New study shows promise for gamified mHealth App in managing MS-related fatigue

Fatigue affects up to 80% of MS patients and has a profound impact on their quality of life with patients feeling exhausted, misunderstood, and unsupported.

Trinity researchers have developed a new gamified mobile health (mHealth) app designed to help people with Multiple Sclerosis (MS) manage fatigue, one of the most common and debilitating symptoms of the disease. 

The research - led by Dr Guido Giunti, Adjunct Professor, School of Medicine, Trinity College Dublin andAssociate Professor of Digital Health at the University of Oulu, Finland, and researchers from the University of Oulu and Oulu University Hospital - evaluated the feasibility, usability, and impact of the app, More Stamina over a 60-day period. The study, which highlights the potential of the app, is published in the journal Multiple Sclerosis and Related Disorders today [Thursday 13^th March 2025].

“Fatigue is an invisible but life-altering symptom of MS,” said Dr. Guido Giunti, Adjunct Professor, School of Medicine, Trinity College Dublin and leader of the More Stamina project. “Managing it requires more than just medication. More Stamina gives people the tools to understand their energy levels, take control of their day, and communicate their needs more effectively.”

The study followed 20 participants from Oulu University Hospital in Finland, who used the app daily for two months. 

KEY FINDINGS

• Users became more aware of their fatigue patterns, enabling them to plan their days more effectively.
• Higher engagement correlated with increased self-awareness, particularly among those with more severe fatigue.
• The app helped facilitate discussions with family members and healthcare providers, improving mutual understanding of fatigue’s impact.
• Usability improved over time, though some users found data entry cognitively demanding, indicating areas for refinement.

An Evidence-Driven Digital Health Solution

More Stamina (www.morestaminaapp.com) helps users track their daily activities and energy expenditure using “Stamina Credits”, a gamified approach that visualizes energy use and helps users make informed decisions about their daily plans.

Unlike many digital health solutions, More Stamina stands out for its research-driven approach at every stage, from identifying patient needs to design, prototyping, development, and testing. Each phase has been accompanied by peer-reviewed research, creating a transparent scientific trail for a mobile health solution.

Bringing Digital Health into MS Care

Fatigue affects up to 80% of MS patients and has a profound impact on their quality of life. Managing fatigue is challenging, as it involves physical, cognitive, and emotional factors, often leaving patients feeling exhausted, misunderstood, and unsupported. While digital health solutions have been increasingly proposed to help manage chronic conditions like MS, few have been rigorously evaluated to ensure their effectiveness and real-world impact. Neurologists at Oulu University Hospital emphasize the potential of such solutions in complementing traditional MS care.

While the study confirmed that More Stamina is a feasible and acceptable tool, researchers emphasize that larger and longer-term studies are needed to evaluate its full clinical impact. The team is now exploring ways to integrate More Stamina into broader MS care strategies.

Professor Minna Isomursu, University of Oulu, said:

“Digital health solutions are only as good as their foundation. We worked with real patients and healthcare professionals from the start to build something truly useful. That is key to creating tools that people actually find useful in their daily lives.”

Empowering Patients and Strengthening Family Dialogue

One of the unexpected yet powerful outcomes of the study was the role More Stamina played in facilitating conversations between MS patients and their families. Many participants reported that sharing their fatigue patterns with loved ones helped them feel understood and supported.

More Stamina’s development was not just about technology, it was about people. Active participation from patient representatives was key to ensuring that the app addressed real-life challenges.

Tonja Molin-Juustila, a patient representative involved in the project, said:

“Invisible fatigue is hard to explain to those who don’t experience it, especially since I do not always understand it myself. More Stamina gives you a concrete tool to look at fatigue and discuss it with the family. Instead of repeating ‘I’m so tired now’, it becomes ‘It seems you need to rest more often’. This makes a huge difference, turning the interaction from perceived guilt into mutual understanding.”

A Blueprint for Future Digital Health Solutions

Beyond its success in MS fatigue management, More Stamina serves as a model for future digital health innovations. By combining scientific rigor, user-centered design, and real-world testing, this project has created a blueprint for how digital solutions should be developed and integrated into healthcare.

Dr. Guido Giunti concluded:

"We need to move beyond gimmicks and ensure digital health solutions are truly beneficial. The way we’ve worked with More Stamina is proof that when we bring together science, technology, and patient voices, we can create tools that actually improve lives. We hope this approach sets a new standard for future digital health solutions.”

You can read the study ‘Feasibility and Usability Evaluation of a Gamified Fatigue Management Mobile Application for Persons with Multiple Sclerosis in Everyday Life’ at this link: https://www.sciencedirect.com/science/article/pii/S221103482500121X

The study was funded by Business Finland, the Finnish Innovation Fund (Sitra), the Riitta ja Jorma J. Takanen Foundation, and Marie Sklodowska-Curie Actions.