Association of Continuous Assessment of Step Count by Remote Monitoring With Disability Progression Among Adults With Multiple Sclerosis

Abstract

Importance Disability measures in multiple sclerosis (MS) fail to capture potentially important variability in walking behavior. More sensitive and ecologically valid outcome measures are needed to advance MS research. Objectives To assess continuous step count activity remotely among individuals with MS for 1 year and determine how average daily step count is associated with other measures of MS disability. Design, Setting, and Participants In a prospective longitudinal observational cohort study, 95 adults with relapsing or progressive MS who were able to walk more than 2 minutes with or without an assistive device were recruited between June 15, 2015, and August 8, 2016, and remotely monitored in their natural environment for 1 year. Patients were excluded if they had a clinical relapse within 30 days or comorbidity contributing to ambulatory impairment. Longitudinal analysis was performed from October 2017 to March 2018. Revised analysis was performed in December 2018. Intervention Activity monitoring of step count using a wrist-worn accelerometer. Main Outcomes and Measures Average daily step count compared with in-clinic assessments and patient-reported outcomes. Results Of the 95 participants recruited (59 women and 36 men; mean [SD] age, 49.6 [13.6] years [range, 22.0-74.0 years]), 35 (37%) had progressive MS, and the median baseline Expanded Disability Status Scale score was 4.0 (range, 0-6.5). At 1 year, 79 participants completed follow-up (83% retention). There was a modest reduction in accelerometer use during the 1 year of the study. A decreasing average daily step count during the study was associated with worsening of clinic-based outcomes (Timed 25-Foot Walk, β = −13.09; P < .001; Timed-Up-and-Go, β = −9.25; P < .001) and patient-reported outcomes (12-item Multiple Sclerosis Walking Scale, β = −17.96; P < .001). A decreasing average daily step count occurred even when the Expanded Disability Status Scale score remained stable, and 12 of 25 participants (48%) with a significant decrease in average daily step count during the study did not have a reduction on other standard clinic-based metrics. Participants with a baseline average daily step count below 4766 (cohort median) had higher odds of clinically meaningful disability (Expanded Disability Status Scale score) worsening at 1 year, adjusting for age, sex, and disease duration (odds ratio, 4.01; 95% CI, 1.17-13.78; P = .03). Conclusions and Relevance Continuous remote activity monitoring of individuals with MS for 1 year appears to be feasible. In this study, a decreasing average daily step count during a 1-year period was associated with worsening of standard ambulatory measures but could also occur even when traditional disability measures remained sta...

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“…An additional one hour of mild exercise in a day can reduce the age of the brain by 1.1 years. Another study tracked the activity of 95 patients with multiple sclerosis with a commercial wearable device for one year [29] wherein the less active group showed a worsening of clinical prognosis.…”

Effects of COVID-19 “Sheltering in Place” on Activity in People With Multiple Sclerosis

“…Average daily step count (STEPS) was measured from a previously detailed UCSF MS Center cohort of PwMS using a wrist-worn accelerometer (Fitbit ® Flex2). 3 STEPS before and after the shelter-in-place were available for 42 participants. Amount, type and frequency of exercise, walking score (a proxy for socioeconomic status [SES] via accessibility of amenities and neighborhood density) 4 , as well as fatigue (Modified Fatigue Index; MFIS-5) and mental health symptoms (Mental Health Inventory; MHI-5) were assessed via questionnaire.…”

“…Amount, type and frequency of exercise, walking score (a proxy for socioeconomic status [SES] via accessibility of amenities and neighborhood density) 4 , as well as fatigue (Modified Fatigue Index; MFIS-5) and mental health symptoms (Mental Health Inventory; MHI-5) were assessed via questionnaire. 3 The UCSF Institutional Review Board approved the protocol. Descriptive statistics and pre-post comparisons were performed using R studio.…”

“…Those who did not rebound also had lower baseline activity and are more vulnerable to disability progression. 3 This highlights the importance of expanding access to telehealth strategies to promote physical activity.…”

“…People with neurological conditions that impair mobility such as multiple sclerosis (MS) have low levels of physical activity, with walking their primary form of exercise. [1][2][3] When the San Francisco Bay Area shelter-in-place order was announced in mid-March 2020 to flatten the curve of SARS-CoV-2 infections, the abrupt closure of gyms, fitness studios, and malls greatly limited options for safe exercise. We leveraged an ongoing study utilizing wearable technology, to understand the impact of the shelter-in-place policy on physical activity in people with MS (PwMS) at-risk for neurological worsening.…”