Exploring the Effect of Sampling Frequency on Real-World Mobility, Sedentary Behaviour, Physical Activity and Sleep Outcomes Measured with Wearable Devices in Rheumatoid Arthritis: Feasibility, Usability and Practical Considerations. (Preprint)

Abstract

BACKGROUND 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. OBJECTIVE 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 robustness of accelerometry outcomes to downsampling to facilitate future prolonged monitoring. METHODS Eleven patients 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 100Hz) 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 was 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 robustness of outcomes sampled at 100Hz versus downsampled at 50Hz and 25Hz. RESULTS 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 devices metrics were robust to downsampling, showing good to excellent agreements (ICC≥0.75). CONCLUSIONS 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 high usability and acceptability of wearable devices, and robustness of outcomes to downsampling, our real-world data supports the feasibility of accelerometry for prolonged remote monitoring of RA disease activity.