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Hadouiri N, Fournel I, Thauvin-Robinet C, Jacquin-Piques A, Ornetti P, Gueugnon M. Walking test outcomes in adults with genetic neuromuscular diseases: a systematic literature review of their measurement properties. Eur J Phys Rehabil Med 2024; 60:257-269. [PMID: 38300152 PMCID: PMC11114158 DOI: 10.23736/s1973-9087.24.08095-x] [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: 06/16/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Neuromuscular diseases (NMDs) include a large group of heterogeneous diseases. NMDs frequently involve gait disorders, which affect quality of life. Several walking tests and tools have been described in the literature, but there is no consensus regarding the use of walking tests and tools in NMDs or of their measurement properties for walking outcomes. The aim of this review is to present an overview of walking tests, including their measurement properties when used in adults with inherited or genetic NMDs. The aim is to help clinicians and researchers choose the most appropriate test for their objective. EVIDENCE ACQUISITION A systematic review was conducted after consulting MEDLINE (via PubMed), EMBASE, Science direct, Google Scholar and Cochrane Central Register of Controlled Trials databases for published studies in which walking outcome measurement properties were assessed. The validity, reliability, measurement error and responsiveness properties were evaluated in terms of statistical methods and methodological design qualities using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. EVIDENCE SYNTHESIS We included 46 studies in NMDs. These studies included 15 different walking tests and a wide variety of walking outcomes, assessed with six types of walking tools. Overall, the 6MWT was the most studied test in terms of measurement properties. The methodological design and statistical methods of most studies evaluating construct validity, reliability and measurement error were "very good." The majority of outcome measurements were valid and reliable. However, studies on responsiveness as minimal important difference or minimal important change were lacking or were found to have inadequate methodological and statistical methods according to the COSMIN guidelines. CONCLUSIONS Most walking outcomes were found to be valid and reliable in NMDs. However, in view of the growing number of clinical trials, further studies are needed to clarify additional measurement properties.
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Affiliation(s)
- Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France -
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France -
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France -
| | - Isabelle Fournel
- Clinical Investigation Center, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Christel Thauvin-Robinet
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), CHU Dijon Bourgogne, Dijon, France
- Centre de Référence Maladies Rares "Maladies neurogénétiques", CHU Dijon Bourgogne, Dijon, France
| | - Agnès Jacquin-Piques
- Centre de Compétences Maladies Rares "Maladies neuromusculaires", Department of Neurology, Dijon University Hospital, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
| | - Mathieu Gueugnon
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
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Migliorelli C, Gómez-Martinez M, Subías-Beltrán P, Claramunt-Molet M, Idelsohn-Zielonka S, Mas-Hurtado E, Miralles F, Montolio M, Roselló-Ruano M, Medina-Cantillo J. Multidimensional Biomechanics-Based Score to Assess Disease Progression in Duchenne Muscular Dystrophy. SENSORS (BASEL, SWITZERLAND) 2023; 23:831. [PMID: 36679627 PMCID: PMC9861677 DOI: 10.3390/s23020831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Duchenne (DMD) is a rare neuromuscular disease that progressively weakens muscles, which severely impairs gait capacity. The Six Minute-Walk Test (6MWT), which is commonly used to evaluate and monitor the disease's evolution, presents significant variability due to extrinsic factors such as patient motivation, fatigue, and learning effects. Therefore, there is a clear need for the establishment of precise clinical endpoints to measure patient mobility. (2) Methods: A novel score (6M+ and 2M+) is proposed, which is derived from the use of a new portable monitoring system capable of carrying out a complete gait analysis. The system includes several biomechanical sensors: a heart rate band, inertial measurement units, electromyography shorts, and plantar pressure insoles. The scores were obtained by processing the sensor signals and via gaussian-mixture clustering. (3) Results: The 6M+ and 2M+ scores were evaluated against the North Star Ambulatory Assessment (NSAA), the gold-standard for measuring DMD, and six- and two-minute distances. The 6M+ and 2M+ tests led to superior distances when tested against the NSAA. The 6M+ test and the 2M+ test in particular were the most correlated with age, suggesting that these scores better characterize the gait regressions in DMD. Additionally, the 2M+ test demonstrated an accuracy and stability similar to the 6M+ test. (4) Conclusions: The novel monitoring system described herein exhibited good usability with respect to functional testing in a clinical environment and demonstrated an improvement in the objectivity and reliability of monitoring the evolution of neuromuscular diseases.
