Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands.
Neurocast B.V., Amsterdam, The Netherlands.
Mult Scler. 2021 Aug;27(9):1421-1431. doi: 10.1177/1352458520968797. Epub 2020 Nov 5.
Clinical measures in multiple sclerosis (MS) face limitations that may be overcome by utilising smartphone keyboard interactions acquired continuously and remotely during regular typing.
The aim of this study was to determine the reliability and validity of keystroke dynamics to assess clinical aspects of MS.
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.
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 ( = 0.407) and latency between key releases with Nine-Hole Peg Test and Symbol Digit Modalities Test (ρ = 0.503 and = -0.553, respectively), s < 0.001.
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.
在多发性硬化症（MS）的临床评估中，临床测量可能存在局限性，而利用智能手机键盘交互来获取日常打字过程中的连续、远程数据，可能有助于克服这些局限性。
本研究旨在确定键击动力学评估多发性硬化症临床方面的可靠性和有效性。
本观察性研究共纳入 102 名 MS 患者和 24 名对照者。通过 Neurokeys 键盘应用程序获取键盘交互数据。使用组内相关系数（ICC）评估 8 个与时间相关的键击特征的可靠性；通过分析组间差异（疲劳、磁共振成像上钆增强病变和患者与对照者）评估结构有效性；并通过与残疾测量相关联评估同时有效性。
两个特征的可靠性为中度（ICC=0.601 和 0.742），其余六个特征的可靠性为良好到极好（ICC=0.760-0.965）。患者的键击潜伏期显著长于对照者。按键之间的潜伏期与扩展残疾状况量表（EDSS）相关性最高（ =0.407），键释放之间的潜伏期与 9 孔钉测试和符号数字模态测试相关性最高（ρ=0.503 和 -0.553，均为 <0.001）。
键击动力学可靠，能区分患者和对照者，且与临床残疾测量相关。因此，键击动力学是 MS 临床残疾的一种有前途的有效替代标志物。
