RH26
Continuous Remote Assessment of Multiple Sclerosis Disability over One Year: The UCSF Fitrims Study

Friday, June 1, 2018: 2:00 PM
205 (Nashville Music City Center)
Valerie A J Block, PT, DPTSc , Neurology, University of California San Francisco, San Francisco, CA
Riley Bove, MD, MMSc , University of California San Francisco, Weill Institute for Neurosciences, San Francisco, CA
Chao Zhao, MSc , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA
Priya Garcha, BSc , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA
Jennifer S Graves, M.D. PhD , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA
Andrew Romeo, MD , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA
Ari J Green, MD , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA
Jill Hollenbach, PhD , Neurology, University of California San Francisco, San Francisco, CA
Jeffrey E Olgin, MD , Medicine, University of California San Francisco, San Francisco, CA
Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS , Cardiology, University of California San Francisco, San Francisco, CA
Mark Pletcher, MD, MPH , Epidemiology, University of California San Francisco, San Francisco, CA
Bruce AC Cree, MD, PhD , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA
Jeffrey M Gelfand, MD, MAS , UCSF Neurology, Weill Institute for Neurosciences, San Francisco, CA



Background: Sensitive and real-world functional outcome measures are needed to advance research and improve care for people with multiple sclerosis (MS), especially for progressive MS and repair/rehabilitation.  

Objectives: To evaluate the feasibility of continuous remote activity monitoring for 1 year in a cohort of patients with multiple sclerosis (MS) and to analyze associations of change in average daily step count (STEPS) with standard clinical and disability metrics. 

Methods: The UCSF FITRiMS (Fitbit Remote monitoring in MS) study enrolled 95 adults with relapsing or progressive MS and who were able to walk at least 2 minutes with or without an assistive device. Participants were asked to wear a Fitbit Flex device for 1-year. Clinic-based and patient-reported outcomes were assessed at baseline and 1 year follow-up, including: Expanded disability status scale (EDSS), Timed-25 Foot walk (T25FW) and MSWS-12 (12-Item MS scale). 

Results: Overall, 79 (83.2% retention) participants completed the year-long study; 9 withdrew and 7 were lost to follow-up. On average, the Fitbit Flex provided valid step data for 3 weeks per month per individual. Participants with greater disability demonstrated lower STEPS over the year. For the cohort as a whole, there was no significant change in STEPS, longitudinal slope assessed via mixed model linear regression with time as an interaction term, (p=0.117) over the year. In participants with baseline STEPS below 4,766 (cohort median), the odds of disability worsening (clinically meaningful change in EDSS) over 1 year was 6.7x higher (CI: 2.21 – 22.92, p=0.001) if the initial EDSS was >4, and 9.4x higher (CI: 3.18 – 32.41, p<0.001) if the initial EDSS was >6. A decrease in STEPS over 1 year was associated with worsening in clinic-based (T25FW) and patient-reported (MSWS-12) measures of ambulation (p<0.001 for each).

Conclusions: 1) Continuous remote activity monitoring is feasible in people with MS over 1 year, 2) a low baseline STEPS (below 4,766 steps/day) substantially increases risk for clinically meaningful decline 1 year later; and 3) decreased STEPS is associated with worsening on clinic-based and patient-reported walking disability measures.

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