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Karas M, Olsen J, Straczkiewicz M, Johnson SA, Burke KM, Iwasaki S, Lahav A, Scheier ZA, Clark AP, Iyer AS, Huang E, Berry JD, Onnela JP. Tracking amyotrophic lateral sclerosis disease progression using passively collected smartphone sensor data. Ann Clin Transl Neurol 2024. [PMID: 38816946 DOI: 10.1002/acn3.52050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/03/2024] [Accepted: 03/05/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Passively collected smartphone sensor data provide an opportunity to study physical activity and mobility unobtrusively over long periods of time and may enable disease monitoring in people with amyotrophic lateral sclerosis (PALS). METHODS We enrolled 63 PALS who used Beiwe mobile application that collected their smartphone accelerometer and GPS data and administered the self-entry ALS Functional Rating Scale-Revised (ALSFRS-RSE) survey. We identified individual steps from accelerometer data and used the Activity Index to summarize activity at the minute level. Walking, Activity Index, and GPS outcomes were then aggregated into day-level measures. We used linear mixed effect models (LMMs) to estimate baseline and monthly change for ALSFRS-RSE scores (total score, subscores Q1-3, Q4-6, Q7-9, Q10-12) and smartphone sensor data measures, as well as the associations between them. FINDINGS The analytic sample (N = 45) was 64.4% male with a mean age of 60.1 years. The mean observation period was 292.3 days. The ALSFRS-RSE total score baseline mean was 35.8 and had a monthly rate of decline of -0.48 (p-value <0.001). We observed statistically significant change over time and association with ALSFRS-RSE total score for four smartphone sensor data-derived measures: walking cadence from top 1 min and log-transformed step count, step count from top 1 min, and Activity Index from top 1 min. INTERPRETATION Smartphone sensors can unobtrusively track physical changes in PALS, potentially aiding disease monitoring and future research.
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Affiliation(s)
- Marta Karas
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave., Boston, Massachusetts, 02115, USA
| | - Julia Olsen
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave., Boston, Massachusetts, 02115, USA
| | - Marcin Straczkiewicz
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave., Boston, Massachusetts, 02115, USA
| | - Stephen A Johnson
- Department of Neurology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, Arizona, 85259, USA
| | - Katherine M Burke
- Neurological Clinical Research Institute and Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, 15 Parkman St #835, Boston, Massachusetts, 02114, USA
| | - Satoshi Iwasaki
- Mitsubishi Tanabe Pharma Holdings America, Inc., 525 Washington Blvd., Jersey City, New Jersey, 07310, USA
| | - Amir Lahav
- Mitsubishi Tanabe Pharma Holdings America, Inc., 525 Washington Blvd., Jersey City, New Jersey, 07310, USA
| | - Zoe A Scheier
- Neurological Clinical Research Institute and Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, 15 Parkman St #835, Boston, Massachusetts, 02114, USA
| | - Alison P Clark
- Neurological Clinical Research Institute and Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, 15 Parkman St #835, Boston, Massachusetts, 02114, USA
| | - Amrita S Iyer
- Neurological Clinical Research Institute and Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, 15 Parkman St #835, Boston, Massachusetts, 02114, USA
| | - Emily Huang
- Department of Statistical Sciences, Wake Forest University, Winston-Salem, North Carolina, 27106, USA
| | - James D Berry
- Neurological Clinical Research Institute and Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital, 15 Parkman St #835, Boston, Massachusetts, 02114, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave., Boston, Massachusetts, 02115, USA
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Beswick E, Christides A, Symonds A, Johnson M, Fawcett T, Newton J, Lyle D, Weaver C, Chandran S, Pal S. Exploratory study to evaluate the acceptability of a wearable accelerometer to assess motor progression in motor neuron disease. J Neurol 2024:10.1007/s00415-024-12449-3. [PMID: 38805054 DOI: 10.1007/s00415-024-12449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
Motor neuron disease (MND) is a rapidly progressive condition traditionally assessed using a questionnaire to evaluate physical function, the revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R). Its use can be associated with poor sensitivity in detecting subtle changes over time and there is an urgent need for more sensitive and specific outcome measures. The ActiGraph GT9X is a wearable device containing multiple sensors that can be used to provide metrics that represent physical activity. The primary aim of this study was to investigate the initial suitability and acceptability of limb-worn wearable devices to group of people with MND in Scotland. A secondary aim was to explore the preliminary associations between the accelerometer sensor data within the ActiGraph GT9X and established measures of physical function. 10 participants with MND completed a 12-week schedule of assessments including fortnightly study visits, both in-person and over videoconferencing software. Participants wore the device on their right wrist and right ankle for a series of movements, during a 6-min walking test and for a period of 24-h wear, including overnight. Participants also completed an ALSFRS-R and questionnaires on their experience with the devices. 80% of the participants found wearing these devices to be a positive experience and no one reported interference with daily living or added burden. However, 30% of the participants experienced technical issues with their devices. Data from the wearable devices correlated with established measures of physical function.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Alexander Christides
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Alexander Symonds
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Micheaela Johnson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Thomas Fawcett
- The School of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland
| | - Judith Newton
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Dawn Lyle
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Christine Weaver
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
- UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland.
