Floodlight smartphone app helps in MS but work is needed to boost use

A smartphone application called Floodlight Open may help in tracking areas of function in people with multiple sclerosis (MS), but more work is needed to improve patient adherence to using the app in a real-world setting, according to a new study.

Researchers tested Floodlight Open’s use among more than 1,000 MS patients — and another 1,000-plus healthy people — to determine its feasibility for monitoring various functional domains, or areas of function, such as cognition, walking ability, known as gait, and hand and motor abilities.

While people with MS were more likely to persistently use the smartphone app relative to those without the neurodegenerative disease, a notable proportion of patients quickly stopped using it. Overall, more than a third of the study’s participants — both the MS patients and healthy people — did not use the app after the first week.

“Such findings inform future development and evolution of digital health technologies in MS clinical care,” the researchers wrote, adding that “finding effective strategies to improve the long-term engagement of people with MS remains an important and open challenge.”

The study, “Use of smartphone-based remote assessments of multiple sclerosis in Floodlight Open, a global, prospective, open-access study,” was published in Scientific Reports. It was funded by Roche, which made the Floodlight App.

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High patient engagement seen with smartphone app in controlled clinical trial

Smartphone-based apps have emerged as an easy and cost-effective way to frequently collect clinical information from people living with chronic diseases like MS.

Floodlight Open employs a range of smartphone sensor-based tests to remotely measure functional domains commonly impacted in MS, including cognition, hand and motor function, gait, and postural stability. A proof-of-concept study showed that the app could reliably evaluate these domains in MS patients, with a performance that correlated well with standard clinical tests.

Use of the app also was linked to high patient engagement and satisfaction over a six-month period during the clinical trial. However, the factors influencing adherence to the app outside of a controlled clinical study — and thus informing its real-world utility — remain to be investigated.

The Floodlight Open study was thus designed to better understand the use of the smartphone app across a global study population of people with and without MS in a naturalistic setting. To best mimic a real-world setting, enrollment and participation were entirely self-driven, with no clinic visits or clinician supervision, and no set study duration.

This analysis of the study focused on 1,350 people with self-reported MS and 1,133 individuals without MS.

These trial participants regularly completed a fixed sequence of active functional tests up to once a day. Certain other tests and patient-reported outcomes were performed independently of that sequence, and general mobility data was collected passively using smartphone sensors.

In general, people with MS persistently used the smartphone app more than did individuals without the disease. The MS patients were found to use it consistently for a mean, or average, of 5.6 weeks — meaning they completed at least one active test in the fixed sequence per week. Conversely, in people without MS, the app was used persistently for a mean of 2.3 weeks.

Persistence outside the context of a supervised trial continues to be one of the most important hurdles in the adoption of remote digital health technology tools.

In both groups, persistence to the passively-collected mobility test was higher. MS patients provided data on at least one day per week for a mean of 9.8 weeks, while those in the control group (the healthy participants) did so for a mean of 6.3 weeks.

Still, more than a third of all study participants — 38% in total — stopped participating after the first week of using the app.

“Persistence outside the context of a supervised trial continues to be one of the most important hurdles in the adoption of remote digital health technology tools,” the researchers wrote.

Importantly, persistence was higher among MS patients who used the app beyond the first week of the study, extending to a mean of 10.3 weeks for active tests, and 16.3 weeks for passive mobility monitoring.

App persistence generally decreased slowly over time, which is in line with previous studies of digital assessment tools, according to the researchers.

Participants also commonly took breaks for weeks or months from the smartphone app before returning to it. Moreover, many patients were found to start the fixed sequence of active tests, but did not complete it in the same session.

“This observation suggests that there may be benefits in performing different tests independently from one another at a time that is convenient for the user, rather than performing them in a fixed sequence,” the researchers noted.

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Older age, MS disease status tied to greater use of Floodlight Open

Self-declared MS disease status and older age were linked to greater persistence with the Floodlight Open app. MS patients in Denmark, who were using the app as part of a supervised clinical study, also showed greater persistence compared with people from all other countries, where app usage was not clinically monitored.

In general, MS participants performed worse on active functional tests compared with healthy people, confirming Floodlight’s ability to distinguish the MS disease state.

Altogether, the researchers noted that, while the study finds Floodlight Open feasible, there is a need to optimize “the perceived value on effort” for users to better promote adherence to the digital tool.

Linking the app’s use directly with clinical care is one way to improve willingness to participate, according to the scientists. The ability to review app data with their doctor could offer participants a tangible, motivating benefit.

As such, support from healthcare providers and researchers will be critical for the widespread adoption of these digital tools, the team concluded.

Data from the Floodlight Open study have been made openly available to researchers worldwide, who can use the information to further study the use of digital assessment tools in MS.

“Future work could include further exploration of the user experience to increase persistence, further refinement and validation of specific tests to use as disease-monitoring tools in clinical care, and the integration of the app in clinical studies and MS clinical care,” the team concluded.