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Affiliation(s)
- Carolina Migliorelli
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
| | | | - Paula Subías-Beltrán
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
| | - Mireia Claramunt-Molet
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
- Ephion Health, 08005 Barcelona, Spain
| | - Sebastian Idelsohn-Zielonka
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
- Ephion Health, 08005 Barcelona, Spain
| | - Eudald Mas-Hurtado
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
| | - Felip Miralles
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
- Ephion Health, 08005 Barcelona, Spain
| | - Marisol Montolio
- Duchenne Parent Project, 28032 Madrid, Spain
- Department of Cell Biology, Fisiology and Immunology, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain
| | - Marina Roselló-Ruano
- Duchenne Parent Project, 28032 Madrid, Spain
- Department of Cell Biology, Fisiology and Immunology, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain
| | - Julita Medina-Cantillo
- Unidad de Patología Neuromuscular, Servicio de Rehabilitación, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain
- Investigación Aplicada en Enfermedades Neuromusculares, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
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3
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Roberts-Lewis SF, White CM, Ashworth M, Rose MR. Validity of Fitbit activity monitoring for adults with progressive muscle diseases. Disabil Rehabil 2022; 44:7543-7553. [PMID: 34719329 DOI: 10.1080/09638288.2021.1995057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Measuring physical activity informs activity recommendations in clinical practice and provides outcomes in clinical trials that are meaningful to patients. Activity assessment in muscle disease is challenging and there is insufficient evidence to support any single activity measure; however, multi-modal activity measurement might have potential. MATERIALS AND METHODS This two-part study included 20 and 95 adults with progressive muscle diseases with mobility ranging from independent to assisted, including wheelchair users. Their activity was measured using a multi-sensor Fitbit activity monitor, for which criterion validity and acceptability were tested in study 1 and validity, reliability, and responsiveness were tested in the longitudinal, home-based study 2. RESULTS Study 1: Fitbit was acceptable and had strong criterion validity (rho/kappa ≥0.90), although up to 15% measurement error. Study 2: Fitbit had satisfactory concurrent and construct validity, reliability, and responsiveness. However, Fitbit active minutes registered 75 min more activity per week than gold standard moderate and vigorous physical activity (MVPA) time. CONCLUSIONS Fitbit had satisfactory measurement properties for monitoring physical activity in adults with progressive muscle diseases. However, Fitbit should not be considered an exact step counter, heart rate monitor or calorimeter and Fitbit active minutes are not synonymous with MVPA time.Implications for rehabilitationPeople with progressive muscle diseases mobilise independently, with walking aids and with wheelchairs; physical activity measurement can be challenging in this population.Multisensor smart activity monitoring by Fitbit had satisfactory validity, reliability, responsiveness, and acceptability for the estimation of physical activity in adults with progressive muscle diseases.Fitbit active minutes are not synonymous with moderate and vigorous physical activity (MVPA) time measured using a research grade accelerometer.
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Affiliation(s)
- Sarah F Roberts-Lewis
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Claire M White
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Michael R Rose
- Neurology Department, King's College Hospital, London, UK
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4
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Tard C, Bayot M, Davion JB, Danjoux L, Thomas R, Perez T, Mallart A, Fry S, Moreau C, Nguyen S, Defebvre L, Delval A. Factors impacting performance on the 6-minute walk test by people with late-onset Pompe disease. Muscle Nerve 2022; 65:693-697. [PMID: 35362614 DOI: 10.1002/mus.27543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Pompe disease is a progressive myopathy that combines motor, respiratory, and cardiac impairments. The 6-min walk test is the gold standard for assessing disease severity at the motor level. The objective of this study was to better determine the parameters that influence the total distance covered in patients with Pompe disease. METHODS We performed a retrospective review of 15 patients with late-onset Pompe disease who were followed regularly at a single referral center. Logistic regression was used to investigate the links between motor, respiratory and cardiac variables and 6-min walk test performance. RESULTS When considering baseline clinical and demographic variables, a seven-step backward elimination regression analysis yielded a model with two predictors (age and the use of an assistive device) that explained 85.5% of the variance. When considering the cardiorespiratory variables monitored during gait, a three-step backward elimination regression analysis showed that two predictors (heart rate recovery and the baseline partial pressure of carbon dioxide) explained 42.2% of the variance. DISCUSSION Our results highlighted the importance of respiratory and cardiac adaptation during exercise (along with motor ability) during the 6-min walk test in patients with Pompe disease. Further studies of larger cohorts are necessary to validate the model, which might enable investigators to determine whether intra-individual fluctuations in 6-min walk test performance are related to physiological parameters and/or to other variables such as the patient's level of motivation during the test.
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Affiliation(s)
- Céline Tard
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, University of Lille, Lille, France
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Madli Bayot
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, University of Lille, Lille, France
| | - Jean-Baptiste Davion
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, University of Lille, Lille, France
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Loïc Danjoux
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Romain Thomas
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Thierry Perez
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Anne Mallart
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Stéphanie Fry
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Caroline Moreau
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, University of Lille, Lille, France
| | - Sylvie Nguyen
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
| | - Luc Defebvre
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, University of Lille, Lille, France
| | - Arnaud Delval
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, University of Lille, Lille, France
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The Impact of a Precision-Based Exercise Intervention in Childhood Hematological Malignancies Evaluated by an Adapted Yo-Yo Intermittent Recovery Test. Cancers (Basel) 2022; 14:cancers14051187. [PMID: 35267495 PMCID: PMC8909675 DOI: 10.3390/cancers14051187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023] Open
Abstract
During cancer treatments in childhood hematological malignancies, reduced exercise tolerance is one of the main hardships. Precision-based training programs help children, adolescents, and young adults and their families to resume regular physical activity, exercise, and sports once they return to their communities after the intensive phases spent in hospital. This study was aimed at verifying whether an intermittent recovery test, the Yo-Yo AD, could provide a simple and valid way to evaluate an individual’s capacity to perform repeated intense exercise and to follow up on the impact of tailored exercise in children, adolescents, and young adults with hematological malignancies. The Yo-Yo AD involved the repetition of several shuttles to muscle exhaustion, at pre-established speeds (walking and slow running). The heart rate (HR) and oxygen saturation (SaO2) were monitored during the test. The total distance and the walking/running ability, measured as the slope of the HR vs. distance correlation, were investigated before (T0) and after 11 weeks (T1) of precision exercise intervention. The Yo-Yo AD was also performed by healthy children (CTRL). Ninety-seven patients (10.58 ± 4.5 years, 46% female) were enrolled. The Yo-Yo AD showed the positive impact of the exercise intervention by increasing the distance covered by the individuals (T0 = 946.6 ± 438.2 vs. T1 = 1352.3 ± 600.6 m, p < 0.001) with a more efficient walking/running ability (T0 = 2.17 ± 0.84 vs. T1 = 1.73 ± 0.89 slope, p < 0.0164). CTRLs performed better (1754.0 ± 444.0 m, p = 0.010). They were equally skillful (1.71 ± 0.27 slope) when compared to the patients after they received the precision-based intervention. No adverse events occurred during the Yo-Yo AD and it proved to be an accurate way of correctly depicting the changes in performance in childhood hematological malignancies.
