Continuous daily assessment of multiple sclerosis disability using remote step count monitoring
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Disability measures in multiple sclerosis (MS) rely heavily on ambulatory function, and current metrics fail to capture potentially important variability in walking behavior. We sought to determine whether remote step count monitoring using a consumer-friendly accelerometer (Fitbit Flex) can enhance MS disability assessment. 99 adults with relapsing or progressive MS able to walk ≥2-min were prospectively recruited. At 4 weeks, study retention was 97% and median Fitbit use was 97% of days. Substudy validation resulted in high interclass correlations between Fitbit, ActiGraph and manual step count tally during a 2-minute walk test, and between Fitbit and ActiGraph (ICC = 0.76) during 7-day home monitoring. Over 4 weeks of continuous monitoring, daily steps were lower in progressive versus relapsing MS (mean difference 2546 steps, p < 0.01). Lower average daily step count was associated with greater disability on the Expanded Disability Status Scale (EDSS) (p < 0.001). Within each EDSS category, substantial variability in step count was apparent (i.e., EDSS = 6.0 range 1097–7152). Step count demonstrated moderate-strong correlations with other walking measures. Lower average daily step count is associated with greater MS disability and captures important variability in real-world walking activity otherwise masked by standard disability scales, including the EDSS. These results support remote step count monitoring as an exploratory outcome in MS trials.
KeywordsMultiple sclerosis Outcome measurement Remote physical activity monitoring Accelerometer Progressive Relapsing
We thank Dan Robeson, DPT, and Patrick Sullivan, DPT, for assistance with data collection in the clinic.
Compliance with ethical standards
Valerie J Block has no disclosures.
Antoine Lizée has no disclosures.
Elizabeth Crabtree-Hartman has received educational grants from the MS Foundation, Teva neurosciences, and Biogen. She has served as a consultant to Genzyme, Teva and Novartis. She is on the Speakers Bureau for Genzyme, Teva and Biogen.
Carolyn J Bevan has no disclosures.
Jennifer Graves has current research grants from Race to Erase MS, National MS Society, Genentech, and Biogen.
Riley Bove has no disclosures.
Ari Green has received research grants from the NMSS, NIH, Novartis and Inception 5 Sciences. He has served on an end point adjudication committee for Mediimmune and a steering committee for OCTIMs. He has served as an expert witness for Mylan and Amneal. He also is on the Scientific Advisory Board of Bionure and Inception Sciences.
Matthew Tremblay has no disclosures.
Bardia Nourbakhsh has received research support from American Brain Foundation, Biogen and National MS Society.
Pierre-Antoine Gourraud has no disclosures.
Madelena Ng has no disclosures.
Jeffrey Olgin has no disclosures.
Gregory M Marcus has no disclosures.
Jeffrey M Pletcher has no disclosures.
Diane D Allen has received compensation as an instructor for the Neurologic Physical Therapy Residency Program at Kaiser Redwood City. She has also received compensation for co-developing an online continuing education course in rehabilitation for people with multiple sclerosis for Western Schools.
Bruce C Cree has received personal compensation for consulting from Abbvie, Biogen, EMD Serono, MedImmune, Novartis, Sanofi Genzyme, Shire and Teva.
Jeffrey M Gelfand has received personal compensation for consulting on a scientific advisory board for MedImmune and Genentech, research support to UCSF from Quest Diagnostics for development of a dementia care pathway, and personal compensation for medical legal consulting as an expert witness.
National Center for Advancing Translational Sciences of NIH (KL2TR000143) (JMG).
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