076231173520. [PMID: 37214657 PMCID: PMC10196529 DOI: 10.1177/20552076231173520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Background Multiple Sclerosis (MS) is a chronic and progressive neurological autoimmune disease currently affecting 250,000 individuals in Germany. Patients suffering from the disease can be severely impaired in their day-to-day activities. BRISA is a digital app specifically designed to help MS patients monitor their disease by regularly tracking symptoms. Lengthy and time-consuming questionnaires for patient-reported outcomes (PRO) are the standard method to assess the patients' current condition. Here, we examine whether simplified versions of these questionnaires can provide comparable information regarding individual symptom presentations in BRISA users. Methods 828 users were included in the analysis. Patients who provided onboarding information and answered at least one questionnaire and the corresponding simplified smiley symptoms assessment were included. Correlation of questionnaire and symptom scores was calculated using Pearson's correlation. Results Our analysis cohort predominantly consisted of female, 26-55-year-olds. Relapsing-remitting MS (RRMS) was the most common MS type recorded. Most patients were diagnosed 2-5 years ago. Questionnaires regarding fatigue and vision impairment were among the most answered, those regarding bowel movement and sexual satisfaction received fewest responses. Overall, the scores from questionnaires and symptoms correlated positively. Scoring correlation could also be shown across the subgroups divided by gender, age groups, type of MS, and time since diagnosis of the disease. Conclusion Scores recorded from traditional PRO questionnaires can be reflected more easily as a trend in a simplified scale using smileys. Nevertheless, traditional questionnaires are needed to also maintain a more objective assessment. In conclusion, the patient will benefit most from an adaptive combination of regular traditional PRO questionnaire assessments and simplified symptom recording.
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Affiliation(s)
| | | | | | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience,
Department of Neurology, University Hospital Carl Gustav Carus, Dresden University
of Technology, Dresden, Germany
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Kuhlmann T, Moccia M, Coetzee T, Cohen JA, Correale J, Graves J, Marrie RA, Montalban X, Yong VW, Thompson AJ, Reich DS. Multiple sclerosis progression: time for a new mechanism-driven framework. Lancet Neurol 2023; 22:78-88. [PMID: 36410373 PMCID: PMC10463558 DOI: 10.1016/s1474-4422(22)00289-7] [Citation(s) in RCA: 146] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
Abstract
Traditionally, multiple sclerosis has been categorised by distinct clinical descriptors-relapsing-remitting, secondary progressive, and primary progressive-for patient care, research, and regulatory approval of medications. Accumulating evidence suggests that the clinical course of multiple sclerosis is better considered as a continuum, with contributions from concurrent pathophysiological processes that vary across individuals and over time. The apparent evolution to a progressive course reflects a partial shift from predominantly localised acute injury to widespread inflammation and neurodegeneration, coupled with failure of compensatory mechanisms, such as neuroplasticity and remyelination. Ageing increases neural susceptibility to injury and decreases resilience. These observations encourage a new consideration of the course of multiple sclerosis as a spectrum defined by the relative contributions of overlapping pathological and reparative or compensatory processes. New understanding of key mechanisms underlying progression and measures to quantify progressive pathology will potentially have important and beneficial implications for clinical care, treatment targets, and regulatory decision-making.
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Affiliation(s)
- Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany; Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Timothy Coetzee
- National Multiple Sclerosis Society (USA), New York, NY, USA
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jorge Correale
- Fleni, Department of Neurology, Buenos Aires, Argentina; Institute of Biological Chemistry and Biophysics (IQUIFIB), CONICET/UBA, Buenos Aires, Argentina
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Ruth Ann Marrie
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia and Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, Faculty of Brain Sciences, University College London, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Giannopoulou P, Vlamos P. Using Biomarkers for Cognitive Enhancement and Evaluation in Mobile Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1424:161-166. [PMID: 37486490 DOI: 10.1007/978-3-031-31982-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Clinicians are increasingly using biomarkers to diagnose and monitor cognitive conditions such as mild cognitive impairment, Alzheimer's disease, and dementia. Biomarkers are classified into two main categories based on their clinical goal: disease-associated biomarkers and drug-related biomarkers. In the case of disease-associated biomarkers, neuroimaging biomarkers are used to predict and validate Alzheimer's disease at any of its stages including mild cognitive impairment. The use of mobile and wearable devices to collect data about a person's daily activities and behaviors has led to the emergence of a new type of biomarker known as digital biomarkers. This type of data provides a digital reflection of a person's function in the context of everyday life and can be used to monitor and track changes in an individual's health and behaviors over time. The use of biomarkers in mobile applications for cognitive enhancement and evaluation can provide valuable insights into an individual's cognitive health and can help to optimize treatment and prevention strategies.