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Bergs PMJ, Maas DM, Janssen MCH, Groothuis JT. Feasible and clinical relevant outcome measures for adults with mitochondrial disease. Mol Genet Metab 2022; 135:102-108. [PMID: 34961688 DOI: 10.1016/j.ymgme.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
There is no consensus on clinical outcome measures that reflect function, activities and participation which are suitable for adults with mitochondrial diseases (MD). The aim of this study was to determine feasible and clinically relevant outcome measures for patients with MD . In 156 adult patients with MD, endurance, balance, strength and mobility tests were evaluated. All tests showed a negative deviation to healthy reference values. Balance tests were feasible and significantly correlated with clinical severity. The Åstrand cycle test was not feasible in 55%, whereas the feasibility of the 6 min walking test is unclear in patients with MD.
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Affiliation(s)
- Peggy M J Bergs
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Daphne M Maas
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Radboud Center for Mitochondrial Medicine, Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands.
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7
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Servais L, Yen K, Guridi M, Lukawy J, Vissière D, Strijbos P. Stride Velocity 95th Centile: Insights into Gaining Regulatory Qualification of the First Wearable-Derived Digital Endpoint for use in Duchenne Muscular Dystrophy Trials. J Neuromuscul Dis 2021; 9:335-346. [PMID: 34958044 PMCID: PMC9028650 DOI: 10.3233/jnd-210743] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 2019, stride velocity 95th centile (SV95C) became the first wearable-derived digital clinical outcome assessment (COA) qualified by the European Medicines Agency (EMA) for use as a secondary endpoint in trials for Duchenne muscular dystrophy. SV95C was approved via the EMA’s qualification pathway for novel methodologies for medicine development, which is a voluntary procedure for assessing the regulatory acceptability of innovative methods used in pharmaceutical research and development. SV95C is an objective, real-world digital ambulation measure of peak performance, representing the speed of the fastest strides taken by the wearer over a recording period of 180 hours. SV95C is correlated with traditional clinic-based assessments of motor function and has greater sensitivity to clinical change over 6 months than other wearable-derived stride variables, for example, median stride length or velocity. SV95C overcomes many limitations of episodic, clinic-based motor function testing, allowing the assessment of ambulation ability between clinic visits and under free-living conditions. Here we highlight considerations and challenges in developing SV95C using evidence generated by a high-performance wearable sensor. We also provide a commentary of the device’s technical capabilities, which were a determining factor in the regulatory approval of SV95C. This article aims to provide insights into the methods employed, and the challenges faced, during the regulatory approval process for researchers developing new digital tools for patients with diseases that affect motor function.
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Affiliation(s)
- Laurent Servais
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège and University of Liège, Liège, Belgium.,Muscular Dystrophy UK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Karl Yen
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Pini J, Siciliano G, Lahaut P, Braun S, Segovia-Kueny S, Kole A, Hérnando I, Selb J, Schirinzi E, Duong T, Hogrel JY, Olmedo JJS, Vissing J, Servais L, Vincent-Genod D, Vuillerot C, Bannwarth S, Eggenspieler D, Vicart S, Diaz-Manera J, Lochmüller H, Sacconi S. E-Health & Innovation to Overcome Barriers in Neuromuscular Diseases. Report from the 1st eNMD Congress: Nice, France, March 22-23, 2019. J Neuromuscul Dis 2021; 8:743-754. [PMID: 33843694 PMCID: PMC8385527 DOI: 10.3233/jnd-210655] [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] [Indexed: 11/15/2022]
Abstract
By definition, neuromuscular diseases are rare and fluctuating in terms of symptoms; patients are often lately diagnosed, do not have enough information to understand their condition and be proactive in their management. Usually, insufficient resources or services are available, leading to patients' social burden. From a medical perspective, the rarity of such diseases leads to the unfamiliarity of the medical staff and caregiver and an absence of consensus in disease assessment, treatment, and management. Innovations have to be developed in response to patients' and physicians' unmet needs.It is vital to improve several aspects of patients' quality of life with a better comprehension of their disease, simplify their management and follow-up, help their caregiver, and reduce the social and economic burden for living with a rare debilitating disease. Database construction regrouping patients' data and symptoms according to specific country registration on data privacy will be critical in establishing a clear consensus on neuromuscular disease treatment.Clinicians also need technological innovations to help them recognize neuromuscular diseases, find the best therapeutic approach based on medical consensus, and tools to follow patients' states regularly. Diagnosis also has to be improved by implementing automated systems to analyze a considerable amount of data, representing a significant step forward to accelerate the diagnosis and the patients' follow up. Further, the development of new tools able to precisely measure specific outcomes reliably is of the matter of importance in clinical trials to assess the efficacy of a newly developed compound.In this context, creation of an expert community is essential to communicate and share ideas. To this end, 97 clinicians, healthcare professionals, researchers, and representatives of private companies from 9 different countries met to discuss the new perspective and challenges to develop and implement innovative tools in the field of neuromuscular diseases.