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3
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van Unnik JWJ, Meyjes M, Janse van Mantgem MR, van den Berg LH, van Eijk RPA. Remote monitoring of amyotrophic lateral sclerosis using wearable sensors detects differences in disease progression and survival: a prospective cohort study. EBioMedicine 2024; 103:105104. [PMID: 38582030 PMCID: PMC11004066 DOI: 10.1016/j.ebiom.2024.105104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND There is an urgent need for objective and sensitive measures to quantify clinical disease progression and gauge the response to treatment in clinical trials for amyotrophic lateral sclerosis (ALS). Here, we evaluate the ability of an accelerometer-derived outcome to detect differential clinical disease progression and assess its longitudinal associations with overall survival in patients with ALS. METHODS Patients with ALS wore an accelerometer on the hip for 3-7 days, every 2-3 months during a multi-year observation period. An accelerometer-derived outcome, the Vertical Movement Index (VMI), was calculated, together with predicted disease progression rates, and jointly analysed with overall survival. The clinical utility of VMI was evaluated using comparisons to patient-reported functionality, while the impact of various monitoring schemes on empirical power was explored through simulations. FINDINGS In total, 97 patients (70.1% male) wore the accelerometer for 1995 days, for a total of 27,701 h. The VMI was highly discriminatory for predicted disease progression rates, revealing faster rates of decline in patients with a worse predicted prognosis compared to those with a better predicted prognosis (p < 0.0001). The VMI was strongly associated with the hazard for death (HR 0.20, 95% CI: 0.09-0.44, p < 0.0001), where a decrease of 0.19-0.41 unit was associated with reduced ambulatory status. Recommendations for future studies using accelerometery are provided. INTERPRETATION The results serve as motivation to incorporate accelerometer-derived outcomes in clinical trials, which is essential for further validation of these markers to meaningful endpoints. FUNDING Stichting ALS Nederland (TRICALS-Reactive-II).
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Affiliation(s)
- Jordi W J van Unnik
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Myrte Meyjes
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mark R Janse van Mantgem
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands; Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Tzeplaeff L, Jürs AV, Wohnrade C, Demleitner AF. Unraveling the Heterogeneity of ALS-A Call to Redefine Patient Stratification for Better Outcomes in Clinical Trials. Cells 2024; 13:452. [PMID: 38474416 PMCID: PMC10930688 DOI: 10.3390/cells13050452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Despite tremendous efforts in basic research and a growing number of clinical trials aiming to find effective treatments, amyotrophic lateral sclerosis (ALS) remains an incurable disease. One possible reason for the lack of effective causative treatment options is that ALS may not be a single disease entity but rather may represent a clinical syndrome, with diverse genetic and molecular causes, histopathological alterations, and subsequent clinical presentations contributing to its complexity and variability among individuals. Defining a way to subcluster ALS patients is becoming a central endeavor in the field. Identifying specific clusters and applying them in clinical trials could enable the development of more effective treatments. This review aims to summarize the available data on heterogeneity in ALS with regard to various aspects, e.g., clinical, genetic, and molecular.
