{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:27Z","timestamp":1785545067604,"version":"3.56.0"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Efforts are being made to integrate digital health technologies into clinical care for multiple sclerosis (MS) to improve patient monitoring. Efficiently probing how they might impact clinical care could streamline digital tool development. The Floodlight digital tool, comprising 5 smartphone sensor\u2013based tests, was used to generate health-related data on patient function and symptoms in a clinical simulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The study had 3 objectives: (1) assess the utility of simulated clinical encounters as a research methodology for exploring the introduction of digital health technologies into clinical practice in MS, (2) confirm the fidelity of the simulated environment and patient cases developed and understand what metrics (eg, workflow, comprehensive evaluation) could be generated, and (3) generate insights into the utility of digitally collected data, including usability, clinical decision contribution, and impact on workflows, in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 2 patient cases consisting of clinical, radiological, and digital health data were developed with clinician input. US-based neurologists prepared for and conducted 2 simulated teleconsultations each, with an actor briefed on case profiles. Floodlight data were available, via the Floodlight MS\u2122 Health Care Professional Portal, for 1 of the 2 consultations. Participant neurologists completed interviews and surveys assessing the fidelity of the cases presented, user experience and workflow metrics, patient concerns identified, care decisions made, and confidence in making decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All 10 neurologists indicated that the simulations were high-fidelity representations of real consultations. Using the Floodlight technology for the first time, median time taken to prepare for and conduct the consultation was ~1.7\u20102 minutes longer, with slightly greater mental effort reported by participants, compared with not using the tool. The Floodlight MS Health Care Professional Portal scored an \u201cabove average\u201d 79 on the System Usability Scale and an \u201cacceptable\u201d Net Promoter Score of 10. In total, 6 of the 10 neurologists \u201cstrongly agreed\u201d that it was easier and quicker to identify patient concerns when they had access to the patient-generated Floodlight data to prepare for their encounters than when they did not. Overall, more care and management decisions were taken when the digital tool was used (37 vs 29). Of those 37 decisions, Floodlight data were reported as a trigger for 20 decisions, always in combination with other elements including patient history (20\/20) and clinical exam findings (9\/20).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings advance our understanding of clinical simulation as a method for evaluating digital tools and other innovative technologies for MS care. High-fidelity patient cases could be provided for the mock teleconsultations, and the simulated clinical environment was useful for evaluating usability and utility of a new digital tool\u2014yielding preliminary evidence on how digital data could be accessed and utilized by neurologists to support routine MS care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/67845","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T05:39:55Z","timestamp":1765517995000},"page":"e67845-e67845","source":"Crossref","is-referenced-by-count":0,"title":["Simulation of Clinical Visits as a Novel Approach to Evaluate Digital Health in Multiple Sclerosis: Simulation Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2034-8800","authenticated-orcid":false,"given":"Riley","family":"Bove","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-2406","authenticated-orcid":false,"given":"Luca","family":"Capezzuto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9452-9113","authenticated-orcid":false,"given":"Imogen","family":"West","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6713-0334","authenticated-orcid":false,"given":"Simon","family":"Dryden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4487-6904","authenticated-orcid":false,"given":"Saira","family":"Ghafur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8094-5420","authenticated-orcid":false,"given":"Jack","family":"Halligan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6578-4147","authenticated-orcid":false,"given":"Stanislas","family":"Hubeaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1609-4588","authenticated-orcid":false,"given":"Agne","family":"Kazlauskaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"issue":"9","key":"R1","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1001\/jamaneurol.2020.1568","article-title":"Contribution of relapse-independent progression vs relapse-associated worsening to overall confirmed disability accumulation in typical relapsing multiple sclerosis in a pooled analysis of 2 randomized clinical trials","volume":"77","author":"Kappos","journal-title":"JAMA Neurol"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1177\/1352458515599075","article-title":"Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression","volume":"22","author":"Moccia","journal-title":"Mult Scler"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1038\/s41572-018-0041-4","article-title":"Multiple sclerosis","volume":"4","author":"Filippi","journal-title":"Nat Rev Dis Primers"},{"issue":"10130","key":"R4","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/S0140-6736(18)30481-1","article-title":"Multiple sclerosis","volume":"391","author":"Thompson","journal-title":"Lancet"},{"issue":"9","key":"R5","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11091247","article-title":"Developing a digital solution for remote assessment in multiple sclerosis: from concept to software as a medical device","volume":"11","author":"van der Walt","journal-title":"Brain Sci"},{"issue":"11","key":"R6","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1212\/wnl.