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Affiliation(s)
- Jonathan Pini
- Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Peripheral Nervous System and Muscle Department, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France
| | - Gabriele Siciliano
- Neurological Clinic, Department of Clinical and Experimental Medicine, Ospedale Santa Chiara, University of Pisa, Pisa, Italy
| | - Pauline Lahaut
- Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Peripheral Nervous System and Muscle Department, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France
| | | | | | - Anna Kole
- Public Health Policy Director Rare 2030 Lead EURORDIS
| | | | - Julij Selb
- University Clinic Golnik, Golnik, Slovenia -Medical consultant Parsek, Vienna, Austria
| | - Erika Schirinzi
- Neurological Clinic, Department of Clinical and Experimental Medicine, Ospedale Santa Chiara, University of Pisa, Pisa, Italy
| | - Tina Duong
- Department of Neurology Stanford University, Palo Alto, CA, USA
| | - Jean-Yves Hogrel
- Neuromuscular Physiology and Evaluation Lab, Neuromuscular Investigation Centre, Institute of Myology, Paris, France
| | - José Javier Serrano Olmedo
- Laboratory of Bioinstrumentation and Nanomedicine, Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain.,Networking Center for Biomedical Research on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,Escuela Técnica Superior de Ingenieros de Telecomunicación, Madrid, Spain
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laurent Servais
- MDUK Oxford Neuromuscular Center Department of Pediatrics University of Oxford, Oxford, UK.,Division of Child Neurology Reference Center for Neuromuscular Disease, Centre Hospitalier Régional de Références des Maladies Neuromusculaires, Department of Paediatrics, University, Oxford, UK
| | | | - Carole Vuillerot
- Neuron Interaction Team, NeuroMyogène Institute, Lyon University, Lyon, France
| | - Sylvie Bannwarth
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice University Hospital, Nice, France.,Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, Université Côte D'Azur (UCA), Nice, France
| | | | - Savine Vicart
- Channelopahies Reference Center, Service of Neuro-Myology, University Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK.,Neurology department. Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain
| | | | - Hanns Lochmüller
- Childrens Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada.,Department of Neuropediatrics and Muscle Disorders, Medical Center -University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia, Spain
| | - Sabrina Sacconi
- Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Peripheral Nervous System and Muscle Department, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France.,Institute for Research on Cancer and Aging of Nice (IRCAN), Faculty of Medicine, Université Côte D'Azur (UCA), Nice, France.,Fédération Hospitalo-Universitaire Oncoage, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur (UCA), Nice, France
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9
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Andersen LK, Witting N, Vissing J. Effects of rhythmic auditory stimulation on walking during the 6-minute walk test in patients with generalised Myasthenia Gravis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1876760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Linda Kahr Andersen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Witting
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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10
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Baroudi L, Newman MW, Jackson EA, Barton K, Shorter KA, Cain SM. Estimating Walking Speed in the Wild. Front Sports Act Living 2020; 2:583848. [PMID: 33345151 PMCID: PMC7739717 DOI: 10.3389/fspor.2020.583848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022] Open
Abstract
An individual's physical activity substantially impacts the potential for prevention and recovery from diverse health issues, including cardiovascular diseases. Precise quantification of a patient's level of day-to-day physical activity, which can be characterized by the type, intensity, and duration of movement, is crucial for clinicians. Walking is a primary and fundamental physical activity for most individuals. Walking speed has been shown to correlate with various heart pathologies and overall function. As such, it is often used as a metric to assess health performance. A range of clinical walking tests exist to evaluate gait and inform clinical decision-making. However, these assessments are often short, provide qualitative movement assessments, and are performed in a clinical setting that is not representative of the real-world. Technological advancements in wearable sensing and associated algorithms enable new opportunities to complement in-clinic evaluations of movement during free-living. However, the use of wearable devices to inform clinical decisions presents several challenges, including lack of subject compliance and limited sensor battery life. To bridge the gap between free-living and clinical environments, we propose an approach in which we utilize different wearable sensors at different temporal scales and resolutions. Here, we present a method to accurately estimate gait speed in the free-living environment from a low-power, lightweight accelerometer-based bio-logging tag secured on the thigh. We use high-resolution measurements of gait kinematics to build subject-specific data-driven models to accurately map stride frequencies extracted from the bio-logging system to stride speeds. The model-based estimates of stride speed were evaluated using a long outdoor walk and compared to stride parameters calculated from a foot-worn inertial measurement unit using the zero-velocity update algorithm. The proposed method presents an average concordance correlation coefficient of 0.80 for all subjects, and 97% of the error is within ±0.2m· s -1. The approach presented here provides promising results that can enable clinicians to complement their existing assessments of activity level and fitness with measurements of movement duration and intensity (walking speed) extracted at a week time scale and in the patients' free-living environment.
