Predictors of Successful Acceptance of Home Telemanagement in Multiple Sclerosis

Background: MS is an auto-immune disease that affects central nervous system. Patients suffer from a wide range of symptoms including muscle spasms, vision loss, problems with walking, and coordination. Due to the nature of MS progression, many patients are unable or unwilling to travel to visit a doctor. In this study, we assessed feasibility and acceptance of an on-line telemedicine application that facilitates remote MS monitoring and management by helping patients maintain a symptom diary, educating them about MS, and communicating patient status to a case manager.

Objectives: The Home Automated Telemanagement (HAT) system was developed as a tool to assist patients with multiple sclerosis (MS) with more effective MS self-management. This study investigated factors affecting successful acceptance of home telemanagement by veterans with MS.

Methods: A total of 20 consecutive patients with MS were recruited from Washington DC VA Medical Center. First, the research staff visited the patient’s home and provided a training session on how to access MS HAT from their home computer. The link to the website, user ID and password was given to each patient. During the home visit, a set of questionnaires was administered to collect information about demographics and self-care strategies. Then the patients were asked to use the MS HAT for at least one month preferably on a daily basis. The data was transferred via secure internet network to a care management web site. MS HAT acceptance was ascertained using a semi-structured qualitative patient interviews and attitudinal surveys at the end of the study. A regression model with acceptance score as a primary outcome was used to identify factors affecting acceptance of MS HAT. The model included age, race, years of education, years of having MS, English proficiency, Expanded Disability Scale Score (EDSS) and frequency of computer use at home. Statistical analyses were performed using SAS version 9.0.      

Results: The mean age of participants was 54 years old (53.9±10.0) and they had MS on average for 15 years (14.5±8.3), 70% were men, 60% were African Americans, 85% used computer at home, and 80% reported internet use on a daily basis. The initial training session lasted on average 26.6±8.9 minutes. The mean EDSS score was 5.3±2.3 ranging from 1.0 to 8.0; 15% of participants had Primary Progressive MS, 30% - Relapsing Remitting, and 55% - Secondary Progressive MS. Based on the linear regression model, less years of having MS, computer use at home once a week or less, and better English proficiency were significant factors for MS HAT acceptance. Age, race, years of education and race did not show statistically significant association with the acceptance score. 

Conclusions: The MS HAT application provides a novel way to manage MS and to bring the patients and the doctors more closely. Tailoring this technology to patient needs and preferences may improve its acceptance by veterans with MS.