Abstract
Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.
Highlights
Physical mobility is an essential aspect of health
855 records were eligible for inclusion (PD: n = 307; multiple sclerosis (MS): n = 270; chronic obstructive pulmonary disease (COPD): n = 225; proximal femoral fracture (PFF): n = 53), representing 5019 unique analyses from 775 studies (Fig. 2)
Recent calls to validate real-world Digital mobility outcomes (DMOs) are based on three premises: that DMOs are clinically meaningful, that relationships observed in clinical settings translate to real-world walking, and that opportunities for collaboration across clinical disciplines exist[30,31]
Summary
Physical mobility is an essential aspect of health. Mobility impairment is associated with reduced quality of life, falls, hospitalization, mortality, and other adverse events in many chronic conditions[1,2,3,4,5,6,7]. Traditional mobility measures include patient-reported outcomes (how well an individual thinks they can walk), objective clinical assessments (an individual’s examined capacity to walk), and subjective clinical assessments (how well a clinician thinks an individual can walk given a set of standard criteria). These measures can be subject to recall bias, Hawthorne effects, substantial training requirements, and ceiling or floor effects, among other limitations[14,15,16,17,18,19,20]. They are acquired infrequently and often conducted in clinical settings that rarely reflect the complex environmental determinants of real-world function, raising questions of their ecological validity[14,21,22,23]
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