Sarvestan Javad, Baker Kenneth F, Del Din Silvia
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 7RU, UK.
Bioengineering (Basel). 2024 Dec 28;12(1):18. doi: 10.3390/bioengineering12010018.
Modern treat-to-target management of rheumatoid arthritis (RA) involves titration of drug therapy to achieve remission, requiring close monitoring of disease activity through frequent clinical assessments. Accelerometry offers a novel method for continuous remote monitoring of RA activity by capturing fluctuations in mobility, sedentary behaviours, physical activity and sleep patterns over prolonged periods without the expense, inconvenience and environmental impact of extra hospital visits. We aimed to (a) assess the feasibility, usability and acceptability of wearable devices in patients with active RA; (b) investigate the multivariate relationships within the dataset; and (c) explore the robustness of accelerometry outcomes to downsampling to facilitate future prolonged monitoring. Eleven people with active RA newly starting an arthritis drug completed clinical assessments at 4-week intervals for 12 weeks. Participants wore an Axivity AX6 wrist device (sampling frequency 100 Hz) for 7 days after each clinical assessment. Measures of macro gait (volume, pattern and variability), micro gait (pace, rhythm, variability, asymmetry and postural control of walking), sedentary behaviour (standing, sitting and lying) and physical activity (moderate to vigorous physical activity [MVPA], sustained inactive bouts [SIBs]) and sleep outcomes (sleep duration, wake up after sleep onset, number of awakenings) were recorded. Feasibility, usability and acceptability of wearable devices were assessed using Rabinovich's questionnaire, principal component (PC) analysis was used to investigate the multivariate relationships within the dataset, and Bland-Altman plots (bias and Limits of Agreement) and Intraclass Correlation Coefficient (ICC) were used to test the robustness of outcomes sampled at 100 Hz versus downsampled at 50 Hz and 25 Hz. Wearable devices obtained high feasibility, usability and acceptability scores among participants. Macro gait outcomes and MVPA (first PC) and micro gait outcomes and number of SIBs (second PC) exhibited the strongest loadings, with these first two PCs accounting for 40% of the variance of the dataset. Furthermore, these device metrics were robust to downsampling, showing good to excellent agreements (ICC ≥ 0.75). We identified two main domains of mobility, physical activity and sleep outcomes of people with RA: micro gait outcomes plus MVPA and micro gait outcomes plus number of SIBs. Combined with the high usability and acceptability of wearable devices and the robustness of outcomes to downsampling, our real-world data supports the feasibility of accelerometry for prolonged remote monitoring of RA disease activity.
类风湿关节炎（RA）的现代达标治疗管理涉及调整药物治疗以实现缓解，这需要通过频繁的临床评估密切监测疾病活动度。加速度计提供了一种新颖的方法，可通过长时间捕捉活动能力、久坐行为、身体活动和睡眠模式的波动，对RA活动进行连续远程监测，而无需额外门诊带来的费用、不便和环境影响。我们旨在：（a）评估可穿戴设备在活动性RA患者中的可行性、易用性和可接受性；（b）研究数据集中的多变量关系；（c）探索加速度计结果对下采样的稳健性，以方便未来进行长时间监测。11名新开始使用关节炎药物的活动性RA患者每隔4周进行一次临床评估，为期12周。每次临床评估后，参与者佩戴Axivity AX6腕部设备7天（采样频率100Hz）。记录宏观步态（步幅、模式和变异性）、微观步态（步速、节奏、变异性、不对称性和行走姿势控制）、久坐行为（站立、坐着和躺着）、身体活动（中度至剧烈身体活动[MVPA]、持续不活动时段[SIBs]）和睡眠结果（睡眠时间、睡眠开始后醒来、觉醒次数）。使用拉比诺维奇问卷评估可穿戴设备的可行性、易用性和可接受性，主成分（PC）分析用于研究数据集中的多变量关系，布兰德 - 奥特曼图（偏差和一致性界限）和组内相关系数（ICC）用于测试在100Hz采样与50Hz和25Hz下采样的结果的稳健性。可穿戴设备在参与者中获得了较高的可行性、易用性和可接受性评分。宏观步态结果与MVPA（第一主成分）以及微观步态结果与SIBs数量（第二主成分）表现出最强的载荷，这前两个主成分占数据集方差的40%。此外，这些设备指标对下采样具有稳健性，显示出良好到极好的一致性（ICC≥0.75）。我们确定了RA患者活动能力、身体活动和睡眠结果的两个主要领域：微观步态结果加MVPA以及微观步态结果加SIBs数量。结合可穿戴设备的高易用性和可接受性以及结果对下采样的稳健性，我们的真实世界数据支持加速度计用于长时间远程监测RA疾病活动度的可行性。