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36
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Bonnechère B. Integrating Rehabilomics into the Multi-Omics Approach in the Management of Multiple Sclerosis: The Way for Precision Medicine? Genes (Basel) 2022; 14:63. [PMID: 36672802 PMCID: PMC9858788 DOI: 10.3390/genes14010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Over recent years, significant improvements have been made in the understanding of (epi)genetics and neuropathophysiological mechanisms driving the different forms of multiple sclerosis (MS). For example, the role and importance of the bidirectional communications between the brain and the gut-also referred to as the gut-brain axis-in the pathogenesis of MS is receiving increasing interest in recent years and is probably one of the most promising areas of research for the management of people with MS. However, despite these important advances, it must be noted that these data are not-yet-used in rehabilitation. Neurorehabilitation is a cornerstone of MS patient management, and there are many techniques available to clinicians and patients, including technology-supported rehabilitation. In this paper, we will discuss how new findings on the gut microbiome could help us to better understand how rehabilitation can improve motor and cognitive functions. We will also see how the data gathered during the rehabilitation can help to get a better diagnosis of the patients. Finally, we will discuss how these new techniques can better guide rehabilitation to lead to precision rehabilitation and ultimately increase the quality of patient care.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
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Elkefi S, Asan O. Digital Twins for Managing Health Care Systems: Rapid Literature Review. J Med Internet Res 2022; 24:e37641. [PMID: 35972776 PMCID: PMC9428772 DOI: 10.2196/37641] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/30/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although most digital twin (DT) applications for health care have emerged in precision medicine, DTs can potentially support the overall health care process. DTs (twinned systems, processes, and products) can be used to optimize flows, improve performance, improve health outcomes, and improve the experiences of patients, doctors, and other stakeholders with minimal risk. OBJECTIVE This paper aims to review applications of DT systems, products, and processes as well as analyze the potential of these applications for improving health care management and the challenges associated with this emerging technology. METHODS We performed a rapid review of the literature and reported available studies on DTs and their applications in health care management. We searched 5 databases for studies published between January 2002 and January 2022 and included peer-reviewed studies written in English. We excluded studies reporting DT usage to support health care practice (organ transplant, precision medicine, etc). Studies were analyzed based on their contribution toward DT technology to improve user experience in health care from human factors and systems engineering perspectives, accounting for the type of impact (product, process, or performance/system level). Challenges related to the adoption of DTs were also summarized. RESULTS The DT-related studies aimed at managing health care systems have been growing over time from 0 studies in 2002 to 17 in 2022, with 7 published in 2021 (N=17 studies). The findings reported on applications categorized by DT type (system: n=8; process: n=5; product: n=4) and their contributions or functions. We identified 4 main functions of DTs in health care management including safety management (n=3), information management (n=2), health management and well-being promotion (n=3), and operational control (n=9). DTs used in health care systems management have the potential to avoid unintended or unexpected harm to people during the provision of health care processes. They also can help identify crisis-related threats to a system and control the impacts. In addition, DTs ensure privacy, security, and real-time information access to all stakeholders. Furthermore, they are beneficial in empowering self-care abilities by enabling health management practices and providing high system efficiency levels by ensuring that health care facilities run smoothly and offer high-quality care to every patient. CONCLUSIONS The use of DTs for health care systems management is an emerging topic. This can be seen in the limited literature supporting this technology. However, DTs are increasingly being used to ensure patient safety and well-being in an organized system. Thus, further studies aiming to address the challenges of health care systems challenges and improve their performance should investigate the potential of DT technology. In addition, such technologies should embed human factors and ergonomics principles to ensure better design and more successful impact on patient and doctor experiences.
