From checkboxes to emojis: a novel approach to patient-reported outcomes in multiple sclerosis.

BACKGROUND

Patient-reported outcome measures (PROMs) improve multiple sclerosis (MS) management by reflecting patients' perspectives of their disease. Mayo Clinic Electronic Emoji Based Neurological Impairment Status (MEBNIS) is a short PROM consisting of four equally-weighted domains (Memory, Mood, Fatigue-Sleepiness, and Ambulation) and Composite, which are based on emojis.

OBJECTIVE

To investigate the correlations of MEBNIS with patient-reported, examination-based, performance-based, and radiological metrics of disease severity in persons with MS (pwMS).

METHODS

PwMS (n = 195) prospectively completed MEBNIS, Expanded Disability Status Scale (EDSS), MS Functional Composite (MSFC) and its subtests [25-Foot Walk Test (25FWT), 9-Hole Peg Test (9HPT), Paced Auditory Serial Addition Test (PASAT)], Beck Depression Inventory (BDI), Fatigue Questionnaire (FQ), and Epworth Sleepiness Scale (ESS) between May 2021 and May 2024. Participants also underwent brain MRIs. Correlations were summarized using Spearman's rank correlation coefficients.

RESULTS

Memory correlated (p≤0.001) with PASAT (rho = -0.25), ESS (rho = 0.24), FQ (rho = 0.36), and BDI (rho = 0.36). Mood correlated (p<0.001) with FQ (rho = 0.40) and BDI (rho = 0.46). Fatigue-Sleepiness correlated (p<0.001) with ESS (rho = 0.49), FQ (rho = 0.59), and BDI (rho = 0.44). Ambulation correlated (p<0.001) with EDSS (rho = 0.69), MSFC z-score (rho = -0.59), 25FWT (rho = 0.66), 9HPT (rho = 0.54), PASAT (rho = -0.32), FQ (rho = 0.41), and BDI (rho = 0.37). Composite correlated (p<0.001) with EDSS (rho = 0.47), MSFC z-score (rho = -0.42), 25FWT (rho = 0.49), 9HPT (rho = 0.36), PASAT (rho = -0.26), ESS (rho = 0.38), FQ (rho = 0.64), and BDI (rho = 0.58). Memory, Ambulation and Composite correlated with cortical gray matter (Memory rho = -0.17; Ambulation rho = -0.30; Composite rho = -0.20) and thalamus (Memory rho = -0.17; Ambulation rho = -0.20; Composite rho = -0.17) volumes (p<0.05).

CONCLUSIONS

As a novel visual PROM, MEBNIS correlates with established patient-reported, examination-based, performance-based, and radiological metrics of MS severity. It offers a fast, intuitive, and accessible multi-domain evaluation of impairment and disease severity in MS, applicable to both clinical practice and clinical trials as a potential digital tool.