Short Bouts of Gait Data and Body-Worn Inertial Sensors Can Provide Reliable Measures of Spatiotemporal Gait Parameters from Bilateral Gait Data for Persons with Multiple Sclerosis

Wearable devices equipped with inertial sensors enable objective gait assessment for persons with multiple sclerosis (MS), with potential use in ambulatory care or home and community-based assessments. However, gait data collected in non-controlled settings are often fragmented and may not provide enough information for reliable measures. This paper evaluates a novel approach to (1) determine the effects of the length of the walking task on the reliability of calculated measures and (2) identify digital biomarkers for gait assessments from fragmented data. Thirty-seven participants (37) diagnosed with relapsing-remitting MS (EDSS range 0 to 4.5) executed two trials, walking 20 m each, with inertial sensors attached to their right and left shanks. Gait events were identified from the medio-lateral angular velocity, and short bouts of gait data were extracted from each trial, with lengths varying from 3 to 9 gait cycles. Intraclass correlation coefficients (ICCs) evaluate the degree of agreement between the two trials of each participant, according to the number of gait cycles included in the analysis. Results show that short bouts of gait data, including at least six gait cycles of bilateral data, can provide reliable gait measurements for persons with MS, opening new perspectives for gait assessment using fragmented data (e.g., wearable devices, community assessments). Stride time variability and asymmetry, as well as stride velocity variability and asymmetry, should be further explored as digital biomarkers to support the monitoring of symptoms of persons with neurological diseases.

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Short bouts of gait data and inertial sensors can provide reliable measures of spatiotemporal gait parameters from bilateral gait data of participants with multiple sclerosis

10.21203/rs.3.rs-27071/v1 ◽

2020 ◽

Author(s):

Lilian Genaro Motti Ader ◽

Barry R. Greene ◽

Killian McManus ◽

Niall Tubridy ◽

Brian Caulfield

Keyword(s):

Multiple Sclerosis ◽

Inertial Sensors ◽

Intraclass Correlation ◽

Full Length ◽

Time Variability ◽

Stride Time ◽

Good Reliability ◽

Time Asymmetry ◽

Gait Assessment ◽

Gait Parameters

Abstract Background:Wearable devices equipped with inertial sensors enable objective gait assessment for persons with multiple sclerosis (MS), with potential use in ambulatory care or home and community-based assessments. However, gait data collected in non-controlled settings is often fragmented and may not provide enough information for reliable measures. We evaluate a novel approach, extracting pre-defined numbers of gait cycles from the full length of a walking task, and their effects on the reliability of spatiotemporal gait parameters.Methods:The present study evaluates intra-session reliability of spatiotemporal gait parameters for short bouts of gait data extracted from the full length of the walking tasks to 1) determine the effects of the length of the walking task on the reliability of calculated measures and 2) identify spatiotemporal gait parameters that can provide reliable measures for gait assessments and reference data in different settings.Thirty-seven participants (37) diagnosed with relapsing-remitting MS (EDSS rage 0 to 4.5) executed two trials, walking 20m each, with inertial sensors attached to their right and left shanks. Previously published algorithms were applied to identify gait events from the medio-lateral angular velocity. Short bouts of gait data were extracted from each trial, with lengths varying from 3 to 9 gait cycles. Twenty-one measures of spatiotemporal gait parameters were calculated. Intraclass correlation coefficients (ICCs) were calculated to evaluate how the degree of agreement between the two trials of each participant varied with the number of gait cycles included in the analysis.Results:Spatiotemporal gait parameters calculated as the mean across included gait cycles reach excellent reliability from three gait cycles. Stride time variability and asymmetry, as well as stride velocity variability and asymmetry, reach good reliability from six gait cycles and should be further explored for persons with MS, while stride time asymmetry and step time asymmetry do not seem to provide reliable measures and should be reported carefully.Conclusion:Short bouts of gait data, including at least six gait cycles of bilateral data, can provide reliable gait measurements for persons with MS, opening new perspectives for gait assessment using wearable devices in non-controlled environments, to support monitoring of symptoms of persons with neurological diseases.Trial registrationNot applicable.