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Affiliation(s)
- Laura Tzeplaeff
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
| | - Alexandra V. Jürs
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Camilla Wohnrade
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Antonia F. Demleitner
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
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Hamy V, Llop C, Yee CW, Garcia-Gancedo L, Maxwell A, Chen WH, Tomlinson R, Bobbili P, Bendelac J, Landry J, DerSarkissian M, Yenikomshian M, Mody EA, Duh MS, Williams R. Patient-centric assessment of rheumatoid arthritis using a smartwatch and bespoke mobile app in a clinical setting. Sci Rep 2023; 13:18311. [PMID: 37880288 PMCID: PMC10600111 DOI: 10.1038/s41598-023-45387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Rheumatoid arthritis (RA) is a fluctuating progressive disease requiring frequent symptom assessment for appropriate management. Continuous tracking using digital technologies may provide greater insights of a patient's experience. This prospective study assessed the feasibility, reliability, and clinical utility of using novel digital technologies to remotely monitor participants with RA. Participants with moderate to severe RA and non-RA controls were monitored continuously for 14 days using an iPhone with an integrated bespoke application and an Apple Watch. Participants completed patient-reported outcome measures and objective guided tests designed to assess disease-related impact on physical function. The study was completed by 28 participants with RA, 28 matched controls, and 2 unmatched controls. Completion rates for all assessments were > 97% and were reproducible over time. Several guided tests distinguished between RA and control cohorts (e.g., mean lie-to-stand time [seconds]: RA: 4.77, control: 3.25; P < 0.001). Participants with RA reporting greater stiffness, pain, and fatigue had worse guided test performances (e.g., wrist movement [P < 0.001] and sit-to-stand transition time [P = 0.009]) compared with those reporting lower stiffness, pain, and fatigue. This study demonstrates that digital technologies can be used in a well-controlled, remote clinical setting to assess the daily impact of RA.
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Affiliation(s)
- Valentin Hamy
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK.
| | | | | | | | - Aoife Maxwell
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK
| | | | | | | | | | | | | | | | - Elinor A Mody
- Rheumatology Department, Reliant Medical Group, Auburn, USA
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Poleur M, Markati T, Servais L. The use of digital outcome measures in clinical trials in rare neurological diseases: a systematic literature review. Orphanet J Rare Dis 2023; 18:224. [PMID: 37533072 PMCID: PMC10398976 DOI: 10.1186/s13023-023-02813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Developing drugs for rare diseases is challenging, and the precision and objectivity of outcome measures is critical to this process. In recent years, a number of technologies have increasingly been used for remote monitoring of patient health. We report a systematic literature review that aims to summarize the current state of progress with regard to the use of digital outcome measures for real-life motor function assessment of patients with rare neurological diseases. Our search of published literature identified 3826 records, of which 139 were included across 27 different diseases. This review shows that use of digital outcome measures for motor function outside a clinical setting is feasible and employed in a broad range of diseases, although we found few outcome measures that have been robustly validated and adopted as endpoints in clinical trials. Future research should focus on validation of devices, variables, and algorithms to allow for regulatory qualification and widespread adoption.
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Affiliation(s)
- Margaux Poleur
- Department of Neurology, Liege University Hospital Center, Liège, Belgium.
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium.
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium.
| | - Theodora Markati
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium
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7
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Wearable device and smartphone data quantify ALS progression and may provide novel outcome measures. NPJ Digit Med 2023; 6:34. [PMID: 36879025 PMCID: PMC9987377 DOI: 10.1038/s41746-023-00778-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) therapeutic development has largely relied on staff-administered functional rating scales to determine treatment efficacy. We sought to determine if mobile applications (apps) and wearable devices can be used to quantify ALS disease progression through active (surveys) and passive (sensors) data collection. Forty ambulatory adults with ALS were followed for 6-months. The Beiwe app was used to administer the self-entry ALS functional rating scale-revised (ALSFRS-RSE) and the Rasch Overall ALS Disability Scale (ROADS) surveys every 2-4 weeks. Each participant used a wrist-worn activity monitor (ActiGraph Insight Watch) or an ankle-worn activity monitor (Modus StepWatch) continuously. Wearable device wear and app survey compliance were adequate. ALSFRS-R highly correlated with ALSFRS-RSE. Several wearable data daily physical activity measures demonstrated statistically significant change over time and associations with ALSFRS-RSE and ROADS. Active and passive digital data collection hold promise for novel ALS trial outcome measure development.
