Contributions
Abstract: P343
Type: Poster
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: Multiple Sclerosis (MS) is a leading cause of ambulatory disability in young adults. Remote step count monitoring in the patient´s natural environment has the potential to enhance the meaningfulness of MS-related disability and disease progression. Commercial-grade accelerometers are inexpensive and patient-friendly, which may allow for longer term continuous recording.
Objective: To determine whether average daily step count over 1 month of continuous monitoring measured via a commercial-grade accelerometer (Fitbit Flex) is associated with MS disability in a well-phenotyped prospective cohort.
Methods: 80 participants with relapsing or progressive MS from a MS clinic received a wrist worn Fitbit Flex between July 2015 and April 2016. Participants had to be able to walk for at least 2 minutes and were excluded if they had a clinical relapse within 30 days or major physical comorbidities contributing to gait impairment. Participants were instructed to continue normal daily life. Fitbit data were collected using the UCSF Health eHeart electronic study platform and processed through an analytical pipeline for quality control. Baseline testing included the Expanded Disability Status Scale (EDSS), Timed 25 Foot Walk (T25FW), Timed-Up and Go (TUG) and the MS Walking Scale (MSWS-12).
Results: At 1 month, study retention was 95%, and no devices were lost. Lower average daily step count was associated with greater ambulatory disability as assessed by EDSS (rho = -.71, p< 0.001, adjusting for age and sex). Within each EDSS group there was substantial variability; for example, in EDSS 6.0, average daily step count ranged from 1097 to 7152. Counts were lower in progressive versus relapsing MS (mean difference 2546 steps, p = 0.001). Average daily step count had moderate-strong significant correlations with T25FW (rho = -.65), TUG (rho = - .67) and MSWS-12
(rho = -.65).
Discussion: Lower average daily step count, over 1 month of monitoring, was associated with greater MS disability in our prospective cohort of well-phenotyped MS patients with a wide range of ambulatory disability. The use of commercially available monitors is feasible and well tolerated in people with MS and can identify important variability in real-world walking activity within EDSS groups otherwise masked by usual categorization. Continuous step count monitoring may provide a finer scale by which to measure real-world ambulatory improvement, particularly for trials in progressive MS.
Disclosure:
V J Block has nothing to disclose.
A Lizée has nothing to disclose.
Dr. E Crabtree has received educational grants from the MS Foundation, Teva neurosciences, and Biogen. She has served as a consultant to Genzyme, Teva and Novartis. She is on the Speakers Bureau for Genzyme, Teva and Biogen.
Dr. C Bevan has nothing to disclose.
Dr. J Graves has current research grants from Race to Erase MS, National MS Society, Genentech, and Biogen.
Dr. R Bove has nothing to disclose.
Dr. A Green has received research grants from the NMSS, NIH, Novartis and Inception 5 Sciences. He has served on an end point adjudication committee for Mediimmune and a steering committee for OCTIMs. He has served as an expert witness for Mylan and Amneal. He also is on the Scientific Advisory Board of Bionure and Inception Sciences.
Dr. M Tremblay has nothing to disclose.
Dr. B Nourbakhsh has received research support from American Brain Foundation, Biogen and National MS Society.
Dr. Olgin has nothing to disclose.
Dr. G M Marcus has nothing to disclose.
Dr. J M Pletcher has nothing to disclose.
Dr. D D Allen has received compensation as an instructor for the Neurologic Physical Therapy Residency Program at Kaiser Redwood City. She has also received compensation for co-developing an online continuing education course in rehabilitation for people with multiple sclerosis for Western Schools.
Dr. B C Cree has received personal compensation for consulting from Abbvie, Biogen, EMD Serono, MedImmune, Novartis, Sanofi Genzyme, Shire and Teva
Dr. J M Gelfand has served as a consultant on a scientific advisory board for MedImmune and Hoffman La Roche; has received research support from Quest Diagnostics through UCSF on a dementia care pathway; and has received personal compensation for medical legal consulting.
