Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia.
Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
J Neurol. 2023 May;270(5):2597-2605. doi: 10.1007/s00415-023-11584-7. Epub 2023 Feb 6.
Actigraphy has been proposed as a measure for tracking functional decline and disease progression in patients with Motor Neuron Disease (MND). There is, however, little evidence to show that wrist-based actigraphy measures correlate with functional decline, and no consensus on how best to implement actigraphy. We report on the use of wrist actigraphy to show decreased activity in patients compared to controls, and compared the utility of wrist- and hip-based actigraphy for assessing functional decline in patients with MND.
In this multi-cohort, multi-centre, natural history study, wrist- and hip-based actigraphy were assessed in 139 patients with MND (wrist, n = 97; hip, n = 42) and 56 non-neurological control participants (wrist, n = 56). For patients with MND, longitudinal measures were contrasted with clinical outcomes commonly used to define functional decline.
Patients with MND have reduced wrist-based actigraphy scores when compared to controls (median differences: prop. active = - 0.053 [- 0.075, - 0.026], variation axis 1 = - 0.073 [- 0.112, - 0.021]). When comparing wrist- and hip-based measures, hip-based accelerometery had stronger correlations with disease progression (prop. active: τ = 0.20 vs 0.12; variation axis 1: τ = 0.33 vs 0.23), whereas baseline wrist-based accelerometery was better related with future decline in fine-motor function (τ = 0.14-0.23 vs 0.06-0.16).
Actigraphy outcomes measured from the wrist are more variable than from the hip and present differing sensitivity to specific functional outcomes. Outcomes and analysis should be carefully constructed to maximise benefit, should wrist-worn devices be used for at-home monitoring of disease progression in patients with MND.
运动活动记录仪已被提议作为一种测量运动神经元病（MND）患者功能下降和疾病进展的方法。然而，几乎没有证据表明腕部运动活动记录仪测量结果与功能下降相关，也没有关于如何最好地实施运动活动记录仪的共识。我们报告了使用腕部运动活动记录仪来显示与对照组相比患者活动减少的情况，并比较了腕部和髋部运动活动记录仪在评估 MND 患者功能下降方面的效用。
在这项多队列、多中心的自然史研究中，对 139 名 MND 患者（腕部，n=97；髋部，n=42）和 56 名非神经科对照组参与者（腕部，n=56）进行了腕部和髋部运动活动记录仪评估。对于 MND 患者，纵向测量结果与常用于定义功能下降的临床结果进行了对比。
与对照组相比，MND 患者的腕部运动活动记录仪评分较低（中位数差异：活动比例=−0.053[−0.075，−0.026]，第一变程轴=−0.073[−0.112，−0.021]）。在比较腕部和髋部测量结果时，髋部加速度计与疾病进展的相关性更强（活动比例：τ=0.20 与 0.12；第一变程轴：τ=0.33 与 0.23），而基线腕部加速度计与精细运动功能的未来下降相关性更好（τ=0.14-0.23 与 0.06-0.16）。
从手腕测量得到的运动活动记录仪结果比从臀部测量的结果更具变异性，并且对特定的功能结果具有不同的敏感性。如果使用腕部佩戴设备对 MND 患者在家中进行疾病进展监测，那么应该仔细构建结果和分析，以最大限度地发挥效益。
