Author Of 3 Presentations
P0146 - Reliability, concurrent and ecological validity of smartphone-based cognition and walking tests (ID 780)
Abstract
Background
The early detection and monitoring of cognitive and ambulatory dysfunction in multiple sclerosis (MS) may be enhanced with smartphone-adapted cognition and walking tests. Contrary to clinical measures, smartphone-based assessment allows more frequent measurements in the everyday environment, which potentially better reflects daily functioning.
Objectives
To determine the reliability, concurrent and ecological validity of self-administered smartphone-adapted Symbol Digit Modalities Test (SDMT) and Two-Minute Walking Test (2MWT).
Methods
Patients with MS were recruited. At baseline the SDMT and Timed 25-foot Walk Test (T25FW) were assessed clinically. During a 28-day follow-up, patients used the MS sherpa® app to perform the smartphone SDMT and 2MWT three times a week. The smartphone SDMT was assessed through tapping numbers corresponding to symbols on the smartphone during 90 seconds. The 2MWT measured walking distance utilizing the smartphone built-in sensors during two minutes of normal walking. Reliability of the smartphone tests were assessed by calculating intra-class correlation coefficients (ICC) between scores from week 2 and 3. Concurrent validity was addressed by calculation of correlation coefficients between the smartphone tests and their clinical counterparts. MS sherpa® also included one-item self-report scores for perceived fatigue and impact of MS on daily functioning. To assess ecological validity, the temporal association between the MS sherpa® tests and self-report scores from the everyday environment were analyzed using linear mixed models with the repeated measures as random effects.
Results
102 patients with MS were included. During the 28-day follow-up 102 patients completed a mean (± SD) of 12.1 (± 6.8) SDMTs and 74 patients completed a mean (± SD) of 8.8 (± 6.1) 2MWTs. Smartphone SDMT correlated significantly with the clinical SDMT (r = 0.607, p < 0.001) and demonstrated excellent reliability (ICC = 0.923). 2MWT was significantly correlated with T25FW (ρ = -0.352, p = 0.001) and demonstrated good reliability (ICC = 0.845). Over the 28-day period, higher 2MWT scores were related with lower perceived impact of MS on daily functioning (b = -0.005, 95% CI [-0.010, -0.001]) and higher SDMT scores were related with lower perceived fatigue (b = -0.014, 95% CI [-0.026, -0.003]).
Conclusions
Smartphone-adapted cognition and walking tests can be assessed frequently from the participants’ own environment and demonstrated validity and reliability in assessment of information processing speed and ambulatory function in MS. Support for ecological validity was found for perceived fatigue and impact on functioning in the everyday environment.
P0163 - Smartphone keystroke dynamics are sensitive to changes in disease activity and clinical disability measures in multiple sclerosis (ID 748)
Abstract
Background
Typing behavior on a smartphone may be used as a biomarker in patients with multiple sclerosis (MS) by analyzing their keystroke dynamics (KD). The continuous acquisition of high sample rate data may provide unprecedented insights in short-term changes in important health outcomes in MS.
Objectives
To investigate the sensitivity of KD to clinically relevant change (i.e. responsiveness) in disease activity, fatigue, and clinical disability outcomes in patients with MS.
Methods
Patients with MS were recruited in this cohort study. Clinical outcomes were assessed at baseline and 3 months follow-up, including: MRI gadolinium-enhancing lesions (Gd-EL), patient-perceived fatigue, and clinical disability measures (Expanded Disability Status Scale, EDSS; Timed 25-foot Walk Test, TWT; Nine-Hole Peg Test, NHPT; Arm function in MS Questionnaire, AMSQ). Throughout the study, patients used the Neurokeys App which replaces the native keyboard with a smart-keyboard and unobtrusively collects time-stamped key press and release events in the real-world setting. Keystroke data of 14 days surrounding the clinical visits were aggregated for the analyses. The area under the receiver operating characteristics curve (AUROC) was calculated to assess responsiveness of KD in classifying anchor-based change within clinical outcomes. The minimally important change (MIC) was calculated as the mean change in KD in the lower +2 SD portion (to approximate minimal change) of patients with clinically relevant change for each clinical outcome. The MIC was compared to the smallest detectable change (SDC) to assess the capability of KD to distinguish important change from measurement error.
