title: Continuous daily assessment of multiple sclerosis disability using remote step count monitoring.
abstract: 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.
authors.affiliation: Department of Physical Therapy and Rehabilitation, University of California, San Francisco and San Francisco State University, San Francisco, CA, USA.
authors.forename: V J
authors.initials: VJ
authors.lastname: Block
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lizée
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: E
authors.initials: E
authors.lastname: Crabtree-Hartman
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bevan
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Graves
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bove
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Green
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: B
authors.initials: B
authors.lastname: Nourbakhsh
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tremblay
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: P-A
authors.initials: PA
authors.lastname: Gourraud
authors.affiliation: Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: M Y
authors.initials: MY
authors.lastname: Ng
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pletcher
authors.affiliation: Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Olgin
authors.affiliation: Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Marcus
authors.affiliation: Department of Physical Therapy and Rehabilitation, University of California, San Francisco and San Francisco State University, San Francisco, CA, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Allen
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
authors.forename: B A C
authors.initials: BA
authors.lastname: Cree
authors.affiliation: Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA. Jeffrey.Gelfand@ucsf.edu.
authors.forename: J M
authors.initials: JM
authors.lastname: Gelfand
mesh_terms: D061725:Accelerometry / Q000379:methods*; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis* / Q000503:physiopathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D017216:Telemedicine / Q000379:methods*; D016138:Walking / Q000502:physiology
keywords: Accelerometer; Multiple sclerosis; Outcome measurement; Progressive; Relapsing; Remote physical activity monitoring