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Quantifying observable movement reserve in multiple sclerosis via upper diurnal activity quantiles.

Pratim Guha Niyogi1, Muraleetharan Sanjayan2, Rahul Ghosal3

  • 1Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|January 2, 2026
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Summary

Peak activity levels measured by accelerometry can indicate functional capacity in multiple sclerosis (MS) patients. This metric correlates with disability scores, aiding in early detection of functional decline.

Keywords:
DisabilityEDSSdiurnal activity curvesfatiguequantilesscalar-on-function regression

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Area of Science:

  • Neurology
  • Biomedical Engineering
  • Rehabilitation Medicine

Background:

  • Functional capacity in multiple sclerosis (MS) is crucial, yet conventional assessments like the Expanded Disability Status Scale (EDSS) may miss subtle changes.
  • Accelerometry can track 24-hour motor activity but often fails to capture peak activity and its diurnal variations, limiting its use in assessing observable movement reserve.
  • Observable movement reserve, the ability to sustain high-effort activity, is a potential marker for functional capacity in MS.

Purpose of the Study:

  • To determine if upper diurnal activity quantiles from accelerometry can effectively measure observable movement reserve in individuals with MS.
  • To investigate the association between these peak activity metrics and disability levels (EDSS) in MS patients.

Main Methods:

  • 248 adults with MS (mean age 54.8, 71% female, EDSS 0-6.5) underwent 2-week wrist-worn accelerometry.
  • Scalar-on-function regression was employed to analyze associations between EDSS and diurnal activity curves (mean, variability, 50th-100th percentiles).
  • Models were adjusted for age, sex, BMI, cognition, and fatigue, with cross-validated R-squared used for performance assessment.

Main Results:

  • The strongest associations with EDSS were observed in the upper activity quantiles (95th-100th percentile).
  • Activity levels recorded in the late afternoon and evening demonstrated the highest predictive power for disability.
  • Diurnal peak activity, particularly in the later parts of the day, emerged as a significant correlate of MS-related disability.

Conclusions:

  • Diurnal peak activity, captured by accelerometry, serves as a sensitive and time-specific indicator of observable movement reserve in MS.
  • This metric, by quantifying both the timing and intensity of peak activity, offers a more precise way to track functional decline and disability in MS.
  • Incorporating diurnal peak activity analysis into assessments may enhance the early detection of functional changes and improve personalized management strategies for individuals with MS.