Value of gait analysis for measuring disease severity using inertial sensors in patients with multiple sclerosis: protocol for a systematic review and meta-analysis

Gait impairment is a hallmark of multiple sclerosis (MS) which significantly endangers the quality of life of the individual. Inertial measurement units (IMUs) are small, light wearable sensors that can be used in routine neurological practice. InertiaLocoGraphy (ILG), the quantification of gait with IMUs, has proven useful to detect early changes in MS undetectable with standard stopwatch-timed measures. Still, whether such markers are useful for evaluating the severity of the disease remains unknown. Therefore, the correlation between ILG and disease progression would be worth exploring.

We will search MEDLINE via PubMed, Cochrane, and EMBASE electronic databases to identify articles published before May 2, 2018 that measure gait using IMUs in MS patients. In addition, grey literature will be searched. Inclusion criteria will be adults with a clinical diagnosis of MS and gait measured by using inertial sensors. We will exclude from the meta-analysis articles that do not provide sufficient data for evaluating the correlations between ILG parameters and disease severity as measured by at least one of the six following tests: the Expanded Disability Status Scale (EDSS), the Multiple Sclerosis Walking Scale-12 (MSWS), the Multiple Sclerosis Severity Score (MSSS), the Multiple Sclerosis Impact Scale (MSIS-29), the Multiple Sclerosis Functional Composite (MSFC), and the Timed 25-ft Walk Test (T25FW). Extracted data from included articles will be presented descriptively, and effect sizes will be computed based on the recommendations from the Cochrane Collaboration handbook and RevMan software.

Identifying changes in disease state throughout the course of MS is essential for optimal care. Current clinical and performance tests allow for identifying advanced gait alteration but lack sensitivity to detect subtle gait change. IMUs can be easily used in clinical practice to quantify gait in MS patients. Nevertheless, whether these outcomes are clinically relevant is uncertain because no study has evaluated their correlation with disease severity across different settings. This systematic review and meta-analysis would bring insight into the potential of this outcome as a marker of disease evolution.

This review was registered with the International Prospective Register of Systematic Reviews on May 2, 2018 (Registration: CRD42018092651). Both the search strategy and study protocol are available at https://​www.​crd.​york.​ac.​uk/​PROSPERO/​display_​record.​php?​RecordID=​92651.