I was born in Aberdeen in Scotland and did my undergraduate and master’s degree at Aberdeen University before moving to England in 2010 to do my PhD at Newcastle University. I moved to Australia in 2018; I lived in Melbourne for a couple of years and then moved to sunny Queensland.

Over the last 12 years I have been interested in research methods called N-of-1 trials and other ‘single-case’ designs. These methods involve taking repeated outcome measurements from an individual over time to draw conclusions that are specific to that individual. I discovered that these methods could apply well to MS research because MS is a heterogeneous condition, where the symptoms experienced by one person with MS can differ dramatically from the symptoms of another. I believe methods that focus on individuals can provide a crucial perspective to our understanding and management of MS.

In recent years there has been a lot of interesting research conducted in Australia and internationally. One development that I think is particularly exciting to hear is that there are more potential MS therapies in development today than at any other time in history. I am excited about the potential to use N-of-1 trials to test therapies for managing the symptoms of MS. Research often uses large clinical trials to determine whether a treatment works on average. In contrast, N-of-1 trials can be used to test treatments in an individual by using them as their own control. We know that response to therapy can be heterogeneous in MS so N- of-1 trials would be valuable for determining individual patient response to therapies.

We are interested in understanding fatigue fluctuations and triggers in MS at the individual patient level. We will use N-of-1 methods to capture day-to-day fluctuations in fatigue and potential triggers of fatigue (e.g., sleep quality, stress) over time. Participants will wear a wrist-worn electronic diary with an integrated activity monitor and complete brief questionnaires each day rating their symptoms and potential triggers. At the end of each N-of-1 study, the data will be analysed to identify personalised patterns and triggers of fatigue for the participant. We will share our scientific insights with the participant and this information may help them to better understand and self-manage their fatigue symptoms. We will also interview participants about their experience of participating in an N-of-1 study. This will help us to determine whether N-of-1 methods are feasible and acceptable to people with MS for future research.

Existing research on fatigue in MS has typically used research methods that involve large groups of patients and a focus on analysing the data at the group level. This tells us little about fatigue at the individual patient level. It is likely that fatigue fluctuations and triggers may differ substantially between people with MS, but group-based research focuses on results for the 'average' patient. The use of N-of-1 methods is novel in MS and it acknowledges that ‘every body is different’. Furthermore, if our interviews show that N-of-1 studies are feasible and acceptable to conduct with people with MS, we can extend our study protocol into other areas in MS. For example, we can use N-of-1 trials for testing treatments at the individual patient level, which provides personalised treatment results for each patient.

I am fortunate to work with a very talented multi-disciplinary team who have a great amount of experience and expertise in their area. One challenge that clinical researchers often face is difficulty in obtaining funding for research because there is a high level of competition for finite funds. We would like to say thank you to MS Australia for supporting our research and we look forward to sharing our results.