Abstract: P343
Type: Poster
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: Multiple Sclerosis (MS) is a leading cause of ambulatory disability in young adults. Remote step count monitoring in the patient´s natural environment has the potential to enhance the meaningfulness of MS-related disability and disease progression. Commercial-grade accelerometers are inexpensive and patient-friendly, which may allow for longer term continuous recording.
Objective: To determine whether average daily step count over 1 month of continuous monitoring measured via a commercial-grade accelerometer (Fitbit Flex) is associated with MS disability in a well-phenotyped prospective cohort.
Methods: 80 participants with relapsing or progressive MS from a MS clinic received a wrist worn Fitbit Flex between July 2015 and April 2016. Participants had to be able to walk for at least 2 minutes and were excluded if they had a clinical relapse within 30 days or major physical comorbidities contributing to gait impairment. Participants were instructed to continue normal daily life. Fitbit data were collected using the UCSF Health eHeart electronic study platform and processed through an analytical pipeline for quality control. Baseline testing included the Expanded Disability Status Scale (EDSS), Timed 25 Foot Walk (T25FW), Timed-Up and Go (TUG) and the MS Walking Scale (MSWS-12).
Results: At 1 month, study retention was 95%, and no devices were lost. Lower average daily step count was associated with greater ambulatory disability as assessed by EDSS (rho = -.71, p< 0.001, adjusting for age and sex). Within each EDSS group there was substantial variability; for example, in EDSS 6.0, average daily step count ranged from 1097 to 7152. Counts were lower in progressive versus relapsing MS (mean difference 2546 steps, p = 0.001). Average daily step count had moderate-strong significant correlations with T25FW (rho = -.65), TUG (rho = - .67) and MSWS-12
(rho = -.65).
Discussion: Lower average daily step count, over 1 month of monitoring, was associated with greater MS disability in our prospective cohort of well-phenotyped MS patients with a wide range of ambulatory disability. The use of commercially available monitors is feasible and well tolerated in people with MS and can identify important variability in real-world walking activity within EDSS groups otherwise masked by usual categorization. Continuous step count monitoring may provide a finer scale by which to measure real-world ambulatory improvement, particularly for trials in progressive MS.
Disclosure:
V J Block has nothing to disclose.
A Lizée has nothing to disclose.
Dr. E Crabtree has received educational grants from the MS Foundation, Teva neurosciences, and Biogen. She has served as a consultant to Genzyme, Teva and Novartis. She is on the Speakers Bureau for Genzyme, Teva and Biogen.
Dr. C Bevan has nothing to disclose.
Dr. J Graves has current research grants from Race to Erase MS, National MS Society, Genentech, and Biogen.
Dr. R Bove has nothing to disclose.
Dr. A Green has received research grants from the NMSS, NIH, Novartis and Inception 5 Sciences. He has served on an end point adjudication committee for Mediimmune and a steering committee for OCTIMs. He has served as an expert witness for Mylan and Amneal. He also is on the Scientific Advisory Board of Bionure and Inception Sciences.
Dr. M Tremblay has nothing to disclose.
Dr. B Nourbakhsh has received research support from American Brain Foundation, Biogen and National MS Society.
Dr. Olgin has nothing to disclose.
Dr. G M Marcus has nothing to disclose.
Dr. J M Pletcher has nothing to disclose.
Dr. D D Allen has received compensation as an instructor for the Neurologic Physical Therapy Residency Program at Kaiser Redwood City. She has also received compensation for co-developing an online continuing education course in rehabilitation for people with multiple sclerosis for Western Schools.
Dr. B C Cree has received personal compensation for consulting from Abbvie, Biogen, EMD Serono, MedImmune, Novartis, Sanofi Genzyme, Shire and Teva
Dr. J M Gelfand has served as a consultant on a scientific advisory board for MedImmune and Hoffman La Roche; has received research support from Quest Diagnostics through UCSF on a dementia care pathway; and has received personal compensation for medical legal consulting.