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Validity of Inertial Sensors for Assessing Balance Kinematics and Mobility during Treadmill-Based Perturbation and Dance Training

Sensors ◽

10.3390/s21093065 ◽

2021 ◽

Vol 21 (9) ◽

pp. 3065

Author(s):

Ernest Kwesi Ofori ◽

Shuaijie Wang ◽

Tanvi Bhatt

Keyword(s):

Concurrent Validity ◽

Inertial Sensors ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Human Motion ◽

Intraclass Correlation Coefficients ◽

Dance Training ◽

Silver Standard ◽

Mean Square Errors ◽

Reactive Balance

Inertial sensors (IS) enable the kinematic analysis of human motion with fewer logistical limitations than the silver standard optoelectronic motion capture (MOCAP) system. However, there are no data on the validity of IS for perturbation training and during the performance of dance. The aim of this present study was to determine the concurrent validity of IS in the analysis of kinematic data during slip and trip-like perturbations and during the performance of dance. Seven IS and the MOCAP system were simultaneously used to capture the reactive response and dance movements of fifteen healthy young participants (Age: 18–35 years). Bland Altman (BA) plots, root mean square errors (RMSE), Pearson’s correlation coefficients (R), and intraclass correlation coefficients (ICC) were used to compare kinematic variables of interest between the two systems for absolute equivalency and accuracy. Limits of agreements (LOA) of the BA plots ranged from −0.23 to 0.56 and −0.21 to 0.43 for slip and trip stability variables, respectively. The RMSE for slip and trip stabilities were from 0.11 to 0.20 and 0.11 to 0.16, respectively. For the joint mobility in dance, LOA varied from −6.98–18.54, while RMSE ranged from 1.90 to 13.06. Comparison of IS and optoelectronic MOCAP system for reactive balance and body segmental kinematics revealed that R varied from 0.59 to 0.81 and from 0.47 to 0.85 while ICC was from 0.50 to 0.72 and 0.45 to 0.84 respectively for slip–trip perturbations and dance. Results of moderate to high concurrent validity of IS and MOCAP systems. These results were consistent with results from similar studies. This suggests that IS are valid tools to quantitatively analyze reactive balance and mobility kinematics during slip–trip perturbation and the performance of dance at any location outside, including the laboratory, clinical and home settings.

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Developing a crosswalk between the RAND-12 and the health utilities index for multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458519852722 ◽

2019 ◽

Vol 26 (9) ◽

pp. 1102-1110 ◽

Cited By ~ 1

Author(s):

Ruth Ann Marrie ◽

Brenden Dufault ◽

Tuula Tyry ◽

Gary R Cutter ◽

Robert J Fox ◽

...

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Health Utilities Index ◽

Research Committee ◽

Health Utilities ◽

The North ◽

Many Instruments ◽

Related Quality ◽

Health Related

Background: Researchers studying health-related quality of life (HRQOL) in multiple sclerosis (MS) can choose from many instruments, but findings from studies which use different instruments cannot be easily combined. We aimed to develop a crosswalk that associates scores from the RAND-12 to scores on the Health Utilities Index—Mark III (HUI3) in persons with MS. Methods: In 2018, participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry completed the RAND-12 and the HUI3 to assess HRQOL. We used item-response theory (IRT) and equipercentile linking approaches to develop a crosswalk between instruments. We compared predicted scores for the HUI3 from each crosswalk to observed scores using Pearson correlations, intraclass correlation coefficients (ICCs), and Bland–Altman plots. Results: Of 11,389 invited participants, 7129 (62.6%) responded. Predicted and observed values of the HUI3 from the IRT-linking method were moderately correlated (Pearson r = 0.76) with good concordance (ICC = 0.72). However, the Bland–Altman plots suggested biased prediction. Predicted and observed values from the equipercentile linking method were also moderately correlated (Pearson r = 0.78, ICC = 0.78). The Bland–Altman plots suggested no bias. Conclusion: We developed a crosswalk between the RAND-12 and the HUI3 in the MS population which will facilitate data harmonization efforts.

