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Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study

Andrews, Jacob A; Craven, Michael P; Guo, Boliang; Weyer, Janice; Lees, Simon; Zormpas, Spyridon I; Thorpe, Sarah E; Devonshire, Julie; San Antonio-Arce, Victoria; Whitehouse, William P; Julie, Jessica; Malins, Sam; Hammers, Alexander; Reif, Andreas; Ruhe, Henricus G; Durbano, Federico; Barlati, Stefano; Sen, Arjune; Frederiksen, Jette L; Martinelli, Alessandra; Callen, Antonio; Torras-Borrell, Joan; Berrocal-Izquierdo, Nuria; Zabalza, Ana; Morriss, Richard; Hollis, Chris; RADAR-CNS Consortium

Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study Thumbnail


Industry Engagement Manager: mental Heal

Associate Professor

Janice Weyer

Simon Lees

Spyridon I Zormpas

Sarah E Thorpe

Julie Devonshire

Victoria San Antonio-Arce

William P Whitehouse

Jessica Julie

Sam Malins

Alexander Hammers

Andreas Reif

Henricus G Ruhe

Federico Durbano

Stefano Barlati

Arjune Sen

Jette L Frederiksen

Alessandra Martinelli

Antonio Callen

Joan Torras-Borrell

Nuria Berrocal-Izquierdo

Ana Zabalza

Professor of Psychiatry and Community Mental Health

Professor of Child and Adolescent Psychiatry and Digital Mental Health

RADAR-CNS Consortium


Background: Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system conditions in which remote measurement technology (RMT) may offer benefits compared with usual assessment. We previously worked with clinicians, patients, and researchers to develop 13 use cases for RMT: 5 in epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis), 3 in MS (detecting silent progression, detecting depression in MS, and donating data to a biobank), and 5 in depression (detecting trends, reviewing treatment, self-management, comorbid monitoring, and carer alert).

Objective: In this study, we aimed to evaluate the use cases and related implementation issues with an expert panel of clinicians external to our project consortium.

Methods: We used a Delphi exercise to validate the use cases and suggest a prioritization among them and to ascertain the importance of a variety of implementation issues related to RMT. The expert panel included clinicians from across Europe who were external to the project consortium. The study had 2 survey rounds (n=23 and n=17) and a follow-up interview round (n=9). Data were analyzed for consensus between participants and for stability between survey rounds. The interviews explored the reasons for answers given in the survey.

Results: The findings showed high stability between rounds on questions related to specific use cases but lower stability on questions relating to wider issues around the implementation of RMT. Overall, questions on wider issues also had less consensus. All 5 use cases for epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis) were considered beneficial, with consensus among participants above the a priori threshold for most questions, although use case 3 (risk scoring) was considered less likely to facilitate or catalyze care. There was very little consensus on the benefits of the use cases in MS, although this may have resulted from a higher dropout rate of MS clinicians (50%). Participants agreed that there would be benefits for all 5 of the depression use cases, although fewer questions on use case 4 (triage support) reached consensus agreement than for depression use cases 1 (detecting trends), 2 (reviewing treatment), 3 (self-management), and 5 (carer alert). The qualitative analysis revealed further insights into each use case and generated 8 themes on practical issues related to implementation.

Conclusions: Overall, these findings inform the prioritization of use cases for RMT that could be developed in future work, which may include clinical trials, cost-effectiveness studies, and the commercial development of RMT products and services. Priorities for further development include the use of RMT to provide more accurate records of symptoms and treatment response than is currently possible and to provide data that could help inform patient triage and generate timely alerts for patients and carers.

Journal Article Type Article
Acceptance Date Feb 24, 2023
Online Publication Date Apr 25, 2023
Publication Date 2023
Deposit Date Apr 25, 2023
Publicly Available Date Apr 27, 2023
Journal JMIR Neurotechnology
Electronic ISSN 2817-092X
Publisher JMIR Publications Inc.
Peer Reviewed Peer Reviewed
Volume 2
Article Number e41439
Keywords mobile health; mHealth; wearable; wearable technology; smartphone; use case; implementation; epilepsy; multiple sclerosis; MS; depression; depressive disorder; Delphi; remote measurement technology; RMT; central nervous system; nervous system disorder; ne
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