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)","volume":"33","author":"Kurtzke","journal-title":"Neurology (ECronicon)"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1177\/20552173231155055","article-title":"New algorithmic approach for easier and faster extended disability status scale calculation","volume":"9","author":"Fouad","journal-title":"Mult Scler J Exp Transl Clin"},{"issue":"7","key":"R8","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1212\/WNL.0000000000012185","article-title":"American Academy of Neurology telehealth position statement","volume":"97","author":"Hatcher-Martin","journal-title":"Neurology (ECronicon)"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200070","article-title":"Remote observational research for multiple sclerosis: a natural experiment","volume":"10","author":"Bove","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2024.107544","article-title":"VIRTUAL versus usual in-office care for multiple sclerosis: the VIRTUAL-MS multi-site randomized clinical trial study protocol","volume":"142","author":"McGinley","journal-title":"Contemp Clin Trials"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/rehab.7805","article-title":"The use of digital and remote communication technologies as a tool for multiple sclerosis management: narrative review","volume":"5","author":"Marziniak","journal-title":"JMIR Rehabil Assist Technol"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2016.07.003","article-title":"Brain health: time matters in multiple sclerosis","volume":"9 Suppl 1","author":"Giovannoni","journal-title":"Mult Scler Relat Disord"},{"issue":"3","key":"R13","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1097\/WCO.0000000000000561","article-title":"Disease-modifying treatments for early and advanced multiple sclerosis: a new treatment paradigm","volume":"31","author":"Giovannoni","journal-title":"Curr Opin Neurol"},{"issue":"5","key":"R14","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1002\/ana.25463","article-title":"Silent progression in disease activity-free relapsing multiple sclerosis","volume":"85","author":"University of California, San Francisco MS-EPIC Team","journal-title":"Ann Neurol"},{"issue":"6","key":"R15","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000162","article-title":"Evaluating more naturalistic outcome measures: a 1-year smartphone study in multiple sclerosis","volume":"2","author":"Bove","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2018.00740","article-title":"Identifying and quantifying neurological disability via smartphone","volume":"9","author":"Boukhvalova","journal-title":"Front Neurol"},{"issue":"3","key":"R17","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1089\/dia.2008.0283","article-title":"WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction","volume":"10","author":"Quinn","journal-title":"Diabetes Technol Ther"},{"issue":"2","key":"R18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7309\/jmtm.6.2.1","article-title":"Patient-oriented health technologies: patients\u2019 perspectives and use","volume":"6","author":"Bauer","journal-title":"J Mob Technol Med"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1177\/1352458516671204","article-title":"Shared decision-making in multiple sclerosis","volume":"23","author":"Colligan","journal-title":"Mult Scler"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-020-00314-2","article-title":"Challenges for the evaluation of digital health solutions\u2014a call for innovative evidence generation approaches","volume":"3","author":"Guo","journal-title":"NPJ Digit Med"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","first-page":"35","DOI":"10.4103\/1319-1683.68787","article-title":"Simulation-based medical teaching and learning","volume":"17","author":"Al-Elq","journal-title":"J Family Community Med"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1542\/peds.2013-3267","article-title":"Designing and conducting simulation-based research","volume":"133","author":"Cheng","journal-title":"Pediatrics"},{"issue":"11","key":"R23","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1177\/1352458518793527","article-title":"Toward a low-cost, in-home, telemedicine-enabled assessment of disability in multiple sclerosis","volume":"25","author":"Bove","journal-title":"Mult Scler"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/46521","article-title":"Assessment of upper extremity function in multiple sclerosis: feasibility of a digital pinching test","volume":"7","author":"Graves","journal-title":"JMIR Form Res"},{"issue":"Suppl","key":"R25","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211044667","article-title":"A digital remote assessment for measuring impairment in information processing speed in people with MS","volume":"27","author":"Dondelinger","journal-title":"Mult