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Holdom CJ, van Unnik JWJ, van Eijk RPA, van den Berg LH, Henderson RD, Ngo ST, Steyn FJ. Use of hip- versus wrist-based actigraphy for assessing functional decline and disease progression in patients with motor neuron disease. J Neurol 2023; 270:2597-2605. [PMID: 36740646 PMCID: PMC10129939 DOI: 10.1007/s00415-023-11584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Actigraphy has been proposed as a measure for tracking functional decline and disease progression in patients with Motor Neuron Disease (MND). There is, however, little evidence to show that wrist-based actigraphy measures correlate with functional decline, and no consensus on how best to implement actigraphy. We report on the use of wrist actigraphy to show decreased activity in patients compared to controls, and compared the utility of wrist- and hip-based actigraphy for assessing functional decline in patients with MND. METHODS In this multi-cohort, multi-centre, natural history study, wrist- and hip-based actigraphy were assessed in 139 patients with MND (wrist, n = 97; hip, n = 42) and 56 non-neurological control participants (wrist, n = 56). For patients with MND, longitudinal measures were contrasted with clinical outcomes commonly used to define functional decline. RESULTS Patients with MND have reduced wrist-based actigraphy scores when compared to controls (median differences: prop. active = - 0.053 [- 0.075, - 0.026], variation axis 1 = - 0.073 [- 0.112, - 0.021]). When comparing wrist- and hip-based measures, hip-based accelerometery had stronger correlations with disease progression (prop. active: τ = 0.20 vs 0.12; variation axis 1: τ = 0.33 vs 0.23), whereas baseline wrist-based accelerometery was better related with future decline in fine-motor function (τ = 0.14-0.23 vs 0.06-0.16). CONCLUSIONS Actigraphy outcomes measured from the wrist are more variable than from the hip and present differing sensitivity to specific functional outcomes. Outcomes and analysis should be carefully constructed to maximise benefit, should wrist-worn devices be used for at-home monitoring of disease progression in patients with MND.
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Affiliation(s)
- Cory J Holdom
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
| | - Jordi W J van Unnik
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert D Henderson
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia.,Wesley Medical Research, The Wesley Hospital, Brisbane, Australia
| | - Shyuan T Ngo
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia.,Wesley Medical Research, The Wesley Hospital, Brisbane, Australia
| | - Frederik J Steyn
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia. .,Wesley Medical Research, The Wesley Hospital, Brisbane, Australia. .,School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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9
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Beswick E, Fawcett T, Hassan Z, Forbes D, Dakin R, Newton J, Abrahams S, Carson A, Chandran S, Perry D, Pal S. A systematic review of digital technology to evaluate motor function and disease progression in motor neuron disease. J Neurol 2022; 269:6254-6268. [PMID: 35945397 PMCID: PMC9363141 DOI: 10.1007/s00415-022-11312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common subtype of motor neuron disease (MND). The current gold-standard measure of progression is the ALS Functional Rating Scale-Revised (ALS-FRS(R)), a clinician-administered questionnaire providing a composite score on physical functioning. Technology offers a potential alternative for assessing motor progression in both a clinical and research capacity that is more sensitive to detecting smaller changes in function. We reviewed studies evaluating the utility and suitability of these devices to evaluate motor function and disease progression in people with MND (pwMND). We systematically searched Google Scholar, PubMed and EMBASE applying no language or date restrictions. We extracted information on devices used and additional assessments undertaken. Twenty studies, involving 1275 (median 28 and ranging 6-584) pwMND, were included. Sensor type included accelerometers (n = 9), activity monitors (n = 4), smartphone apps (n = 4), gait (n = 3), kinetic sensors (n = 3), electrical impedance myography (n = 1) and dynamometers (n = 2). Seventeen (85%) of studies used the ALS-FRS(R) to evaluate concurrent validity. Participant feedback on device utility was generally positive, where evaluated in 25% of studies. All studies showed initial feasibility, warranting larger longitudinal studies to compare device sensitivity and validity beyond ALS-FRS(R). Risk of bias in the included studies was high, with a large amount of information to determine study quality unclear. Measurement of motor pathology and progression using technology is an emerging, and promising, area of MND research. Further well-powered longitudinal validation studies are needed.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Thomas Fawcett
- The School of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Zack Hassan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Deborah Forbes
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Rachel Dakin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Judith Newton
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Sharon Abrahams
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.,Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.,UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - David Perry
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK. .,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, Scotland, UK. .,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.
