Smart watch, smarter EDSS: Improving disability assessment in multiple sclerosis clinical practice

Area of Science:

• Neurology
• Biomedical Engineering
• Rehabilitation Science

Background:

• Patient walking ability is crucial for the Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS) clinical practice.
• Current EDSS assessments rely on subjective patient estimates or infrequent neurologist observations.
• Limitations in current methods hinder accurate tracking of MS-related mobility impairments.

Purpose of the Study:

• To evaluate the agreement between patient and neurologist estimates of maximum walking ability and GPS-measured daily walking.
• To assess the limitations of current methods for evaluating walking ability in MS patients.
• To explore the utility of remote measurement technologies in MS care.

Main Methods:

• Seventy-three MS patients were enrolled.
• Walking ability was assessed using patient/neurologist estimates and GPS smartwatch measurements.
• Statistical analysis included Intraclass Correlation Coefficients (ICC) to determine agreement.

Main Results:

• Patient estimates showed modest agreement with GPS data (ICC 0.29), influenced by disease course, mood, and distance estimation errors.
• Neurologist estimates had better agreement with GPS data (ICC 0.68) but showed increased variability for longer distances.
• Factors like fatigue, depressive symptoms, and disease progression affected neurologist estimates.

Conclusions:

• There is poor agreement between patient/neurologist estimates and objective GPS measurements of walking ability in MS.
• Multiple factors influence subjective assessments of walking ability in MS.
• Remote measurement technologies, like GPS, may offer a more objective and comprehensive understanding of MS's impact on daily mobility.