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Affiliation(s)
- Safa Elkefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
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38
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Schütz N, Knobel SEJ, Botros A, Single M, Pais B, Santschi V, Gatica-Perez D, Buluschek P, Urwyler P, Gerber SM, Müri RM, Mosimann UP, Saner H, Nef T. A systems approach towards remote health-monitoring in older adults: Introducing a zero-interaction digital exhaust. NPJ Digit Med 2022; 5:116. [PMID: 35974156 PMCID: PMC9381599 DOI: 10.1038/s41746-022-00657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
Using connected sensing devices to remotely monitor health is a promising way to help transition healthcare from a rather reactive to a more precision medicine oriented proactive approach, which could be particularly relevant in the face of rapid population ageing and the challenges it poses to healthcare systems. Sensor derived digital measures of health, such as digital biomarkers or digital clinical outcome assessments, may be used to monitor health status or the risk of adverse events like falls. Current research around such digital measures has largely focused on exploring the use of few individual measures obtained through mobile devices. However, especially for long-term applications in older adults, this choice of technology may not be ideal and could further add to the digital divide. Moreover, large-scale systems biology approaches, like genomics, have already proven beneficial in precision medicine, making it plausible that the same could also hold for remote-health monitoring. In this context, we introduce and describe a zero-interaction digital exhaust: a set of 1268 digital measures that cover large parts of a person’s activity, behavior and physiology. Making this approach more inclusive of older adults, we base this set entirely on contactless, zero-interaction sensing technologies. Applying the resulting digital exhaust to real-world data, we then demonstrate the possibility to create multiple ageing relevant digital clinical outcome assessments. Paired with modern machine learning, we find these assessments to be surprisingly powerful and often on-par with mobile approaches. Lastly, we highlight the possibility to discover novel digital biomarkers based on this large-scale approach.
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Affiliation(s)
- Narayan Schütz
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Samuel E J Knobel
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Angela Botros
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Michael Single
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Bruno Pais
- LaSource School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Valérie Santschi
- LaSource School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Daniel Gatica-Perez
- Idiap Research Institute, Martigny, Switzerland.,School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Prabitha Urwyler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stephan M Gerber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René M Müri
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern, Switzerland
| | - Urs P Mosimann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern, Switzerland
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Sahal R, Alsamhi SH, Brown KN. Personal Digital Twin: A Close Look into the Present and a Step towards the Future of Personalised Healthcare Industry. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22155918. [PMID: 35957477 PMCID: PMC9371419 DOI: 10.3390/s22155918] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 05/12/2023]
Abstract
Digital twins (DTs) play a vital role in revolutionising the healthcare industry, leading to more personalised, intelligent, and proactive healthcare. With the evolution of personalised healthcare, there is a significant need to represent a virtual replica for individuals to provide the right type of care in the right way and at the right time. Therefore, in this paper, we surveyed the concept of a personal digital twin (PDT) as an enhanced version of the DT with actionable insight capabilities. In particular, PDT can bring value to patients by enabling more accurate decision making and proper treatment selection and optimisation. Then, we explored the progression of PDT as a revolutionary technology in healthcare research and industry. However, although several research works have been performed for smart healthcare using DT, PDT is still at an early stage. Consequently, we believe that this work can be a step towards smart personalised healthcare industry by guiding the design of industrial personalised healthcare systems. Accordingly, we introduced a reference framework that empowers smart personalised healthcare using PDTs by bringing together existing advanced technologies (i.e., DT, blockchain, and AI). Then, we described some selected use cases, including the mitigation of COVID-19 contagion, COVID-19 survivor follow-up care, personalised COVID-19 medicine, personalised osteoporosis prevention, personalised cancer survivor follow-up care, and personalised nutrition. Finally, we identified further challenges to pave the PDT paradigm toward the smart personalised healthcare industry.
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Affiliation(s)
- Radhya Sahal
- School of Computer Science and Information Technology, University College Cork, T12 E8YV Cork, Ireland
- Correspondence: (R.S.); (K.N.B.)
| | - Saeed H. Alsamhi
- Insight Centre for Data Analytics, National University of Ireland, N37 W089 Galway, Ireland
- Faculty of Engineering, IBB University, Ibb 70270, Yemen
| | - Kenneth N. Brown
- School of Computer Science and Information Technology, University College Cork, T12 E8YV Cork, Ireland
- Correspondence: (R.S.); (K.N.B.)