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Affiliation(s)
- Loubna Baroudi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Mark W. Newman
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth A. Jackson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Alabama, Birmimgham, AL, United States
| | - Kira Barton
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - K. Alex Shorter
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Stephen M. Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
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11
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De Cannière H, Smeets CJP, Schoutteten M, Varon C, Van Hoof C, Van Huffel S, Groenendaal W, Vandervoort P. Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study. J Med Internet Res 2020; 22:e17326. [PMID: 32432552 PMCID: PMC7270861 DOI: 10.2196/17326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/06/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. OBJECTIVE The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. METHODS A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. RESULTS All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HRpeak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HRrec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HRrec1: P<.001, HRrec2: P<.001, HRrec3: P<.001, HRrec4: P<.001, and HRrec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses. CONCLUSIONS This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome.
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Affiliation(s)
- Hélène De Cannière
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Christophe J P Smeets
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
- Holst Centre, imec the Netherlands, Eindhoven, Netherlands
| | - Melanie Schoutteten
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Carolina Varon
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
- Circuits and Systems (CAS), Department of Microelectronics, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Chris Van Hoof
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
- imec vzw Belgium, Leuven, Belgium
| | - Sabine Van Huffel
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
| | | | - Pieter Vandervoort
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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12
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Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease. Sci Rep 2020; 10:5169. [PMID: 32198360 PMCID: PMC7083974 DOI: 10.1038/s41598-020-61932-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/17/2020] [Indexed: 11/09/2022] Open
Abstract
One quarter of individuals with Preserved Ratio Impaired Spirometry (PRISm) will develop airflow obstruction, but there are no established methods to identify these individuals. We examined the utility of FVC/TLC in identifying features of obstructive lung disease. The ratio of post-bronchodilator FVC and TLCCT from chest CT (FVC/TLCCT) among current and former smokers with PRISm (FEV1/FVC ≥ 0.7 and FEV1 < 80%) in COPDGene was used to stratify subjects into quartiles: very high, high, low, and very low. We examined the associations between FVC/TLCCT quartiles and (1) baseline characteristics, (2) respiratory exacerbations, (3) progression to COPD at 5 years, and (4) all-cause mortality. Among participants with PRISm at baseline (n = 1,131), the very low FVC/TLCCT quartile was associated with increased gas trapping and emphysema, and higher rates of progression to COPD at 5 years (36% versus 17%; p < 0.001) relative to the very high quartile. The very low FVC/TLCCT quartile was associated with increased total (IRR = 1.65; 95% CI [1.07–2.54]) and severe (IRR = 2.24; 95% CI [1.29–3.89]) respiratory exacerbations. Mortality was lower in the very high FVC/TLCCT quartile relative to the other quartiles combined. Reduced FVC/TLCCT ratio in PRISm is associated with increased symptoms, radiographic emphysema and gas trapping, exacerbations, and progression to COPD.
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13
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Ansari B, Salort-Campana E, Ogier A, Le Troter PhD A, De Sainte Marie B, Guye M, Delmont E, Grapperon AM, Verschueren A, Bendahan D, Attarian S. Quantitative muscle MRI study of patients with sporadic inclusion body myositis. Muscle Nerve 2020; 61:496-503. [PMID: 31953869 DOI: 10.1002/mus.26813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fat infiltration in individual muscles of sporadic inclusion body myositis (sIBM) patients has rarely been assessed. METHODS Sixteen sIBM patients were assessed using MRI of the thighs and lower legs (LL). The severity of fat infiltration, proximal-to-distal and side asymmetries, and the correlations with clinical and functional parameters were investigated. RESULTS All the patients had fat-infiltrated muscles, and thighs were more severely affected than LL. A proximal-to-distal gradient of fat infiltration was mainly observed for adductors, quadriceps, sartorius, and medial gastrocnemius muscles. A strong negative correlation was observed between the whole muscle fat fraction in the thighs and LL and the Inclusion Body Myositis Functional Rating Scale and Medical Research Council scores for the lower limbs. CONCLUSIONS Fat infiltration in individual muscles of sIBM patients is heterogeneous in terms of proximal-to-distal gradient and severity was correlated with clinical scores. These results should be considered for both natural history investigation and clinical trials.
