iPad 9-Hole Peg Test Correlates With MS Imaging

Damian McNamara

October 15, 2018

BERLIN — The time it takes to complete a manual dexterity test (MDT) on an iPad significantly correlated with multiple patient-reported outcomes and MRI markers of multiple sclerosis in a study with nearly 1000 participants.

Dominant hand performance on the tablet-based test most strongly aligned with results of the Patient Determined Disease Steps (PDDS) and upper- and lower-extremity Neuro-QOL function testing. Patient performance was also particularly associated with T2 lesion volume, normalized whole-brain volume, thalamic volume, and cervical spinal cord area on imaging.

"The relationship of the 9-Hole Peg Test and manual dexterity test...with patient outcomes is incompletely studied in real-world settings," Laura Baldassari, MD, a clinical neuroimmunology fellow at the Mellen Center for Multiple Sclerosis at Cleveland Clinic in Ohio, said here at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2018.

So she and colleagues studied how quickly 955 patients completed the Multiple Sclerosis Performance Test (MSPT) on an iPad at their institution. The MSPT collects patient-reported outcomes and data regarding four neuroperformance test metrics: processing speed, walking, manual dexterity, and contrast sensitivity.

Because the data are collected on an iPad, the MSPT "can be accomplished under the supervision of medical assistant or independently by the patient," Baldassari said.

Results are automatically uploaded to Cleveland Clinic's electronic medical record system and are immediately available for clinician review.

The researchers tracked time to complete the MDT for both dominant and nondominant hands.

Participants completed the MSPT between December 2015 and December 2017. The mean age of the patients was 48 years, and 72% of the cohort were women.

Patient-reported outcomes included results the Neuro-QOL quality-of-life measure, the Patient Health Questionnaire–9 (PHQ9) and the PDDS, which is a self-reported adaptation of the Expanded Disability Status Scale.

In addition, participants underwent a brain MRI within 3 months of taking the MSPT.

The data were analyzed using Spearman correlation coefficients and linear regression models.

A Need for Speed

The researchers reported a statistically significant correlation between the time to complete a dominant-hand MDT and all patient-reported outcomes (P < .001).

The strongest links emerged between MDT time and PDDS (rho value, 0.52), and Neuro-QOL upper-extremity (-0.53) and Neuro-QOL lower-extremity (-0.56) results.

In other words, "With increasingly improved upper-extremity function, the speed on the MDT improved as well," Baldassari said.

In addition, the investigators found significant moderate correlations between MDT performance and MRI findings: T2 lesion volume (rho value, 0.36), brain volume (-0.32), thalamic volume (-0.36), and cervical spinal cord area (-0.27).

For example, a quicker time to complete the MDT was associated with a larger whole-brain volume, whereas a longer time was observed among participants with greater T2 lesion volume.

In a linear regression analysis controlling for age, sex, and PDDS score, MDT performance significantly correlated with all of the MRI metrics (P < .001). "The most significant MRI contributors were T2 lesion volume and whole-brain fraction [measures]," she said.

"These correlations support validity of MDT," Baldassari said.

Session comoderator Jürg Kesselring, Dr Med, of the Department of Neurology and Neurorehabilitation at the Rehabilitation Center in Valens, Switzerland, asked Baldassari if she had compared how well the iPad-based test correlated with the manual 9-Hole Peg Test.

"We did not do that as part of this project, but other ongoing studies show a strong correlation between the two," she replied.

Baldassari and colleagues plan to next focus on evaluating the longitudinal association over time between neuroperformance testing and patient-reported outcomes and imaging findings.

A User-Friendly Option

Asked to comment on the findings, session moderator Anat Achiron, MD, PhD, of the Multiple Sclerosis Center at Sheba Medical Center in Tel Aviv, Israel, who was not affiliated with the study, told Medscape Medical News that the iPad-based test is something that could "definitely" be used in clinical practice.

This technology appears user-friendly for both occupational therapists and patients, she added. The test could be completed while a patient is waiting in the clinic or at home, "so it will save time."

Her only reservation is that a learning effect could happen over time, Achiron said, because patients could attain better skills through practice.

A National Multiple Sclerosis Society grant supported the study. Dr Baldassari is a member of the scientific advisory board for Teva and receives funding via a Sylvia Lawry Physician Fellowship grant through the National Multiple Sclerosis Society. Dr Achiron has disclosed no relevant financial relationships.

34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2018. Abstract 275, presented October 12, 2018.

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