Scler"},{"issue":"5","key":"R26","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/ab8771","article-title":"Smartphone-based remote assessment of upper extremity function for multiple sclerosis using the Draw a Shape Test","volume":"41","author":"Creagh","journal-title":"Physiol Meas"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2020.11.025","article-title":"U-turn speed is a valid and reliable smartphone-based measure of multiple sclerosis-related gait and balance impairment","volume":"84","author":"Cheng","journal-title":"Gait Posture"},{"issue":"20","key":"R28","doi-asserted-by":"publisher","DOI":"10.3390\/s20205906","article-title":"Gait characteristics harvested during a smartphone-based self-administered 2-minute walk test in people with multiple sclerosis: test-retest reliability and minimum detectable change","volume":"20","author":"Bourke","journal-title":"Sensors (Basel)"},{"issue":"3","key":"R29","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1109\/JBHI.2020.2998187","article-title":"Smartphone- and smartwatch-based remote characterisation of ambulation in multiple sclerosis during the two-minute walk test","volume":"25","author":"Creagh","journal-title":"IEEE J Biomed Health Inform"},{"issue":"8","key":"R30","doi-asserted-by":"publisher","DOI":"10.2196\/14863","article-title":"Adherence and satisfaction of smartphone- and smartwatch-based remote active testing and passive monitoring in people with multiple sclerosis: nonrandomized interventional feasibility study","volume":"21","author":"Midaglia","journal-title":"J Med Internet Res"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s40120-021-00239-2","article-title":"Comprehensive approach to management of multiple sclerosis: addressing invisible symptoms\u2014a narrative review","volume":"10","author":"Lakin","journal-title":"Neurol Ther"},{"issue":"8","key":"R32","doi-asserted-by":"publisher","DOI":"10.2196\/37290","article-title":"System usability scale benchmarking for digital health apps: meta-analysis","volume":"10","author":"Hyzy","journal-title":"JMIR Mhealth Uhealth"},{"key":"R33","doi-asserted-by":"crossref","unstructured":"Paas F Ayres P Pachman M . Assessment of cognitive load in multimedia learning: theory, methods and applications. In: Robinson DH Schraw G , editors. Recent Innovations in Educational Technology That Facilitate Student Learning. Information Age Publishing Inc; 2008:11-36. URL: https:\/\/researchers.mq.edu.au\/en\/publications\/assessment-of-cognitive-load-in-multimedia-learning-theory-method\/ [Accessed 02-12-2025] ISBN: 9781593116521","DOI":"10.1108\/978-1-60752-942-220251003"},{"key":"R34","unstructured":"Luck I . What is a Good Net Promoter Score (NPS)? 4 Approaches. Customer Gauge; 2023. URL: https:\/\/customergauge.com\/what-is-a-good-net-promoter-score [Accessed 23-07-2024]"},{"key":"R35","unstructured":"Our commitment to transparency of clinical study information. Roche. URL: https:\/\/go.roche.com\/data_sharing [Accessed 19-11-2025]"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-14-58","article-title":"Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with multiple sclerosis","volume":"14","author":"Meyer-Moock","journal-title":"BMC Neurol"},{"issue":"13","key":"R37","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1177\/1352458518808204","article-title":"Symbol Digit Modalities Test: a valid clinical trial endpoint for measuring cognition in multiple sclerosis","volume":"25","author":"Strober","journal-title":"Mult Scler"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.103793","article-title":"Challenges to longitudinal characterization of lower urinary tract dysfunction in multiple sclerosis","volume":"62","author":"Kaplan","journal-title":"Mult Scler Relat Disord"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2019.09.017","article-title":"Medical emergencies in the primary care setting: an evidence based practice approach using simulation to improve readiness","volume":"49","author":"Monachino","journal-title":"J Pediatr Nurs"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecns.2021.04.011","article-title":"Using simulation to enhance nurse practitioner students cultural sensitivity, communication, and empathy with vulnerable populations","volume":"56","author":"Turkelson","journal-title":"Clin Simul Nurs"},{"issue":"4","key":"R41","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1212\/CPJ.0000000000000986","article-title":"Electronic health record technology designed for the clinical encounter: MS NeuroShare","volume":"11","author":"Bove","journal-title":"Neurol Clin Pract"},{"issue":"4","key":"R42","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1177\/1757177420907999","article-title":"Electronic hand hygiene monitoring: accuracy, impact on the Hawthorne effect and efficiency","volume":"21","author":"Gould","journal-title":"J Infect Prev"},{"key":"R43","volume":"9","author":"Sujatha","journal-title":"Int J Dev Res"}],"container-title":["JMIR Medical Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medinform.jmir.org\/2025\/1\/e67845","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:27:35Z","timestamp":1785536855000},"score":1,"resource":{"primary":{"URL":"https:\/\/medinform.jmir.org\/2025\/1\/e67845"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":43,"URL":"https:\/\/doi.org\/10.2196\/67845","relation":{},"ISSN":["2291-9694"],"issn-type":[{"value":"2291-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]},"article-number":"v13i9e67845"}}