title: The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: concept, content, and pilot results.
abstract: BACKGROUND
  There is a growing need to offer persons with multiple sclerosis (PwMS) possibilities for self-management and to integrate multidisciplinary health data. In 2009-2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor) for (self-)monitoring, self-management and integrated, multidisciplinary care in MS.
  
  
  METHODS
  The notions underlying the MSmonitor concept and the program's elements are described. We analyze MSmonitor's role in the self-management of fatigue by retrospective comparison of fatigue and health-related quality of life (HRQoL) before and after usage of specific elements of MSmonitor, and by a correlative analysis between frequency of usage and fatigue change.
  
  
  RESULTS
  After a step-wise development the program comprises six validated questionnaires: Multiple Sclerosis Impact Profile, Modified Fatigue Impact Scale-5 items (MFIS-5), Hospital Anxiety and Depression Scale, Multiple Sclerosis Quality of Life-54 items, and the 8-item Leeds Multiple Sclerosis Quality of Life (LMSQoL) questionnaires; two inventories: Medication and Adherence Inventory, Miction Inventory; two diaries: Activities Diary, Miction Diary; and two functionalities: e-consult and personal e-logbook. The program is now used in 17 hospitals by 581 PwMS and their neurologists, MS nurses, physical therapists, rehabilitative doctors, continence nurses, and family doctors. Those PwMS (N=105) who used the LMSQoL and MFIS-5 questionnaires at least twice in a period of up to 6 months, showed improved HRQoL (P<0.026). In the subgroup (N=56) who had also used the Activities Diary twice or more, the frequency of diary usage correlated modestly with the degree of fatigue improvement (r=0.292; P=0.028).
  
  
  CONCLUSIONS
  MSmonitor is an interactive web-based program for self-management and integrated care in PwMS. Pilot data suggest that the repeated use of the short MFIS-5 and LMSQoL questionnaires is associated with an increase in HRQoL, and that a repeated use of the Activities Diary might contribute to the self-management of fatigue.
authors.affiliation: Department of Community and Occupational Medicine, University Medical Center Groningen, University Groningen, Groningen, the Netherlands ; MS4 Research Institute, Nijmegen, the Netherlands.
authors.forename: Peter Joseph
authors.initials: PJ
authors.lastname: Jongen
authors.affiliation: Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: Ludovicus G
authors.initials: LG
authors.lastname: Sinnige
authors.affiliation: Department of Neurology, Medical Centre Alkmaar, Alkmaar, the Netherlands.
authors.forename: Björn M
authors.initials: BM
authors.lastname: van Geel
authors.affiliation: Department of Neurology, Groene Hart Hospital, Gouda, the Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Verheul
authors.affiliation: Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
authors.forename: Wim I
authors.initials: WI
authors.lastname: Verhagen
authors.affiliation: Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands.
authors.forename: Ruud A
authors.initials: RA
authors.lastname: van der Kruijk
authors.affiliation: Department of Neurology, Zuwe Hofpoort Hospital, Woerden, the Netherlands.
authors.forename: Reinoud
authors.initials: R
authors.lastname: Haverkamp
authors.affiliation: Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, the Netherlands.
authors.forename: Hans M
authors.initials: HM
authors.lastname: Schrijver
authors.affiliation: Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, the Netherlands.
authors.forename: J Coby
authors.initials: JC
authors.lastname: Baart
authors.affiliation: Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, Tilburg, the Netherlands.
authors.forename: Leo H
authors.initials: LH
authors.lastname: Visser
authors.affiliation: Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, Tilburg, the Netherlands.
authors.forename: Edo P
authors.initials: EP
authors.lastname: Arnoldus
authors.affiliation: Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands.
authors.forename: H Jacobus
authors.initials: HJ
authors.lastname: Gilhuis
authors.affiliation: Department of Neurology, Viecuri Medical Centre, Venlo-Venray, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Pop
authors.affiliation: Multiple Sclerosis Centre, Amphia Hospital, Breda, the Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Booy
authors.affiliation: Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Lemmens
authors.affiliation: Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Rogier
authors.initials: R
authors.lastname: Donders
authors.affiliation: Curavista bv, Geertruidenberg, the Netherlands.
authors.forename: Anton
authors.initials: A
authors.lastname: Kool
authors.affiliation: Curavista bv, Geertruidenberg, the Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: van Noort
keywords: care; multidisciplinary; multiple sclerosis; patient-reported outcome; self-management; web-based