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Quantifying movement reserve in multiple sclerosis via diurnal activity quantiles.

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Peak activity levels measured by accelerometry, specifically upper diurnal quantiles, offer a sensitive indicator of observable movement reserve in multiple sclerosis (MS). These metrics correlate with Expanded Disability Status Scale (EDSS) scores, providing a novel way to track MS progression.

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Area of Science:

  • Wearable sensor technology and advanced statistical modeling in clinical research.
  • Biomedical engineering and quantitative analysis of human motor function.

Background:

  • Conventional clinical assessments like the Expanded Disability Status Scale (EDSS) may not capture subtle functional declines in multiple sclerosis (MS).
  • Accelerometry offers objective motor activity data, but traditional analyses focusing on averages overlook peak performance and its daily variability.
  • This diurnal peak performance variability is proposed as 'observable movement reserve,' reflecting capacity for high-effort activity despite fatigue.

Purpose of the Study:

  • To determine if upper diurnal activity quantiles from accelerometry data can quantify observable movement reserve in MS patients.
  • To investigate the association between these peak activity measures and EDSS-defined disability levels.

Main Methods:

  • Collected continuous wrist accelerometry data over two weeks from 248 adults with MS (EDSS range 0-6.5).
  • Employed novel scalar-on-function regression (SOFR) to analyze diurnal activity characteristics (mean, variability, 50th-100th percentiles).
  • SOFR models were adjusted for age, sex, and BMI, with cross-validated R-squared used to assess EDSS association strength.

Main Results:

  • Upper diurnal activity quantiles (95th-100th percentiles) showed the strongest association with EDSS, outperforming mean and variability measures.
  • Cross-validated R-squared improved from 0.12 (diurnal mean) to 0.22 (diurnal 100th percentile).
  • Peak activity in late afternoon and evening hours contributed most significantly to predictive power, emphasizing time-of-day relevance.

Conclusions:

  • Diurnal peak activity quantiles serve as a sensitive, time-specific metric for observable movement reserve, closely mirroring EDSS-measured disability in MS.
  • These metrics capture fluctuations likely related to circadian energy and fatigue patterns.
  • The proposed approach offers a clinically valuable tool for monitoring functional changes and tracking MS disease progression.