title: Evaluating more naturalistic outcome measures: A 1-year smartphone study in multiple sclerosis.
abstract: OBJECTIVE
  In this cohort of individuals with and without multiple sclerosis (MS), we illustrate some of the novel approaches that smartphones provide to monitor patients with chronic neurologic disorders in their natural setting.
  
  
  METHODS
  Thirty-eight participant pairs (MS and cohabitant) aged 18-55 years participated in the study. Each participant received an Android HTC Sensation 4G smartphone containing a custom application suite of 19 tests capturing participant performance and patient-reported outcomes (PROs). Over 1 year, participants were prompted daily to complete one assigned test.
  
  
  RESULTS
  A total of 22 patients with MS and 17 cohabitants completed the entire study. Among patients with MS, low scores on PROs relating to mental and visual function were associated with dropout (p < 0.05). We illustrate several novel features of a smartphone platform. First, fluctuations in MS outcomes (e.g., fatigue) were assessed against an individual's ambient environment by linking responses to meteorological data. Second, both response accuracy and speed for the Ishihara color vision test were captured, highlighting the benefits of both active and passive data collection. Third, a new trait, a person-specific learning curve in neuropsychological testing, was identified using spline analysis. Finally, averaging repeated measures over the study yielded the most robust correlation matrix of the different outcome measures.
  
  
  CONCLUSIONS
  We report the feasibility of, and barriers to, deploying a smartphone platform to gather useful passive and active performance data at high frequency in an unstructured manner in the field. A smartphone platform may therefore enable large-scale naturalistic studies of patients with MS or other neurologic diseases.
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Riley
authors.initials: R
authors.lastname: Bove
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: White
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovannoni
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Glanz
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Victor
authors.initials: V
authors.lastname: Golubchikov
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Hujol
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Charles
authors.initials: C
authors.lastname: Jennings
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Langdon
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Anna
authors.initials: A
authors.lastname: Legedza
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: James
authors.initials: J
authors.lastname: Paskavitz
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Sashank
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: John
authors.initials: J
authors.lastname: Richert
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Allison
authors.initials: A
authors.lastname: Robbins
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Howard
authors.initials: H
authors.lastname: Weiner
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramachandran
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Martyn
authors.initials: M
authors.lastname: Botfield
authors.affiliation: Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: De Jager