Personalized monitoring of ambulatory function with a smartphone 2-minute walk test in multiple sclerosis

Background: Remote smartphone-based 2-minute walking tests (s2MWTs) allow frequent and potentially sensitive measurements of ambulatory function. Objective: To investigate the s2MWT on assessment of, and responsiveness to change in ambulatory function in MS. Methods: One hundred two multiple sclerosis (MS) patients and 24 healthy controls (HCs) performed weekly s2MWTs on self-owned smartphones for 12 and 3 months, respectively. The timed 25-foot walk test (T25FW) and Expanded Disability Status Scale (EDSS) were assessed at 3-month intervals. Anchor-based (using T25FW and EDSS) and distribution-based (curve fitting) methods were used to assess responsiveness of the s2MWT. A local linear trend model was used to fit weekly s2MWT scores of individual patients. Results: A total of 4811 and 355 s2MWT scores were obtained in patients (n = 94) and HC (n = 22), respectively. s2MWT demonstrated large variability (65.6 m) compared to the average score (129.5 m), and was inadequately responsive to anchor-based change in clinical outcomes. Curve fitting separated the trend from noise in high temporal resolution individual-level data, and statistically reliable changes were detected in 45% of patients. Conclusions: In group-level analyses, clinically relevant change was insufficiently detected due to large variability with sporadic measurements. Individual-level curve fitting reduced the variability in s2MWT, enabling the detection of statistically reliable change in ambulatory function.

Automated summary

This study investigated the use of remote smartphone-based 2-minute walking tests (s2MWTs) in assessing and detecting changes in ambulatory function in multiple sclerosis (MS) patients. The results showed that s2MWTs had large variability and were not sensitive to changes in clinical outcomes. However, individual-level curve fitting analysis was able to reduce variability and detect statistically reliable changes in ambulatory function in 45% of patients.