Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review

Block, Valerie A. J.; Pitsch, Erica A.; Tahir, Peggy; Cree, Bruce A.C.; Allen, Diane D.; Gelfand, Jeffrey M.

doi:10.1371/journal.pone.0154335

Cited by 170 publications

(150 citation statements)

References 169 publications

(329 reference statements)

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“…This finding replicates previous findings of strong 3 correlations between self-report and accelerometry measures for MS [36]. Studies have shown similar correlations between sensor data streams and functional rating scales for other neurological conditions, suggesting this could be an area for further exploration [16]. In addition, participants with no walking symptoms or disability averaged more than 2,000 steps per day compared to those that experience symptoms but did not have a disability, suggesting that the onset of symptom may be a driver of diminished physical activity.…”

Section: Discussionsupporting

confidence: 89%

“…Daily step count data were collected for all participants. The Fitbit One TM has been shown to be a valid and reliable indicator of step counts [15,16].…”

Section: Methodsmentioning

confidence: 99%

“…Digital markers of MS have been extensively studied for symptom tracking, wearables such as accelerometers, gyroscopes, eye-trackers, grip sensors, and multisensors [15]. In other neurological diseases such as Parkinson disease, stroke, dementia, traumatic brain injury, and ataxia, studies have shown associations between activity tracking devices and other mobility assessments [16]. The importance of mobility in MS is irrefutable both as an assessment of overall health status and a component of disease management [17].…”

Section: Introductionmentioning

confidence: 99%

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Free-Living Physical Activity Monitoring in Adult US Patients with Multiple Sclerosis Using a Consumer Wearable Device

et al. 2018

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Introduction: Wearable devices have been used to characterize physical activity in multiple sclerosis (MS). The objectives of this study were to advance the literature on the utility of free-living physical activity tracking from secondary analyses of a pilot study in MS patients. Method: The original observational study was conducted in participants with MS at PatientsLikeMe (www.PatientsLikeMe.com), an online network of patients with chronic diseases. Participants completed a baseline self-assessment, and received a Fitbit One^TM wearable device with instructions to upload data. Eligible participants (1) self-reported MS, (2) logged on to the PatientsLikeMe website 90 days prior to enrollment, and (3) consented to participate electronically. Participants (1) < 18 years, (2) living outside the United States, and (3) requiring wheelchair assistance for most daily activities were excluded. The secondary analyses were limited to participants with complete data on MS type, disease duration, and Multiple Sclerosis Rating Scale (MSRS) and at least 7 days of wearable data. Step count was used as a measure of physical activity. Results: The analysis cohort of 114 participants uploaded a mean of 20.1 days of wearable data over the 23-day study (87% adherence); participants averaged 4,393 steps per day. The mean age of participants was 52 years, predominantly female (75%), relapsing-remitting type (79%), with mean disease duration of 16 years. Mean MSRS score within 30-day of baseline was 32; 72% reported mild-moderate walking disability. The reliability of step count measured by intraclass correlation was 0.55 for a single day, ≥0.7 for 2-day average, and ≥0.9 for 7-day average. After controlling for covariates, self-reported disease severity (MSRS quartile) was an independent predictor of step count (p < 0.001). Least square means (LS means) for participants that were least disabled (lowest quartile) was 5,937 steps, which was significantly higher than participants in the second, third, and fourth quartiles (4,570, 3,490, and 3,272, respectively). Similarly, LS means of participants with no ambulatory disability (measured by MSRS walk component) was 6,931 steps, significantly higher than participants with greater disability (4,743, 4,394, 2,727 steps for symptomatic, mild, and moderate disability, respectively, p < 0.001). Discussion: Using an interactive platform, this study captured free-living mobility data in MS patients. Important metrics such as the use of a minimum of 2-day estimates and self-reported disability were found to be robust indicators and correlates, respectively, of participant activity levels. Further triangulation of such metrics may reduce the burden on patients, clinicians, and researchers when monitoring clinical status.