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Reliability, Internal Consistency, and Validity of Data Obtained With the Functional Gait Assessment

Physical Therapy ◽

10.1093/ptj/84.10.906 ◽

2004 ◽

Vol 84 (10) ◽

pp. 906-918 ◽

Cited By ~ 267

Author(s):

Diane M Wrisley ◽

Gregory F Marchetti ◽

Diane K Kuharsky ◽

Susan L Whitney

Keyword(s):

Internal Consistency ◽

Concurrent Validity ◽

Physical Therapist ◽

Rank Order ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Vestibular Disorders ◽

Intraclass Correlation Coefficients ◽

Gait Assessment ◽

Functional Gait

Background and Purpose. The Functional Gait Assessment (FGA) is a 10-item gait assessment based on the Dynamic Gait Index. The purpose of this study was to evaluate the reliability, internal consistency, and validity of data obtained with the FGA when used with people with vestibular disorders. Subjects. Seven physical therapists from various practice settings, 3 physical therapist students, and 6 patients with vestibular disorders volunteered to participate. Methods. All raters were given 10 minutes to review the instructions, the test items, and the grading criteria for the FGA. The 10 raters concurrently rated the performance of the 6 patients on the FGA. Patients completed the FGA twice, with an hour's rest between sessions. Reliability of total FGA scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the FGA was assessed using the Cronbach alpha and confirmatory factor analysis. Concurrent validity was assessed using the correlation of the FGA scores with balance and gait measurements. Results. Intraclass correlation coefficients of .86 and .74 were found for interrater and intrarater reliability of the total FGA scores. Internal consistency of the FGA scores was .79. Spearman rank order correlation coefficients of the FGA scores with balance measurements ranged from .11 to .67. Discussion and Conclusion. The FGA demonstrates what we believe is acceptable reliability, internal consistency, and concurrent validity with other balance measures used for patients with vestibular disorders.

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Real-world keystroke dynamics are a potentially valid biomarker for clinical disability in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520968797 ◽

2020 ◽

pp. 135245852096879

Author(s):

KH Lam ◽

KA Meijer ◽

FC Loonstra ◽

EME Coerver ◽

J Twose ◽

...

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Surrogate Marker ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Clinical Aspects ◽

Keystroke Dynamics ◽

Intraclass Correlation Coefficients ◽

Magnetic Resonance Imaging Mri ◽

Clinical Measures

Background: Clinical measures in multiple sclerosis (MS) face limitations that may be overcome by utilising smartphone keyboard interactions acquired continuously and remotely during regular typing. Objective: The aim of this study was to determine the reliability and validity of keystroke dynamics to assess clinical aspects of MS. Methods: In total, 102 MS patients and 24 controls were included in this observational study. Keyboard interactions were obtained with the Neurokeys keyboard app. Eight timing-related keystroke features were assessed for reliability with intraclass correlation coefficients (ICCs); construct validity by analysing group differences (in fatigue, gadolinium-enhancing lesions on magnetic resonance imaging (MRI), and patients vs controls); and concurrent validity by correlating with disability measures. Results: Reliability was moderate in two (ICC = 0.601 and 0.742) and good to excellent in the remaining six features (ICC = 0.760–0.965). Patients had significantly higher keystroke latencies than controls. Latency between key presses correlated the highest with Expanded Disability Status Scale ( r = 0.407) and latency between key releases with Nine-Hole Peg Test and Symbol Digit Modalities Test (ρ = 0.503 and r = −0.553, respectively), ps < 0.001. Conclusion: Keystroke dynamics were reliable, distinguished patients and controls, and were associated with clinical disability measures. Consequently, keystroke dynamics are a promising valid surrogate marker for clinical disability in MS.

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Comparison of Fitbit One and ActivPAL3TM in Adults With Multiple Sclerosis in a Free-Living Environment

Journal for the Measurement of Physical Behaviour ◽

10.1123/jmpb.2020-0066 ◽

2021 ◽

Vol 4 (3) ◽

pp. 257-265

Author(s):

Golnoush Mehrabani ◽

Douglas P. Gross ◽

Saeideh Aminian ◽

Patricia J. Manns

Keyword(s):

Multiple Sclerosis ◽

Gait Speed ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Living Environment ◽