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40
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Balakrishnan P, Groenberg J, Jacyshyn-Owen E, Eberl M, Friedrich B, Joschko N, Ziemssen T. Demographic Patterns of MS Patients Using BRISA: An MS-Specific App in Germany. J Pers Med 2022; 12:jpm12071100. [PMID: 35887597 PMCID: PMC9325101 DOI: 10.3390/jpm12071100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Multiple sclerosis (MS) is a chronic, progressive neurological autoimmune disease impacting quality of life. BRISA is an app designed to help MS patients in Germany track their disease course by symptom-monitoring. This study aimed to understand demographic and health-related characteristics of BRISA users. Methods: Demographic data provided by 2095 users were analyzed to describe characteristics such as sex, age, type of MS, and medication. The distribution of tracked symptoms based on age and time since diagnosis were studied. Furthermore, the covariance of specific symptom pairs was analyzed. Results: BRISA users are predominantly female and between 26 and 55 years old. Relapsing–remitting MS was the most prevalent form of MS. First-line category 1 drugs were most frequently used, followed by high-efficacy category 3 drugs (e.g., monoclonal antibodies). The relative frequencies of use of category 1 and category 2 drugs (e.g., spingosine-1-phosphate-receptor modulators) significantly altered with time since diagnosis. Fatigue, concentration disorders, tingling, forgetfulness, and pain were the top five symptoms affecting users. Conclusion: The results highlight the diversity among MS patients and the need for extensive cohort characterization in the real-world scenario. In-depth analysis could help in identifying novel insights that could aid in disease management.
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Affiliation(s)
| | | | | | - Markus Eberl
- Temedica GmbH, 80636 Munich, Germany; (P.B.); (E.J.-O.); (M.E.)
| | - Benjamin Friedrich
- Temedica GmbH, 80636 Munich, Germany; (P.B.); (E.J.-O.); (M.E.)
- Correspondence:
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, 01307 Dresden, Germany;
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An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis. THE CEREBELLUM 2022:10.1007/s12311-022-01435-y. [PMID: 35761144 PMCID: PMC9244122 DOI: 10.1007/s12311-022-01435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/03/2022]
Abstract
Multiple sclerosis (MS) is a progressive disease that often affects the cerebellum. It is characterised by demyelination, inflammation, and neurodegeneration within the central nervous system. Damage to the cerebellum in MS is associated with increased disability and decreased quality of life. Symptoms include gait and balance problems, motor speech disorder, upper limb dysfunction, and oculomotor difficulties. Monitoring symptoms is crucial for effective management of MS. A combination of clinical, neuroimaging, and task-based measures is generally used to diagnose and monitor MS. This paper reviews the present and new tools used by clinicians and researchers to assess cerebellar impairment in people with MS (pwMS). It also describes recent advances in digital and home-based monitoring for people with MS.
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Inojosa H, Proschmann U, Akgün K, Ziemssen T. The need for a strategic therapeutic approach: multiple sclerosis in check. Ther Adv Chronic Dis 2022; 13:20406223211063032. [PMID: 35070250 PMCID: PMC8777338 DOI: 10.1177/20406223211063032] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is the most common chronic autoimmune neurological disease. Its therapeutic management has drastically evolved in the recent years with the development of specific disease-modifying therapies (DMTs). Together with the established injectables, oral and intravenous alternatives are now available for MS patients with significant benefits to modulate the disease course. Certain drugs present with a higher efficacy than the others, profiles and frequencies of adverse events differentiate as well. Thus due to the several and different treatment alternatives, the therapeutic approach adopted by neurologists requires a tactical focus for a targeted, timed, and meaningful treatment decision. An integration of rational and emotional control with proper communication skills is necessary for shared decision-making with patients. In this perspective paper, we reinforce the necessary concept of strategic MS treatment approach using all available therapies based on scientific evidence and current experience. We apply a didactic analogy to the strategic game chess. The opening with oriented attack (i.e. already in early disease stages as clinical isolated syndrome), a correct choice of chess pieces to move (i.e. among the several DMTs), a re-assessment reaction to different scenarios (e.g. sustained disease activity, adverse events, and family planning) and the advantage of real-world data are discussed to try the best approach to ultimately successfully approach the best personalized MS treatment.
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Affiliation(s)
- Hernan Inojosa
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Undine Proschmann
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany
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Korsukewitz C, Mäurer M, Wiendl H. MS-Versorgung heute und Vision für die Zukunft - eine Rolle für die ASV? NEUROTRANSMITTER 2022. [PMCID: PMC9734911 DOI: 10.1007/s15016-022-2998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Catharina Korsukewitz
- Klinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Mathias Mäurer
- Stiftung Juliusspital Würzburg, Chefarzt der Klinik für Neurologie, Juliuspromenade 19, 97070 Würzburg, Germany
| | - Heinz Wiendl
- Klinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Ziemssen T, Haase R. Digital Innovation in Multiple Sclerosis Management. Brain Sci 2021; 12:brainsci12010040. [PMID: 35053784 PMCID: PMC8773844 DOI: 10.3390/brainsci12010040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tjalf Ziemssen
- Correspondence: ; Tel.: +49-351-458-4465; Fax: +49-351-458-5717
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