Tablet app-based dexterity training in multiple sclerosis (TAD-MS): a randomized controlled trial

Abstract

Purpose

Mobile health applications (mHealth apps) may lead to health benefits. In recent years, the use of apps in multiple sclerosis (MS) has increased. Apps to train and improve dexterity in MS are scarce. This study investigated the effectiveness of a tablet app-based home-based training to improve dexterity in individuals with MS.

Materials and methods

In a randomized controlled trial, two standardized 4-week home-based interventions focussing on different aspects of dexterity and upper limb function were compared. Assessments were done at baseline, post-intervention and 12-week follow-up. The primary endpoint was the Arm Function in Multiple Sclerosis Questionnaire, a dexterity-related measure of patient-reported activities of daily living. Secondary endpoints were dexterous function, grip strength and health-related quality of life.

Results

Forty-eight individuals were randomly assigned to a tablet app-based program (n = 26) or a control strengthening exercise program (n = 22). No significant differences were found for the primary endpoint (p = 0.35). Some significant differences in favour of the app-group were found in fine coordinated finger movements and strength. No significant differences were found at the 12-week follow-up for all endpoints. Adherence in both groups was above 90%.

Conclusions

App-based training was not superior compared to a control strengthening exercise program concerning the arm- and hand function from the participant’s perspective. However, app-based training was found to be effective in improving specific dimensions (finger movements and strength), and can easily be applied at home. Therefore, individuals living with MS with impaired dexterity should consider app-based training.

Clinical Trial Registration

Clinicaltrials.gov NCT03369470.

Implications for rehabilitation

• This study provides initial evidence for the effectiveness of a home-based app-based program for improving dexterous function in individuals living with multiple sclerosis through the implementation of a tablet app-based dexterity training.

• App-based training was not superior compared to a control strengthening exercise program concerning the arm- and hand function from the participant’s perspective.

• Patients attending the app-based dexterity program showed some statistically significant improvements in fine coordinated finger movements and strength.

Keywords:

• Multiple sclerosis
• telemedicine
• mobile applications
• upper extremity
• home environment
• randomized controlled trial

Acknowledgements

The authors are very grateful to all participants involved in the study for their effort and valuable feedback. Furthermore, we are indebted to Amy Orellana for providing her app. We would also like to thank Dario Cazzoli for randomization, Janne Veerbeek for discussing and interpreting the results, and Petra Stellmes and Christine Horstmann for enrolling participants.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the Swiss Multiple Sclerosis Society and Bayer AG.