Free Living ◽

Step Counts ◽

Intraclass Correlation Coefficients ◽

Activity Tracker ◽

User Friendly

Walking is the most common and preferred way for people with multiple sclerosis (MS) to be active. Consumer-grade wearable activity monitors may be used as a tool to assist people with MS to track their walking by counting the number of steps. The authors evaluated the validity of Fitbit One activity tracker in individuals with MS by comparing step counts measured over a 7-day period against ActivPAL3TM (AP). Twenty-five ambulatory adults with MS with an average age 51.7 (10.2) years and gait speed 0.98 (0.47) m/s, median Expanded Disability Status Scale 5.5 (2.5–6.5), and 15 years post-MS diagnosis wore Fitbit One (using both waist and ankle placement) and AP for 7 consecutive days. Validity of Fitbit One for measuring step counts against AP was assessed using intraclass correlation coefficients (ICCs), Bland–Altman plots, and t tests. Regardless of wearing location (waist or ankle), there was good agreement between steps recorded by Fitbit One and AP (ICC: .86 [.82, .90]). The ankle-worn Fitbit measured steps more accurately (ICC: .91 [.81, .95]) than the waist-worn Fitbit (ICC: .81 [.62, .85]) especially in individuals (n = 12) who walked slowly (gait speed = 0.74 m/s). Fitbit One as a user-friendly, inexpensive, consumer-grade activity tracker can accurately record steps in persons with MS in a free-living environment.

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Validation of the Brazilian version of the neurological fatigue index for multiple sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160030 ◽

2016 ◽

Vol 74 (4) ◽

pp. 320-328 ◽

Cited By ~ 2

Author(s):

Josiane Lopes ◽

Edson Lopes Lavado ◽

Damacio Ramón Kaimen-Maciel

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Assessment Instrument ◽

Fatigue Index ◽

Intraclass Correlation Coefficients ◽

Culturally Adapted ◽

Brazilian Version ◽

Impact Scale ◽

Back Translation

ABSTRACT The Neurological Fatigue Index for Multiple Sclerosis (NFI-MS) is a new fatigue assessment instrument. The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the NFI-MS (NFI-MS/BR). Method Two hundred and forty subjects with MS were recruited for this study. The adaptation of the NFI-MS was performed by translation and back translation methodology. In psychometric analysis was performed the administration of the questionnaires Epworth Sleep Scale, Fatigue Severity Scale, Modified Fatigue Impact Scale, Multiple Sclerosis Impact Scale-29, NFI-MS/BR and Pittsburgh Sleep Quality Index with retest of the NFI-MS/BR after 7 days. Results Reliability was assessed (intraclass correlation coefficients between 0.77 and 0.86), and validity by testing 41 hypotheses about expected correlations between subscales and confirmed 36. The majority of correlations were demonstrated. Conclusion The NFI-MS/BR is a cross-culturally adapted, valid, and reliable instrument for assessing MS fatigue among Brazilian subjects.

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The timed 25-foot walk in a large cohort of multiple sclerosis patients

Multiple Sclerosis Journal ◽

10.1177/13524585211017013 ◽

2021 ◽

pp. 135245852110170

Author(s):

Anissa Kalinowski ◽

Gary Cutter ◽

Nina Bozinov ◽

Jessica A Hinman ◽

Michael Hittle ◽

...

Keyword(s):

Multiple Sclerosis ◽

Predictive Validity ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Control Analysis ◽

Intraclass Correlation Coefficients ◽

Multiple Sclerosis Patients ◽

Case Control Analysis ◽

Test Retest Reliability ◽

Nested Case Control

Background: The timed 25-foot walk (T25FW) is a key clinical outcome measure in multiple sclerosis patient management and clinical research. Objectives: To evaluate T25FW performance and factors associated with its change in the Multiple Sclerosis Outcome Assessments Consortium (MSOAC) Placebo Database ( n = 2465). Methods: We created confirmed disability progression (CDP) variables for T25FW and Expanded Disability Status Scale (EDSS) outcomes. We used intraclass correlation coefficients (ICCs) and Bland Altman plots to evaluate reliability. We evaluated T25FW changes and predictive validity using a mixed-effects model, survival analysis, and nested case–control analysis. Results: The mean baseline score for the T25FW in this study population was 9.2 seconds, median = 6.1 (standard deviation = 11.0, interquartile range (IQR) = 4.8, 9.0). The T25FW measure demonstrated excellent test–retest reliability (ICC = 0.98). Walk times increased with age, disability, disease type, and disease duration; relapses were not associated with an increase. Patients with T25FW progression had a faster time to EDSS-CDP compared to those without (hazards ratio (HR): 2.6; confidence interval (CI): 2.2, 3.1). Changes in the T25FW were more likely to precede changes in EDSS. Conclusion: This research confirms the association of the T25FW with disability and provides some evidence of predictive validity. Our findings support the continued use of the T25FW in clinical practice and clinical trials.

