Feasibility and usability evaluation of a gamified fatigue management mobile application for persons with multiple sclerosis in everyday life

Journal article, 2025

Background: Fatigue is the most debilitating and prevalent symptom of multiple sclerosis (MS), affecting up to 80 % of patients and significantly impairing quality of life (QoL). Managing MS fatigue is challenging due to its multifactorial nature, encompassing physical, cognitive, and psychosocial components. Mobile health (mHealth) tools offer promising approaches for self-management, but most lack personalization and rigorous validation. More Stamina, a gamified mHealth application, was developed to support MS patients by tracking energy expenditure and facilitating fatigue management. Methods: A 60-day mixed-methods pilot study was conducted with 20 participants recruited from Oulu University Hospital, Finland. Participants, meeting predefined criteria for MS diagnosis and digital health literacy, tracked daily activities using More Stamina. Standardized instruments assessed fatigue: Fatigue Severity Scale (FSS), QoL (15D), System Usability Scale (SUS), and eHealth literacy (eHEALS). App engagement patterns were analyzed using log data, while think-aloud protocols and semi-structured interviews captured qualitative insights into user experience. Results: Participants were segmented into power, regular, and light users based on level of engagement. Power users reported higher fatigue severity (mean FSS = 6.31) but better QoL (mean inverted HRQoL = 0.58) compared to light users. More Stamina usability scores improved over time (SUS mean: Day 1 = 27.75; Day 60 = 35.88), reflecting growing fluency of use. Activity tracking included physical, cognitive, and social tasks, revealing subjective differences in perceived energy costs. Participants highlighted the app's role in increasing self-awareness of fatigue and facilitating communication with family and healthcare providers. Emerging uses included journaling and tracking fatigue patterns for medical consultations. Challenges included technical issues and the cognitive burden of repetitive data entry. Conclusions: More Stamina is a feasible and acceptable gamified mHealth app for MS fatigue management. It seems to improve self-awareness and supports proactive energy planning, particularly for users with severe fatigue. Despite initial technical challenges, the app shows potential for integration into broader MS management strategies. Larger, long-term studies are needed to evaluate clinical efficacy and optimize design for sustained engagement.