Block Valerie J, Gopal Arpita, Rowles William, -Yueh Chu, Gelfand Jeffrey M, Bove Riley
UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA.
Mult Scler J Exp Transl Clin. 2021 Feb 2;7(1):2055217321988937. doi: 10.1177/2055217321988937. eCollection 2021 Jan-Mar.
There are numerous challenges to treating co-occurring symptoms in multiple sclerosis (MS).
To pilot the feasibility of a novel symptom management platform, CoachMS, to monitor MS symptoms (bladder function, ambulation, and mood: BAM) and respond to changes in real-time.
In this 12-week randomized controlled pilot trial, participants' symptoms were monitored using weekly questionnaires and remote ambulatory monitoring (Fitbit Flex2®). Behavioral change principles used included shared goal setting at 2 weeks. Between weeks 2-12, the CoachMS group received targeted contact and interventions if symptoms worsened; the control group were treated through usual clinic practice. Our outcomes were feasibility (retention, adherence and acceptability; primary) and proportion of recommended treatments pursued (secondary); efficacy was explored.
Of 21 participants enrolled, 13 (62%) completed the study; protocol adherence was excellent. CoachMS participants demonstrated greater follow-through with clinical recommendations than controls (OR 9.3, 95% CI (0.9, 97.6)). As a cohort, each BAM symptom tended to improve. Suicidality was detected in one control participant, resulting in urgent evaluation and hospitalization.
The innovative CoachMS platform was feasible and acceptable in this cohort with baseline BAM symptoms. It could represent an accessible, cost-effective tool to monitor MS symptoms in real-time; a larger trial is planned.
治疗多发性硬化症（MS）中同时出现的症状存在诸多挑战。
试行一种新型症状管理平台CoachMS的可行性，以监测MS症状（膀胱功能、行走能力和情绪：BAM）并实时响应变化。
在这项为期12周的随机对照试验中，使用每周问卷调查和远程动态监测（Fitbit Flex2®）对参与者的症状进行监测。所采用的行为改变原则包括在第2周设定共同目标。在第2至12周期间，如果症状恶化，CoachMS组接受有针对性的联系和干预；对照组通过常规门诊治疗。我们的结果包括可行性（保留率、依从性和可接受性；主要指标）和接受推荐治疗的比例（次要指标）；对疗效进行了探索。
在登记的21名参与者中，13名（62%）完成了研究；方案依从性良好。CoachMS组参与者对临床建议的跟进情况优于对照组（比值比9.3，95%置信区间（0.9，97.6））。作为一个队列，每个BAM症状都有改善的趋势。在一名对照参与者中检测到自杀倾向，导致紧急评估和住院治疗。
创新的CoachMS平台在这个有基线BAM症状的队列中是可行且可接受的。它可能是一种可实时监测MS症状的便捷、经济有效的工具；计划进行更大规模的试验。