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Section: Discussionsupporting

confidence: 89%

“…Daily step count data were collected for all participants. The Fitbit One TM has been shown to be a valid and reliable indicator of step counts [15,16].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Free-Living Physical Activity Monitoring in Adult US Patients with Multiple Sclerosis Using a Consumer Wearable Device

et al. 2018

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“…By comparison, there is a substantially smaller, yet steadily increasing body of literature in this area that involves persons with mobility disability such as multiple sclerosis (MS) [2]. This might be explained by the only recent shift in paradigm wherein physical activity is now recognized as yielding beneficial effects on symptoms and function in this population rather than being potentially harmful for MS [3].…”

Section: Introductionmentioning

confidence: 99%

Motion sensors in multiple sclerosis: Narrative review and update of applications

Sasaki

Sandroff

Bamman

et al. 2017

Expert Review of Medical Devices

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Introduction: The use of motion sensors for measuring physical activity in multiple sclerosis (MS) has evolved with increasing research particularly during the past decade. Areas covered: This manuscript reviews the literature regarding the application of motion sensors for measuring physical activity in MS. We first describe ‘what is known’ about their use in MS by examining the evidence generated between 1997 and 2012, including the psychometric properties of motion sensors in MS and the development of MS-specific accelerometer cut-points. We then evaluate ‘what is new’ based on research conducted between 2013 and 2017. This includes newer research on psychometric properties of motion sensors in MS, development of new MS-specific accelerometer and step-rate cut-points, sedentary behavior assessment, and research on fitness trackers and multisensors in MS. The final part presents a picture of “what is next” for the applications of motion sensors in MS, especially pertaining new opportunities for testing and using fitness trackers in MS, and tracking disease and disability progression based on motion sensor output. Expert commentary: The use of motion sensors in MS has grown substantially over the years; however, a lot more can be done to explore the full potential and utility of these devices in MS.

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“…Nonetheless, the evidence presented suggests that multiaxial accelerometer or multisensor devices appear to produce the most valid and reliable data about physical activity in chronic disease populations [14,18,19]. A recent systematic review concluded that remote physical activity monitoring is feasible in individuals with neurological diseases, including those with moderate-to-severe disability [20]. Another recent review which evaluated a range of wearable and non-wearable devices for objectively measuring a range of motor symptoms in Parkinson disease (PD) highlighted that while a number of devices can be recommended, further clinimetric testing and clinical validation are required [21].…”

Section: Introductionmentioning

confidence: 99%

Physical Activity Monitoring in Patients with Neurological Disorders: A Review of Novel Body-Worn Devices

2017

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Aim:The aim was to conduct a systematic review to examine the literature reporting the validity and reliability of wearable physical activity monitoring in individuals with neurological disorders. Method: A systematic search of the literature was performed using a specific search strategy in PubMed and CINAHL. A search constraint of articles published in English, including human participants, published between January 2008 and March 2017 was applied. Peerreviewed studies which enrolled adult participants with any neurological disorder were included. For the studies which sought to explore the validity of activity monitors, the outcomes measured using the monitor were compared to a criterion measure of physical activity. The studies' methodological quality was assessed using an adapted version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) framework. Data extracted from each study included the following: characteristics of the study participants, study setting, devices used, study protocol/methods, outcomes measured, and the validity/reliability of measurement produced. Results: Twenty-three studies examining the validity and reliability of 16 different monitors were included. The identified studies comprised participants with a range of different disorders of neurological origin. The available evidence suggests that biaxial or triaxial accelerometer devices positioned around the ankle produce the most accurate step count measurements in patients with neurological disorders. The findings regarding the reliability and validity of activity counts and energy expenditure are largely inconclusive in this population. Discussion: Ankle-worn biaxial or triaxial accelerometer-type devices provide the most accurate measurement of physical activity. However, further work is required in this field be-

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Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review

Cited by 170 publications

References 169 publications

Free-Living Physical Activity Monitoring in Adult US Patients with Multiple Sclerosis Using a Consumer Wearable Device

Free-Living Physical Activity Monitoring in Adult US Patients with Multiple Sclerosis Using a Consumer Wearable Device

Motion sensors in multiple sclerosis: Narrative review and update of applications

Physical Activity Monitoring in Patients with Neurological Disorders: A Review of Novel Body-Worn Devices

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