Point of choice visual feedback prompts elicit motor behavior changes in persons with multiple sclerosis

Abstract

Falls are common in persons with multiple sclerosis (PwMS), and their consequences further undermine quality of life. Current fall prevention interventions fail to address real-time stability challenges that may occur during cognitively complex daily activities. This need may be fulfilled by means of just-in-time interventions that leverage prompts delivered via a mobile app, having the aim of producing beneficial targeted biomechanical changes. Fourteen ambulatory PwMS completed multiple Timed Up-and-Go tests under cognitive load across two different visits. Two visual feedback prompts targeting trunk flexion during sit-to-stand transitions (STS-TF) and stance width (SW) during gait were delivered terminally via the Just in Time Fall Prevention app. Linear mixed-effects models with Dunnett’s correction were implemented to evaluate prompt-induced changes relative to baseline. Prompts were successfully able to systematically reduce STS-TF by 7.1° (p < 0.001, d = − 0.483) and to increase SW by 8.1 mm (p = 0.021, d = 0.259). The majority of participants reported willingness to use the app with and without physician prescription (95% and 68%, respectively). This study demonstrated for the first time that PwMS can produce targeted biomechanical adaptations in response to point-of-choice visual feedback prompts delivered by a mobile app, supporting just-in-time mobile interventions as a proactive fall prevention strategy.