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Affiliation(s)
- Behnaz Ansari
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille.,Aix-Marseille University, Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS, Marseille, France.,Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emmanuelle Salort-Campana
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille.,INSERM, GMGF, Aix Marseille University, Marseille, France.,FILNEMUS
| | - Augustin Ogier
- Aix-Marseille University, Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS, Marseille, France
| | - Arnaud Le Troter PhD
- Aix-Marseille University, Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS, Marseille, France
| | - Benjamin De Sainte Marie
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille
| | - Maxime Guye
- Aix-Marseille University, Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS, Marseille, France
| | - Emilien Delmont
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille.,FILNEMUS
| | - Aude-Marie Grapperon
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille.,FILNEMUS
| | - Annie Verschueren
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille.,FILNEMUS
| | - David Bendahan
- Aix-Marseille University, Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS, Marseille, France
| | - Shahram Attarian
- Centre de référence PACA Réunion Rhône Alpes, La Timone University Hospital, Aix-Marseille University, Marseille.,INSERM, GMGF, Aix Marseille University, Marseille, France.,FILNEMUS
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14
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Mueller A, Hoefling HA, Muaremi A, Praestgaard J, Walsh LC, Bunte O, Huber RM, Fürmetz J, Keppler AM, Schieker M, Böcker W, Roubenoff R, Brachat S, Rooks DS, Clay I. Continuous Digital Monitoring of Walking Speed in Frail Elderly Patients: Noninterventional Validation Study and Longitudinal Clinical Trial. JMIR Mhealth Uhealth 2019; 7:e15191. [PMID: 31774406 PMCID: PMC6906618 DOI: 10.2196/15191] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/09/2019] [Accepted: 09/24/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Digital technologies and advanced analytics have drastically improved our ability to capture and interpret health-relevant data from patients. However, only limited data and results have been published that demonstrate accuracy in target indications, real-world feasibility, or the validity and value of these novel approaches. OBJECTIVE This study aimed to establish accuracy, feasibility, and validity of continuous digital monitoring of walking speed in frail, elderly patients with sarcopenia and to create an open source repository of raw, derived, and reference data as a resource for the community. METHODS Data described here were collected as a part of 2 clinical studies: an independent, noninterventional validation study and a phase 2b interventional clinical trial in older adults with sarcopenia. In both studies, participants were monitored by using a waist-worn inertial sensor. The cross-sectional, independent validation study collected data at a single site from 26 naturally slow-walking elderly subjects during a parcours course through the clinic, designed to simulate a real-world environment. In the phase 2b interventional clinical trial, 217 patients with sarcopenia were recruited across 32 sites globally, where patients were monitored over 25 weeks, both during and between visits. RESULTS We have demonstrated that our approach can capture in-clinic gait speed in frail slow-walking adults with a residual standard error of 0.08 m per second in the independent validation study and 0.08, 0.09, and 0.07 m per second for the 4 m walk test (4mWT), 6-min walk test (6MWT), and 400 m walk test (400mWT) standard gait speed assessments, respectively, in the interventional clinical trial. We demonstrated the feasibility of our approach by capturing 9668 patient-days of real-world data from 192 patients and 32 sites, as part of the interventional clinical trial. We derived inferred contextual information describing the length of a given walking bout and uncovered positive associations between the short 4mWT gait speed assessment and gait speed in bouts between 5 and 20 steps (correlation of 0.23) and longer 6MWT and 400mWT assessments with bouts of 80 to 640 steps (correlations of 0.48 and 0.59, respectively). CONCLUSIONS This study showed, for the first time, accurate capture of real-world gait speed in slow-walking older adults with sarcopenia. We demonstrated the feasibility of long-term digital monitoring of mobility in geriatric populations, establishing that sufficient data can be collected to allow robust monitoring of gait behaviors outside the clinic, even in the absence of feedback or incentives. Using inferred context, we demonstrated the ecological validity of in-clinic gait assessments, describing positive associations between in-clinic performance and real-world walking behavior. We make all data available as an open source resource for the community, providing a basis for further study of the relationship between standardized physical performance assessment and real-world behavior and independence.
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Affiliation(s)
- Arne Mueller
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Amir Muaremi
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Jens Praestgaard
- Biostatistics and Pharmacometrics, Novartis Pharmaceuticals Corporation, East Hannover, NJ, United States
| | - Lorcan C Walsh
- Novartis Business Services, Novartis Ireland Ltd, Dublin, Ireland
| | - Ola Bunte
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Julian Fürmetz
- University Hospital, Ludwigs-Maximillians Universität, Munich, Germany
| | | | - Matthias Schieker
- Novartis Institutes for BioMedical Research, Basel, Switzerland
- University Hospital, Ludwigs-Maximillians Universität, Munich, Germany
| | - Wolfgang Böcker
- University Hospital, Ludwigs-Maximillians Universität, Munich, Germany
| | | | - Sophie Brachat
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Daniel S Rooks
- Novartis Institutes for BioMedical Research, Cambridge, MA, United States
| | - Ieuan Clay
- Novartis Institutes for BioMedical Research, Basel, Switzerland
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15
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Mueller A, Hoefling H, Nuritdinow T, Holway N, Schieker M, Daumer M, Clay I. Continuous Monitoring of Patient Mobility for 18 Months Using Inertial Sensors following Traumatic Knee Injury: A Case Study. Digit Biomark 2018; 2:79-89. [PMID: 32095759 DOI: 10.1159/000490919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022] Open
Abstract
Continuous patient activity monitoring during rehabilitation, enabled by digital technologies, will allow the objective capture of real-world mobility and aligning treatment to each individual's recovery trajectory in real time. To explore the feasibility and added value of such approaches, we present a case study of a 36-year-old male participant monitored continuously for activity levels and gait parameters using a waist-worn inertial sensor following a tibial plateau fracture on the right side, sustained as a result of a high-energy trauma during a sporting accident. During rehabilitation, data were collected for a period of 553 days, with > 80% daytime compliance, until the participant returned to near full mobility. The participant completed a daily diary with the annotation of major events (falls, near falls, cycling periods, or physiotherapy sessions) and key dates in the patient's recovery, including medical interventions, transitioning off crutches, and returning to work. We demonstrate the feasibility of collecting, storing, and mining of continuous digital mobility data and show that such data can detect changes in mobility and provide insights into long-term rehabilitation. We make both raw data and annotations available as a resource with the aspiration that further methods and insights will be built on this initial exploration of added value and continue to demonstrate that continuous monitoring can be deployed to aid rehabilitation.
