Wearable inertial sensors provide reliable biomarkers of disease severity in multiple sclerosis: A systematic review and meta-analysis

Abstract

Background: Gait impairment is a hallmark of multiple sclerosis (MS). InertiaLocoGraphy, the quantification of gait with inertial measurement units (IMUs), has been found useful to detect early changes in gait in MS. Still, the potential use of IMUs as a reliable biomarker of disease severity in MS remains unknown.

Objective: This systematic review and meta-analysis of observational studies aimed to describe IMU protocols used to assess gait in MS patients and calculate the effect sizes of IMU features associated with disease severity scale measures.

Methods: We searched MEDLINE, Cochrane Central, EMBASE and grey literature to identify articles published before May 2, 2018 that measured gait in MS patients by using IMUs and correlated IMU parameters with disease severity scale measures. We excluded from the meta-analysis articles that did not provide enough data to evaluate the association between IMU parameters and disease severity scale measures. The study was registered with the International Prospective Register of Systematic Reviews on May 2, 2018 (Registration: CRD42018092651) and the protocol was published in Systematic Reviews on January 8, 2019.

Results: We included 36 articles in the systematic review and pooled 12 for the meta-analysis. The risk of bias was moderate, with only 2 articles (none included in the meta-analysis) showing a bias score<50%. Among protocols tested, 2 were predominant (the Timed Up and Go test and 6-min walk test). Speed, step length and step time with IMUs were significantly correlated with the Expanded Disability Status Scale (EDSS) score, and speed and step length were significantly correlated with the Multiple Sclerosis Walking Scale-12 score.

Conclusion: IMU measurement has the potential to increase the sensitivity of clinical and performance tests to identify evolution in gait alteration in MS. Kinematic parameters easily accessible with IMUs, such as speed, step length and step duration, can help follow up disease severity in MS individuals with low to medium EDSS score (1.0-4.5).

Keywords: Accelerometer; Gait analysis; Gait disorders; Gait quantification; Inertial measurement unit; Multiple sclerosis; Wearable inertial sensors.