Design considerations for a multiple sclerosis fatigue mobile app MS Energize: A pragmatic iterative approach using usability testing and resonance checks.

Multiple sclerosis (MS) is a chronic neurological condition affecting around 2.2 million people worldwide. The illness includes a range of symptoms, with fatigue considered to be one of the most disabling. This paper describes how a pragmatic and iterative approach, supported by usability and resonance testing, was used to build a minimum viable product of MS Energize-or MS Energise in UK English regions. MS Energise is a mobile application focused on self-management of fatigue for people with MS. The iterative approach included various stages of testing, during which user feedback including comments about interface, navigation and content, was sought to inform incremental app development and continual improvement. Usability testing was conducted with 11 people with longstanding multiple sclerosis in New Zealand and the United Kingdom, and focused on particular sections of the app as well as the accessibility of the app to users with MS. Two participants contributed to further resonance testing post-release to ensure the app was perceived as relevant and useful to the user. The usability testing and resonance testing phases suggested that user experience of MS Energise was mostly positive. Participants provided a number of suggestions for improvements to aspects of content and design; some of which we implemented during our app development process. Findings will also contribute to future planning and design iteration to enhance the user experience. The next step is further improvement of MS Energise prior to a trial of its clinical and cost effectiveness

Accessibility in health mobile applications

Abstract. Nowadays, there is a vast number of mobile devices capable of storing an individual’s entire life. There are applications for everything, from banking to ordering food and clothes, but also different health applications targeted towards different impairments and self-health care management. Self-health care management applications can have a significant impact on individuals with various diseases and impairments. However, it is essential that these applications are accessible to users with different impairments such as motor and vision impairments. The purpose of this study was to examine accessibility concerns in mobile health applications for individuals with multiple sclerosis and evaluate how these concerns were addressed. Multiple sclerosis was chosen as the focus of this study because its symptoms encompass a range of impairments, including vision, motion, hearing, and cognitive limitations. The study was conducted with benchmarking multiple sclerosis applications obtained in Google Play store. Benchmarking focused on accessibility, and measurements and metrics were gathered testing applications with Google Accessibility Scanner and TalkBack screen reader. Measurements were based on web content accessibility guidelines (WCAG) 2 and accessibility guidelines for mobile applications. None of the tested applications followed accessibility guideline requirements based on benchmarking metrics. When examining the metrics from the perspective of impairments, it was found that applications had accessibility concerns related to motor and vision impairments. The applications addressed requirements for hearing impairments in applicable features, while testing cognitive impairment requirements proved challenging with the selected testing tools. In the future, it is recommended to conduct additional accessibility testing for cognitive impairments using methods such as manual accessibility testing and user testing

The role of mobile technology for fall risk assessment for individuals with multiple sclerosis

Multiple Sclerosis (MS) is a chronic, progressive neurogenerative disease that affects one million people in the United States (Wallin et al., 2019). Common MS symptoms include impaired coordination, poor walking and balance, and fatigue, and these symptoms put people with MS (pwMS) at a higher risk for falls (Cameron & Nilsagard, 2018). Falls are highly prevalent among pwMS and can result in detrimental consequences including bone fractures and even death (Matsuda et al., 2011). To prevent falls and fall related injuries, it is important to first assess for multiple risk factors and then intervene through targeted treatments (Palumbo et al., 2015). Fall risk can be assessed through self-report measures, clinical performance tests, or with technology such as force plates and motion capture systems (Kanekar & Aruin, 2013). However, clinicians have time constraints, technology is expensive, and trained personnel is needed. Moreover, due to the COVID-19 pandemic, access to in-person clinical visits is limited. As a result, pwMS may not receive fall risk screening and remain vulnerable to fall related injuries. Mobile technology offers a solution to increase access to fall risk screening using an affordable, ubiquitous, and portable tool (Guise et al., 2014; Marrie et al., 2019). Therefore, the overarching goal of this study was to develop a usable fall risk health application (app) for pwMS to self-assess their fall risk in the home setting. Four studies were performed: 1) smartphone accelerometry was tested to measure postural control in pwMS; 2) a fall risk algorithm was developed for a mobile health app; 3) a fall risk app, Steady-MS, was developed and its usability was tested; and 4) the feasibility of home-based procedures for using Steady-MS was determined. Results suggest that smartphone accelerometry can assess postural control in pwMS. This information was used to develop an algorithm to measure overall fall risk in pwMS and was then incorporated into Steady-MS. Steady-MS was found to be usable among MS users and feasible to use in the home setting. The results from this project demonstrate that pwMS can independently assess their fall risk with Steady-MS in their homes. For the first time, pwMS are equipped to self-assess their fall risk and can monitor and manage their risk. Home-based assessments also opens the potential to offer individualized and targeted treatments to prevent falls. Ultimately, Steady-MS increases access to home-based assessments to reduce falls and improve functional independence for those with MS