The Role of Wearable Devices to Identify Patients at High Risk of Disease Progression in Multiple Sclerosis

For people with multiple sclerosis (pwMS), current disease-modifying therapies can be highly effective in the prevention of inflammatory disease activity. However, recent insights have shown that pwMS can develop disability progression independent of relapse activity, highlighting the need for new therapeutic options.1 This chronic progression is often subtle and can take many years to become apparent. Conventional clinical assessment scales may fail to identify this subtle chronic progression. For example, the Expanded Disability Status Scale (EDSS) is a categorical scale that is subject to high inter-rater variability and relies heavily on specific milestones of impaired ambulation. EDSS worsening can be especially difficult to quantify in the lower disability ranges, and clinical disease progression often features non-ambulation domains.2 Similarly, scales that use continuous measures, such as the 9-Hole Peg Test (9HPT) and Timed 25-Foot Walk Test (TWT), are affected by high test-retest variability, necessitating relatively high cutoffs to define progression (20%) and limiting the detection of subtle change. In addition, most clinical scales are poorly related to daily life and are only quantified in a hospital environment. Because early treatment and treatment escalation are crucial to prevent permanent disability accumulation, earlier identification of pwMS at high risk of progression is important.2 Digital biomarkers and wearable technologies are potential tools to identify the high-risk population, yet longitudinal studies of these technologies involving MRI markers are needed to push these applications toward clinical implementation.