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Reliability and Validity of Trunk Assessment for People With Multiple Sclerosis

Physical Therapy ◽

10.1093/ptj/86.1.66 ◽

2006 ◽

Vol 86 (1) ◽

pp. 66-76 ◽

Cited By ~ 35

Author(s):

Geert Verheyden ◽

Godelieve Nuyens ◽

Alice Nieuwboer ◽

Pol Van Asch ◽

Piet Ketelaer ◽

...

Keyword(s):

Multiple Sclerosis ◽

Construct Validity ◽

Intraclass Correlation ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Altman Analysis ◽

Bland Altman Analysis ◽

Intraclass Correlation Coefficients ◽

Test Retest Reliability

Abstract Background and Purpose. Standardized scales are a prerequisite for rehabilitation and research. This study was designed to determine the reliability and validity of scores on items of the trunk assessment of the Melsbroek Disability Scoring Test (MDST) and Trunk Impairment Scale (TIS) in people with multiple sclerosis (MS). Subjects. Thirty people with MS participated in the study. Methods. Interrater and test-retest reliability and construct validity were assessed. Results. Kappa and weighted kappa values for the items of the trunk assessment of the MDST ranged from .74 to .95, and the kappa and weighted kappa values for the TIS items ranged from .46 to 1.00. Intraclass correlation coefficients for interrater and test-retest agreement were .93 and .92, respectively, for the trunk assessment of the MDST and .97 and .95, respectively, for the TIS. Bland-Altman analysis showed consistency of scores without observer bias. Construct validity was established. Discussion and Conclusion. The MDST and TIS provide reliable assessments of the trunk and are valid scales for measuring trunk performance in people with MS. [Verheyden G, Nuyens G, Nieuwboer A, et al. Reliability and validity of trunk assessment for people with multiple sclerosis.

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Self-administered Expanded Disability Status Scale with functional system scores correlates well with a physician-administered test

Multiple Sclerosis Journal ◽

10.1177/135245850100700311 ◽

2001 ◽

Vol 7 (3) ◽

pp. 201-206 ◽

Cited By ~ 122

Author(s):

James Bowen ◽

Laura Gibbons ◽

Ann Gianas ◽

George H Kraft

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Functional System ◽

Epidemiological Studies ◽

Female Age ◽

Intraclass Correlation Coefficients ◽

Disability Status ◽

Definite Multiple Sclerosis ◽

Clinically Definite Multiple Sclerosis

Background: Patient-administered measures are needed to assess disability cost-effectively in large epidemiological studies. Setting: An outpatient clinic in a large multiple sclerosis center. Methods: A self-administered EDSS questionnaire was developed (EDSS-S). Consecutive patients with clinically definite multiple sclerosis completed the EDSS-S (n=95). During the same visit, a physician completed an EDSS (EDSS-P). Scores below 4.0 were determined using functional system (FS) scores. Scores above 4.0 were calculated by two methods, using gait alone and using gait and functional system scores combined. Results: EDSS-P scores ranged from 0-9.5 (mean 5.1, median 5.0, 78% female, age 17-78, mean age 45). Mean EDSS-P, EDSS-S and intraclass correlation coefficients of agreement were: EDSS using ambulation alone (4.6, 5.1, 0.89), EDSS using ambulation and FS scores (4.6, 5.3, 0.87), bowel/bladder FS scores (1.6, 1.7, 0.79), pyramidal FS scores (2.1, 2.4, 0.67), sensory FS scores (1.6, 2.1, 0.60), cerebellar FS scores (1.1, 1.6, 0.55), brainstem FS scores (0.5, 1.2, 0.45), vision FS scores (1.9, 1.3, 0.38), cerebral FS scores (0.6, 2.3, 0.27). Conclusions: Very good correlation was seen between patient and physician scores for EDSS and the bowel/bladder FS score. Four other FS scores correlated moderately. In general, patients scored themselves more disabled than physicians.

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