Results
102 patients with MS were included, of whom 94 completed follow-up. Responsiveness of KD were acceptable for change in number of MRI Gd-EL (highest AUROC = 0.73) and arm function based on the AMSQ score (highest AUROCs = 0.75). KD had excellent responsiveness to change in ambulatory function measured with TWT (highest AUROC = 0.84). EDSS and NHPT had lower AUC values than KD in classifying change in Gd-EL and AMSQ, respectively. For all keystroke features the MIC exceeded the SDC with differences ranging from 3.6 to 92.4%.
Conclusions
KD collected in patients with MS using the Neurokeys App demonstrated responsiveness to clinically relevant changes in gadolinium-enhancing lesions on MRI and clinical disability measures for arm and ambulatory function. Responsiveness of KD was higher than commonly used clinical measures in MS and sensitive enough to discriminate important change from measurement error.
P0445 - Cohort description of Project Y: Searching for the cause of phenotype diversity in MS (ID 1352)
Abstract
Background
Detecting factors that influence disease variability in MS patients is crucial to provide novel insights into the etiology of the disease and guide the search for effective therapies. To study the phenotypic variability, well-defined unbiased cohort studies are necessary. The most common and arguably most important variable to be considered as a confounding factor when studying variability of disease course in MS, is age.
Objectives
To identify determinants that explain phenotypic variability in MS, while eliminating the undesirable effect of age variation between MS patients.
Methods
Project Y is an ongoing population-based cross-sectional study of all people with MS born in the Netherlands in 1966. Participants are subjected to extensive examinations of a wide array of potential determinants and outcome measures: functional and static imaging, biomarkers in body fluid, physical and cognitive measurements, and lifestyle factors early and later in life. Age and sex matched controls are included.
Results
As for July 2020, a total of 386 eligible MS patients were identified, of which 31 refused to participate and 86 patients awaiting inclusion. Thirteen patients had passed away prior to study inclusion. Between December 2017 and July 2020, 269 MS patients participated with either a full or partial data collection, together with 125 healthy controls. The total number of identified cases (386) results in a prevalence of at least 1.7/1000 in the birth year 1966.
Conclusions
The first preliminary data of our unique cohort indicate that the previously presumed prevalence of MS in the Netherlands (1/1000) is a serious underestimation of the actual prevalence.
Presenter Of 2 Presentations
P0146 - Reliability, concurrent and ecological validity of smartphone-based cognition and walking tests (ID 780)
Abstract
Background
The early detection and monitoring of cognitive and ambulatory dysfunction in multiple sclerosis (MS) may be enhanced with smartphone-adapted cognition and walking tests. Contrary to clinical measures, smartphone-based assessment allows more frequent measurements in the everyday environment, which potentially better reflects daily functioning.
Objectives
To determine the reliability, concurrent and ecological validity of self-administered smartphone-adapted Symbol Digit Modalities Test (SDMT) and Two-Minute Walking Test (2MWT).
Methods
Patients with MS were recruited. At baseline the SDMT and Timed 25-foot Walk Test (T25FW) were assessed clinically. During a 28-day follow-up, patients used the MS sherpa® app to perform the smartphone SDMT and 2MWT three times a week. The smartphone SDMT was assessed through tapping numbers corresponding to symbols on the smartphone during 90 seconds. The 2MWT measured walking distance utilizing the smartphone built-in sensors during two minutes of normal walking. Reliability of the smartphone tests were assessed by calculating intra-class correlation coefficients (ICC) between scores from week 2 and 3. Concurrent validity was addressed by calculation of correlation coefficients between the smartphone tests and their clinical counterparts. MS sherpa® also included one-item self-report scores for perceived fatigue and impact of MS on daily functioning. To assess ecological validity, the temporal association between the MS sherpa® tests and self-report scores from the everyday environment were analyzed using linear mixed models with the repeated measures as random effects.