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10
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Geronimo A. Remote patient monitoring in neuromuscular disease. Muscle Nerve 2022; 66:233-235. [PMID: 35674416 DOI: 10.1002/mus.27658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/11/2022]
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11
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Youn BY, Ko Y, Moon S, Lee J, Ko SG, Kim JY. Digital Biomarkers for Neuromuscular Disorders: A Systematic Scoping Review. Diagnostics (Basel) 2021; 11:diagnostics11071275. [PMID: 34359358 PMCID: PMC8307187 DOI: 10.3390/diagnostics11071275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Biomarkers play a vital role in clinical care. They enable early diagnosis and treatment by identifying a patient's condition and disease course and act as an outcome measure that accurately evaluates the efficacy of a new treatment or drug. Due to the rapid development of digital technologies, digital biomarkers are expected to grow tremendously. In the era of change, this scoping review was conducted to see which digital biomarkers are progressing in neuromuscular disorders, a diverse and broad-range disease group among the neurological diseases, to discover available evidence for their feasibility and reliability. Thus, a total of 10 studies were examined: 9 observational studies and 1 animal study. Of the observational studies, studies were conducted with amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and spinal muscular atrophy (SMA) patients. Non-peer reviewed poster presentations were not considered, as the articles may lead to erroneous results. The only animal study included in the present review investigated the mice model of ALS for detecting rest disturbances using a non-invasive digital biomarker.
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Affiliation(s)
- Bo-Young Youn
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.M.)
| | - Youme Ko
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (Y.K.); (S.-G.K.)
| | - Seunghwan Moon
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, Seoul 02447, Korea; (B.-Y.Y.); (S.M.)
| | - Jinhee Lee
- Department of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Seung-Gyu Ko
- Department of Preventive Medicine, Kyung Hee University, Seoul 02447, Korea; (Y.K.); (S.-G.K.)
| | - Jee-Young Kim
- Department of Neurology, Cheongna Best Rehabilitation Hospital, Incheon 22883, Korea
- Correspondence:
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Bertran Recasens B, Rubio MA. Neuromuscular Diseases Care in the Era of COVID-19. Front Neurol 2020; 11:588929. [PMID: 33329336 PMCID: PMC7732578 DOI: 10.3389/fneur.2020.588929] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic has pushed health systems to their limit and forced readjustment of standards of care for different pathologies. Management of neuromuscular diseases becomes a challenge since most of them are chronic, disabling, progressive, and/or require immunosuppressive drugs. There are three main aspects of COVID-19 that affect neuromuscular diseases care. The first one relates to how SARS-CoV2 directly affects different neuromuscular pathologies. Respiratory weakness, as seen in myasthenia gravis, amyotrophic lateral sclerosis, and myopathies, and the use of immunomodulatory drugs (Myasthenia Gravis and Chronic Inflammatory Demyelinating Polyneuropathy) make this group of patients potentially more vulnerable. Secondly, safety measures also affect proper care, limiting care continuity, and physical rehabilitation (one of the essential aspects of myopathies treatment). Telemedicine can partially solve the problem allowing for a continuum of close care, avoiding unnecessary visits, and even guaranteeing the attention of professionals from tertiary care centers. However, one of the crucial steps in neuromuscular diseases is diagnosis, and in most scenarios, more than one face-to-face visit is needed. Lastly, the global COVID-19 situation will also have an economic impact on patients and their families. This situation is of particular concern given that neuromuscular diseases already present difficulties due to the scarcity of resources in terms of public healthcare and research.
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Affiliation(s)
| | - Miguel Angel Rubio
- Neuromuscular Unit, Neurology Department, Hospital del Mar, Barcelona, Spain
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