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Affiliation(s)
- Arne Mueller
- Translational Medicine, Novartis Institutes for Biomedical Research, Forum 1, Novartis Campus, Basel, Switzerland
| | - Holger Hoefling
- NIBR Informatics, Novartis Institutes for Biomedical Research, Forum 1, Novartis Campus, Basel, Switzerland
| | - Timur Nuritdinow
- Sylvia Lawry Centre eV, The Human Motion Institute, Munich, Germany
| | - Nicholas Holway
- NIBR Informatics, Novartis Institutes for Biomedical Research, Forum 1, Novartis Campus, Basel, Switzerland
| | - Matthias Schieker
- Translational Medicine, Novartis Institutes for Biomedical Research, Forum 1, Novartis Campus, Basel, Switzerland
| | | | - Ieuan Clay
- Translational Medicine, Novartis Institutes for Biomedical Research, Forum 1, Novartis Campus, Basel, Switzerland
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16
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Witherspoon JW, Vasavada RP, Waite MR, Shelton M, Chrismer IC, Wakim PG, Jain MS, Bönnemann CG, Meilleur KG. 6-minute walk test as a measure of disease progression and fatigability in a cohort of individuals with RYR1-related myopathies. Orphanet J Rare Dis 2018; 13:105. [PMID: 29970108 PMCID: PMC6029052 DOI: 10.1186/s13023-018-0848-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background RYR1-related Myopathies (RYR1-RM) comprise a group of rare neuromuscular diseases (NMDs) occurring in approximately 1/90000 people in the US pediatric population. RYR1-RM result from pathogenic mutations in the ryanodine receptor isoform-1 (RYR1) gene where consequent RyR1 protein calcium dysregulation leads to impaired excitation-contraction coupling, oxidative and nitrosative stress, and mitochondrial depletion. These physiological deficits perpetuate RyR1 dysfunction causing further muscle injury, muscle weakness, and muscle fatigue. Muscle weakness and fatigue are two primary complaints in patients with RYR1-RM and are major symptoms that limit the ability of individuals to perform activities of daily living. The six-minute walk test (6MWT) is an endurance test with high reliability and validity used to measure walking capacity, disease progression, and more recently, fatigability in NMDs with limited results in RYR1-RM. Therefore, the purpose of our study is to objectively assess disease progression and fatigability in RYR1-RM affected individuals using the 6MWT. We hypothesized that 6MWT distance and fatigability would not change significantly between 0 and 6-month visits in RYR1-RM patients, given the clinically reported stable or slowly progressive nature of the disease. We also hypothesized participants would show fatigability during the 6MWT, given muscle weakness and fatigue are the two primary complaints of affected individuals. Results As expected, paired t-test analyses revealed no significant difference between total distance traveled (p = .608) or percent change in speed (p = .141) at 0-months compared with the 6-month visit. Fatigability was observed given the decline in speed between the first and last minute of the 6MWT at the 6-month time point (p ≤ .0005,). Although this decline was not significant at baseline, a significant decline in speed from the 1st minute did occur at minutes 2, 3, and 4 during the baseline visit. Conclusion In this RYR1-RM cohort, the 6MWT showed disease stability over a 6-month period but revealed fatigability during the test. Given these results, the 6MWT may be a promising endpoint for evaluating fatigability and therapeutic efficacy in the 6-month treatment phase of our current n-acetylcysteine trial in this population. Improvement post intervention could be attributed to the intervention rather than variability in disease progression. Trial Registration Clinical Trials.gov, NCT02362425, Registered 13 February 2015-Prospectively registered.
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Affiliation(s)
| | | | | | - Monique Shelton
- National Institute of Nursing Research, NIH, Bethesda, MD, USA
| | | | - Paul G Wakim
- Biostatistics and Clinical Epidemiology, NIH, Bethesda, MD, USA
| | | | - Carsten G Bönnemann
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
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de Gregorio C. Physical Training and Cardiac Rehabilitation in Heart Failure Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1067:161-181. [PMID: 29453669 DOI: 10.1007/5584_2018_144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Regardless of advances in medical and interventional treatment of cardiovascular disease (CVD), a limited number of patients attend a cardiac rehabilitation (CR) programme on a regular basis. Due to modern therapies more individuals will be surviving an acute cardiovascular event, but the expected burden of chronic heart failure will be increasing worldwide.However, both in high- and low-income countries, secondary prevention after an acute myocardial infarction or stroke has been implemented in less than a half of eligible patients.Combined interventions are still needed to reduce decompensations, hospitalizations and mortality in heart failure patients from any origin. In addition to medical treatments, regular exercise has been demonstrated to improve metabolic and hemodynamic conditions in both asymptomatic risk factor carriers and cardiac patients. Risk factor control and exercise should gather together for an effective management of patients.Exercise-based training is a core component of primary and secondary prevention. It should involve healthy carriers of cardiovascular risk factors, and patients with cardiomyopathy as well. The supposed attenuated effect of CR in the era of advanced revascularization and structural interventions is due to the heterogeneity of training models and physical training in the literature. Moreover, lifestyle modification, psycho-social challenges and patient's compliance are potential confounders.In this chapter the most recent evidences about training modalities and potential benefit of CR in heart failure patients are discussed.
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Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine - Cardiology Unit, University Hospital Medical School "Gaetano Martino", Messina, Italy.
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18
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Knak KL, Andersen LK, Vissing J. Aerobic anti-gravity exercise in patients with Charcot-Marie-Tooth disease types 1A and X: A pilot study. Brain Behav 2017; 7:e00794. [PMID: 29299376 PMCID: PMC5745236 DOI: 10.1002/brb3.794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 12/16/2022] Open
Abstract
Background Charcot-Marie-Tooth (CMT) disease is a hereditary neuropathy associated with impaired walking capacity. Some patients are too weak in the lower extremity muscles to walk at gravity with sufficient intensity or duration to gain benefit. Aim The aim was to investigate the effect of aerobic anti-gravity exercise in weak patients with CMT 1A and X. Methods Five adult patients performed moderate-intensity aerobic anti-gravity exercise 3/week for 10 weeks. Results There was a significant positive difference in Berg balance scale and postural stability test between test occasions, and walking distance in the 6-min walk test trended to increase. Conclusions The study indicates that the anti-gravity treadmill training of patients with CMT should be pursued in larger CMT cohorts.