Results
102 patients with MS were included. During the 28-day follow-up 102 patients completed a mean (± SD) of 12.1 (± 6.8) SDMTs and 74 patients completed a mean (± SD) of 8.8 (± 6.1) 2MWTs. Smartphone SDMT correlated significantly with the clinical SDMT (r = 0.607, p < 0.001) and demonstrated excellent reliability (ICC = 0.923). 2MWT was significantly correlated with T25FW (ρ = -0.352, p = 0.001) and demonstrated good reliability (ICC = 0.845). Over the 28-day period, higher 2MWT scores were related with lower perceived impact of MS on daily functioning (b = -0.005, 95% CI [-0.010, -0.001]) and higher SDMT scores were related with lower perceived fatigue (b = -0.014, 95% CI [-0.026, -0.003]).
Conclusions
Smartphone-adapted cognition and walking tests can be assessed frequently from the participants’ own environment and demonstrated validity and reliability in assessment of information processing speed and ambulatory function in MS. Support for ecological validity was found for perceived fatigue and impact on functioning in the everyday environment.
P0163 - Smartphone keystroke dynamics are sensitive to changes in disease activity and clinical disability measures in multiple sclerosis (ID 748)
Abstract
Background
Typing behavior on a smartphone may be used as a biomarker in patients with multiple sclerosis (MS) by analyzing their keystroke dynamics (KD). The continuous acquisition of high sample rate data may provide unprecedented insights in short-term changes in important health outcomes in MS.
Objectives
To investigate the sensitivity of KD to clinically relevant change (i.e. responsiveness) in disease activity, fatigue, and clinical disability outcomes in patients with MS.
Methods
Patients with MS were recruited in this cohort study. Clinical outcomes were assessed at baseline and 3 months follow-up, including: MRI gadolinium-enhancing lesions (Gd-EL), patient-perceived fatigue, and clinical disability measures (Expanded Disability Status Scale, EDSS; Timed 25-foot Walk Test, TWT; Nine-Hole Peg Test, NHPT; Arm function in MS Questionnaire, AMSQ). Throughout the study, patients used the Neurokeys App which replaces the native keyboard with a smart-keyboard and unobtrusively collects time-stamped key press and release events in the real-world setting. Keystroke data of 14 days surrounding the clinical visits were aggregated for the analyses. The area under the receiver operating characteristics curve (AUROC) was calculated to assess responsiveness of KD in classifying anchor-based change within clinical outcomes. The minimally important change (MIC) was calculated as the mean change in KD in the lower +2 SD portion (to approximate minimal change) of patients with clinically relevant change for each clinical outcome. The MIC was compared to the smallest detectable change (SDC) to assess the capability of KD to distinguish important change from measurement error.
Results
102 patients with MS were included, of whom 94 completed follow-up. Responsiveness of KD were acceptable for change in number of MRI Gd-EL (highest AUROC = 0.73) and arm function based on the AMSQ score (highest AUROCs = 0.75). KD had excellent responsiveness to change in ambulatory function measured with TWT (highest AUROC = 0.84). EDSS and NHPT had lower AUC values than KD in classifying change in Gd-EL and AMSQ, respectively. For all keystroke features the MIC exceeded the SDC with differences ranging from 3.6 to 92.4%.
Conclusions
KD collected in patients with MS using the Neurokeys App demonstrated responsiveness to clinically relevant changes in gadolinium-enhancing lesions on MRI and clinical disability measures for arm and ambulatory function. Responsiveness of KD was higher than commonly used clinical measures in MS and sensitive enough to discriminate important change from measurement error.