Initial Clinical Implementation of the Multiple Sclerosis Performance Test

Background: the Multiple Sclerosis Performance Test is an iPad-based assessment comprised of 2 patient-completed questionnaires: MyHealth (MH) and Neuro-QoL (NQ) and four objective performance assessments: the Low Contrast Letter Acuity Test (LCLAT), the Manual Dexterity Test (MDT), the Processing Speed Test (PST) and the Walking Speed Test (WST).  Goals of incorporating the MSPT into the clinical workflow are to 1) enable routine structured data collection to inform individual patient care 2) minimize impact to clinical workflow through self-administered testing 3) allow aggregation of data that will facilitate research. In the initial pilot, 103 MSPT Assessments were obtained allowing us to understand the clinical implications of using MSPT in every day clinical setting. 

Objectives: To report on initial use of the MSPT in the clinical setting.

Methods: In September 2015, go-live occurred in 2 follow-up practices. One Medical Assistant (MA) administered MSPT to up to 2 patients simultaneously prior to their office visit.   Completeness of all MSPT components, Assessment Duration, and patient engagement were analyzed. 

Results: 103 MSPT Assessments were completed and administered by 3 MAs. MA1 completed 20 assessments with a 30% module completeness rate. MA2 completed 70 assessments with 31% module completeness. MA3 completed 13 assessments with a 69% module completeness rate. Total MA completeness 36%. For each of the 6 individual components the completeness percentages were: MH:100%, NQ:53%, LCLAT:43%, MDT:75%, PST:74%, WST:72%. All assessments took an average of 28 minutes. Complete assessments took an average of 31 minutes. Over the first 4 weeks duration to complete did not change but completeness increased. Time to complete each individual module took the following time (minutes:sec): MH: Mean ± SD=8:05 ± 4:28 (n= 103), NQ: 7:38±3:19 (n= 55), LCLAT: 6:22±1:00 (n=44), PST: 4:33±1:28 (n=76) MDT: 4:42±1:29 (n= 77),WST: 2:13±0:36 (n=74). There was a significant association between performance on neuroperformance tests and overall assessment duration.

Conclusions:  The MSPT provides a mechanism to collect structured neuroperformance & patient-entered data in routine clinical practice with minimal assistance. Completeness of the data varied by MA and improved over time and with experience. In our patient cohort, performance on functional tests were predictors of overall assessment duration, with the most significant predictors being PST, MDT (dominant hand) and WST. Completeness & time spent on each component are measurable indicators for clinical workflow. By capturing patient data in this format we hope to improve patient engagement, improve clinical efficiency and allow further advancements in MS care.