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Affiliation(s)
- Kirsten L. Knak
- Copenhagen Neuromuscular CenterDepartment of NeurologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Linda K. Andersen
- Copenhagen Neuromuscular CenterDepartment of NeurologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - John Vissing
- Copenhagen Neuromuscular CenterDepartment of NeurologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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19
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Clay I. Impact of Digital Technologies on Novel Endpoint Capture in Clinical Trials. Clin Pharmacol Ther 2017; 102:912-913. [PMID: 29027665 DOI: 10.1002/cpt.866] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022]
Abstract
Digital technologies have been successfully deployed in clinical settings for many years, yet recent advances in hardware and analytic capabilities have driven an explosion in interest over the potential of digital medicine to change how drugs are developed, centering on how we interact with patients, treat patients, and capture information about patients.
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Affiliation(s)
- Ieuan Clay
- Novartis Institutes for Biomedical Research, Basel, Switzerland
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20
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Kierkegaard M, Petitclerc E, Hébert LJ, Gagnon C. Is one trial enough for repeated testing? Same-day assessments of walking, mobility and fine hand use in people with myotonic dystrophy type 1. Neuromuscul Disord 2017; 27:153-158. [DOI: 10.1016/j.nmd.2016.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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21
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A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment. PLoS One 2016; 11:e0156696. [PMID: 27271157 PMCID: PMC4896626 DOI: 10.1371/journal.pone.0156696] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/18/2016] [Indexed: 12/15/2022] Open
Abstract
Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD) patients (mean age 18.5 ± 5.5 years) collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test) and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment. Trial Registration: ClinicalTrials.gov NCT01611597
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Andersen LK, Knak KL, Witting N, Vissing J. Two- and 6-minute walk tests assess walking capability equally in neuromuscular diseases. Neurology 2016; 86:442-5. [PMID: 26740680 DOI: 10.1212/wnl.0000000000002332] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/07/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This methodologic study investigates if the 2-minute walk test (2MWT) can be a valid alternative to the 6-minute walk test (6MWT) to describe walking capability in patients with neuromuscular diseases. METHODS Patients (n = 115) with different neuromuscular diseases were invited to participate on 2 test days, each consisting of 1 2MWT and 1 6MWT separated by a minimum 30-minute period of rest. The order of the walk tests was randomly assigned via sealed envelopes. A group of 38 healthy controls completed 1 6MWT. RESULTS The mean walking distance for the 2MWT was 142.8 meters and for the 6MWT 405.3 meters. The distance walked in the 2MWT was highly correlated to the distance walked in the 6MWT (r = 0.99, p < 0.001). There was a significant decrease in walking speed from the first to last minute in the 6MWT, both among patients and healthy controls, which was not evident in the 2MWT. Results were consistent across diagnoses and levels of disease severity. CONCLUSION The 2MWT is a potential alternative to the 6MWT to describe walking capability among patients with neuromuscular diseases during clinical trials.
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Affiliation(s)
- Linda Kahr Andersen
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.
| | - Kirsten Lykke Knak
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nanna Witting
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - John Vissing
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
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Nishizawa H, Genno H, Shiba N, Nakamura A. Periodic sound-based 6-minute walk test forpatients with Duchenne muscular dystrophy:a preliminary study. J Phys Ther Sci 2015; 27:3473-9. [PMID: 26696721 PMCID: PMC4681928 DOI: 10.1589/jpts.27.3473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/19/2015] [Indexed: 01/19/2023] Open
Abstract
[Purpose] The purpose of this study was to verify if a periodic sound-based 6-minute walk
test with the best periodic sound could be used to evaluate physical endurance more
precisely than the conventional 6-minute walk test. [Subjects] The subjects were healthy
subjects and 6 ambulant patients with Duchenne muscular dystrophy. [Methods] The subjects
initially walked for 1 minute to a long-interval metronome sound, and the walking distance
was measured. The sound interval was then gradually shortened, and the subjects walked for
1 minute for each of the intervals. The best periodic sound was considered to be the
periodic sound used when the subject walked the longest distance in 1 minute, and the
process of determining it was referred to as the period shortening walk test. This study
administered the 6-minute walk test with the best periodic sound to twenty healthy
subjects and 6 ambulant patients with Duchenne muscular dystrophy and compared the walking
distance. [Results] The periodic sound-based 6-minute walk test distances in both the
healthy subjects and the patients were significantly longer than the conventional 6-minute
walk test distances. [Conclusion] The periodic sound-based 6-minute walk test provided a
better indication of ambulatory potential in an evaluation of physical endurance than the
conventional 6-minute walk test.
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Affiliation(s)
- Hitomi Nishizawa
- School of Health Sciences, Faculty of Medicine, Shinshu University, Japan
| | | | - Naoko Shiba
- Department of Pediatrics, Shinshu University School of Medicine, Japan
| | - Akinori Nakamura
- Intractable Disease Care Center, Shinshu University Hospital, Japan
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