A Pilot Study of Real Time Longitudinal Fatigue Monitoring in Adults with Relapsing Remitting MS (RRMS)

Background: Fatigue is rated as one of the most common and disabling symptoms in adults with multiple sclerosis (MS). Further, fatigue is subjective and occurs at different times of day in and across patients groups (Heine et al., 2016; Kim et al, 2010). Likewise, the time-dependence of fatigue warrants investigation in the form of analyses for personalized patient characteristics.  Convenient and reliable monitoring methods need to be created to capture longitudinal real time data for these measures.

Objectives: To monitor fatigue severity in real time and correlate it with measures of cognition, depression, MS disease duration, MS functional limitations, perceived biopsychosocial disability, and also evaluated medication adherence.

Methods: A convenience sample of adults with MS used web-based surveys to report fatigue, medication adherence, and injection site reactions (ISR) daily for 7 days at baseline and again 30 days later for 7 days. Fatigue was evaluated using the NIH PROMIS MS Fatigue Scale Short Form, cognition with the NIH PROMIS Cognitive Abilities scale, depression severity with the CES-D short form, pain with the VAS scale, MS related functional impairment with the SR- EDSS, and perceived biopsychosocial disability with the WHO-DAS-II. Medication adherence was measured with the Morisky Scale. First day of the first 7 day period (time 1) and first day of the second 7 day period (time 2) were used for the analysis.

Results: Thirty-two participants aged 33 to 67 participated. Fatigue and pain scores did not significantly differ between time 1 and time 2.  Fatigue correlated significantly with pain (p<.01), and WHO-DAS (p<.02). Pain correlated positively with SR-EDSS (p<.01) and WHO-DAS (p<.01) and negatively with disease duration (p<.05). Age and SR-EDSS were also significantly correlated (p<.02) and cognitive impairment and depression severity were correlated at time 2 (p<.02).  Medication adherence indicated a significant difference from baseline at time 1 (p <.009) and at time 2 (p <.03) for forgetting DMT associated with higher fatigue. 

Conclusions: This pilot study of longitudinal fatigue monitoring proved feasible and demonstrated correlations between measures of fatigue and pain with other self-report measures.  Further study using this application is supported based on these results.