Accurate and objective determination of myalgic encephalomyelitis/chronic fatigue syndrome disease severity with a wearable sensor, by Turner Palombo, Andrea Campos, Suzanne D Vernon, Shad Roundy in J Transl Med. 2020 Nov 10;18(1):423 [doi: 10.1186/s12967-020-02583-7]
Research abstract:
Background:
Approximately 2.5 million people in the U.S. suffer from myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). This disease negatively impacts patients’ ability to function, often resulting in difficulty maintaining employment, sustaining financial independence, engaging socially with others, and in particularly severe cases, consistently and adequately performing activities of daily living. The focus of this research was to develop a sensor-based method to measure upright activity defined as time with feet on the floor and referred to as UpTime, as an indicator of ME/CFS disease severity.
Methods:
A commercially available inertial measurement unit (IMU), the Shimmer, was selected for this research. A Kalman filter was used to convert IMU data collected by the Shimmer to angle estimates. Angle estimate accuracy was confirmed by comparison to a motion capture system. Leg angle estimates were then converted to personalized daily UpTime scores using a critical angle of 39º from vertical to differentiate between upright (feet on the floor) and not upright. A 6-day, case-control study with 15 subjects (five healthy controls, five moderate-level ME/CFS, and five severe-level ME/CFS) was conducted to determine the utility of UpTime for assessing disease severity.
Results:
UpTime was found to be a significant measure of ME/CFS disease severity. Severely ill ME/CFS patients spend less than 20% of each day with feet on the floor. Moderately ill ME/CFS patients spend between 20-30% of each day with feet on the floor. Healthy controls have greater than 30% UpTime. IMU-measured UpTime was more precise than self-reported hours of upright activity which were over-estimated by patients.
The angle of each lower leg is compared to the critical angle (θc) to determine uprightness. Accelerometer measurements (ax, ay, and az) and gyroscope (i.e. angular rate) measurements (p, q, and r) are in the local coordinate frame—x, y, and z. Roll (ϕ) and pitch (θ) are measured using the fixed global coordinate frame—X, Y, and Z
Conclusions:
UpTime is an accurate and objective measure of upright activity, a measure that can be used to assess disease severity in ME/CFS patients. Due to its ability to accurately monitor upright activity, UpTime can also be used as a reliable endpoint for evaluating ME/CFS treatment efficacy. Future studies with larger samples and extended data collection periods are required to fully confirm the use of UpTime as a measure of disease severity in ME/CFS.
With the added perspective of large-scale studies, this sensor-based platform could provide a recovery path for individuals struggling with ME/CFS.
Bateman Horne Center: Turning a Self-Report Questionnaire into a Wearable Device, by Suzanne D Vernon
If the proposed measure successfully detects changes in the amount of time in an upright posture, it will then be submitted to the FDA’s biomarker qualification program to qualify it for use in ME/CFS clinical trials. The existence of an FDA qualified biomarker and clinical outcome measure will be an important inducement to researchers and pharmaceutical companies to develop effective treatments.
“There are so many similarities between long Covid and ME/CFS it leads me to believe the underlying pathology is probably the same – except that long Covid is presenting as an epidemic, whereas ME/CFS has presented in a very sporadic way, and by no means in such large numbers in such a short space of time,” said Dr William Weir, a consultant in infectious diseases with a special interest in ME.
“It is crucial to acknowledge that not all long-Covid patients will behave like CFS,” said Dr Manoj Sivan, an associate clinical professor and consultant in rehabilitation medicine at the University of Leeds, who runs a long-Covid clinic in the city. He also sits on the BSRM’s executive committee. “Fatigue is multifactorial, and there are some patients with deconditioning and weakness who might benefit from GET,” he said.
Cognitive function disturbance is a frequently described symptom of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). In this study, the effects of a structured exercise programme (SEP) upon cognitive function in ME/CFS patients was examined.
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