Longitudinal Trend Monitoring of Multiple Sclerosis Ambulation Using Smartphones

Goal: Smartphone and wearable devices may act as powerful tools to remotely monitor physical function in people with neurodegenerative and autoimmune diseases from out-of-clinic environments. Detection of progression onset or worsening of symptoms is especially important in people living with multiple sclerosis (PwMS) in order to enable optimally adapted therapeutic strategies. MS symptoms typically follow subtle and fluctuating disease courses, patient-to-patient, and over time. Current in-clinic assessments are often too infrequently administered to reflect longitudinal changes in MS impairment that impact daily life. This work, therefore, explores how smartphones can administer daily two-minute walking assessments to monitor PwMS physical function at home. Methods: Remotely collected smartphone inertial sensor data was transformed through state-of-the-art Deep Convolutional Neural Networks, to estimate a participant's daily ambulatory-related disease severity, longitudinally over a 24-week study. Results: This study demonstrated that smartphone-based ambulatory severity outcomes could accurately estimate MS level of disability, as measured by the EDSS score (r^{2}: 0.56,p< 0.001). Furthermore, longitudinal severity outcomes were shown to accurately reflect individual participants' level of disability over the study duration. Conclusion: Smartphone-based assessments, that can be performed by patients from their home environments, could greatly augment standard in-clinic outcomes for neurodegenerative diseases. The ability to understand the impact of disease on daily-life between clinical visits, through objective digital outcomes, paves the way forward to better measure and identify signs of disease progression that may be occurring out-of-clinic, to monitor how different patients respond to various treatments, and to ultimately enable the development of better, and more personalised care.