Longitudinal Digital Phenotyping of Multiple Sclerosis Severity Using Passively Sensed Behaviors and Ecological Momentary Assessments

Abstract

Background: Longitudinal tracking of multiple sclerosis (MS) symptoms in an individual's own environment may improve self-monitoring and clinical management for people with MS (pwMS). Objective: We present a machine learning approach that enables longitudinal monitoring of clinically relevant patient-reported symptoms for pwMS by harnessing passively collected data from sensors in smartphones and fitness trackers. Methods: We divide the collected data into discrete periods for each patient. For each prediction period, we first extract patient-level behavioral features from the current period (action features) and the previous period (context features). Then, we apply a machine learning (ML) approach based on Support Vector Machine with Radial Bias Function Kernel and AdaBoost to predict the presence of depressive symptoms (every two weeks) and high global MS symptom burden, severe fatigue, and poor sleep quality (every four weeks). Results: Between November 16, 2019, and January 24, 2021, 104 pwMS (84.6% women, 93.3% non-Hispanic White, 44.0(SD=1.8) years age from a clinic-based MS cohort completed 12-weeks of data collection, including a subset of 44 pwMS (88.6% women, 95.5% non-Hispanic White, 45.7 (SD=11.2) years) who completed 24-weeks of data collection. In total, we collected approximately 12,500 days of passive sensor and behavioral health data from the participants. Among the best-performing models with the least sensor data requirement, ML algorithm predicts depressive symptoms with an accuracy of 80.6% (35.5% improvement over baseline; F1-score: 0.76), high global MS symptom burden with an accuracy of 77.3% (51.3% improvement over baseline; F1-score: 0.77), severe fatigue with an accuracy of 73.8% (45.0% improvement over baseline; F1-score: 0.74), and poor sleep quality with an accuracy of 72.0% (28.1% improvement over baseline; F1-score: 0.70). Further, sensor data were largely sufficient for predicting symptom severity, while the prediction of depressive symptoms benefited from minimal active patient input in the form of response to two brief questions on the day before the prediction point. Conclusions: Our digital phenotyping approach using passive sensors on smartphones and fitness trackers may help patients with real-world, continuous, self-monitoring of common symptoms in their own environment and assist clinicians with better triage of patient needs for timely interventions in MS (and potentially other chronic neurological disorders).