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Meyer T, Schumann P, Weydt P, Petri S, Weishaupt JH, Weyen U, Koch JC, Günther R, Regensburger M, Boentert M, Wiesenfarth M, Koc Y, Kolzarek F, Kettemann D, Norden J, Bernsen S, Elmas Z, Conrad J, Valkadinov I, Vidovic M, Dorst J, Ludolph AC, Hesebeck-Brinckmann J, Spittel S, Münch C, Maier A, Körtvélyessy P. Clinical and patient-reported outcomes and neurofilament response during tofersen treatment in SOD1-related ALS-A multicenter observational study over 18 months. Muscle Nerve 2024; 70:333-345. [PMID: 39031772 DOI: 10.1002/mus.28182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/26/2024] [Accepted: 06/01/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION/AIMS In amyotrophic lateral sclerosis (ALS) caused by SOD1 mutations (SOD1-ALS), tofersen received accelerated approval in the United States and is available via expanded access programs (EAP) outside the United States. This multicenter study investigates clinical and patient-reported outcomes (PRO) and serum neurofilament light chain (sNfL) during tofersen treatment in an EAP in Germany. METHODS Sixteen SOD1-ALS patients receiving tofersen for at least 6 months were analyzed. The ALS progression rate (ALS-PR), as measured by the monthly change of the ALS functional rating scale-revised (ALSFRS-R), slow vital capacity (SVC), and sNfL were investigated. PRO included the Measure Yourself Medical Outcome Profile (MYMOP2), Treatment Satisfaction Questionnaire for Medication (TSQM-9), and Net Promoter Score (NPS). RESULTS Mean tofersen treatment was 11 months (6-18 months). ALS-PR showed a mean change of -0.2 (range 0 to -1.1) and relative reduction by 25%. Seven patients demonstrated increased ALSFRS-R. SVC was stable (mean 88%, range -15% to +28%). sNfL decreased in all patients except one heterozygous D91A-SOD1 mutation carrier (mean change of sNfL -58%, range -91 to +27%, p < .01). MYMOP2 indicated improved symptom severity (n = 10) or yet perception of partial response (n = 6). TSQM-9 showed high global treatment satisfaction (mean 83, SD 16) although the convenience of drug administration was modest (mean 50, SD 27). NPS revealed a very high recommendation rate for tofersen (NPS +80). DISCUSSION Data from this EAP supported the clinical and sNfL response to tofersen in SOD1-ALS. PRO suggested a favorable patient perception of tofersen treatment in clinical practice.
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Affiliation(s)
- Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Peggy Schumann
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Patrick Weydt
- Department for Neuromuscular Disorders, Bonn University, Bonn, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Bonn, Bonn, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jochen H Weishaupt
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bochum, Germany
| | - Jan C Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Dresden, Dresden, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Boentert
- Department of Neurology, Münster University Hospital, Münster, Germany
| | | | - Yasemin Koc
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Kolzarek
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Dagmar Kettemann
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jenny Norden
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Bernsen
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Zeynep Elmas
- Department of Neurology, Ulm University, Ulm, Germany
| | - Julian Conrad
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Ivan Valkadinov
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Maximilian Vidovic
- Department of Neurology, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Dorst
- Department of Neurology, Ulm University, Ulm, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Ulm, Ulm, Germany
| | - Jasper Hesebeck-Brinckmann
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Christoph Münch
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Péter Körtvélyessy
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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2
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Erb MK, Calcagno N, Brown R, Burke KM, Scheier ZA, Iyer AS, Clark A, Higgins MP, Keegan M, Gupta AS, Johnson SA, Chew S, Berry JD. Longitudinal comparison of the self-administered ALSFRS-RSE and ALSFRS-R as functional outcome measures in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:570-580. [PMID: 38501453 DOI: 10.1080/21678421.2024.2322549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Test the feasibility, adherence rates and optimal frequency of digital, remote assessments using the ALSFRS-RSE via a customized smartphone-based app. METHODS This fully remote, longitudinal study was conducted over a 24-week period, with virtual visits every 3 months and weekly digital assessments. 19 ALS participants completed digital assessments via smartphone, including a digital version of the ALSFRS-RSE and mood survey. Interclass correlation coefficients (ICC) and Bland-Altman plots were used to assess agreement between staff-administered and self-reported ALSFRS-R pairs. Longitudinal change was evaluated using ANCOVA models and linear mixed models, including impact of mood and time of day. Impact of frequency of administration of the ALSFRS-RSE on precision of the estimate slope was tested using a mixed effects model. RESULTS In our ALS cohort, digital assessments were well-accepted and adherence was robust, with completion rates of 86%. There was excellent agreement between the digital self-entry and staff-administered scores computing multiple ICCs (ICC range = 0.925-0.961), with scores on the ALSFRS-RSE slightly higher (1.304 points). Digital assessments were associated with increased precision of the slope, resulting in higher standardized response mean estimates for higher frequencies, though benefit appeared to diminish at biweekly and weekly frequency. Effects of participant mood and time of day on total ALSFRS-RSE score were evaluated but were minimal and not statistically significant. CONCLUSION Remote collection of digital patient-reported outcomes of functional status such as the ALSFRS-RSE yield more accurate estimates of change over time and provide a broader understanding of the lived experience of people with ALS.
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Affiliation(s)
| | - Narghes Calcagno
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
- Neurology Residency Program, University of Milan, Milan, Italy
| | | | - Katherine M Burke
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Zoe A Scheier
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Amrita S Iyer
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Alison Clark
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Max P Higgins
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Mackenzie Keegan
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Stephen A Johnson
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Sheena Chew
- Biogen, Inc, Cambridge, MA, USA
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
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Bingham IN, Norel R, Roitberg EG, Peller J, Trevisan MA, Agurto C, Shalom DE, Aguirre F, Embon I, Taitz A, Harris D, Wright A, Seaver K, Sullivan S, Green JR, Ostrow LW, Fraenkel E, Berry JD. Listener effort quantifies clinically meaningful progression of dysarthria in people living with amyotrophic lateral sclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308140. [PMID: 38853969 PMCID: PMC11160879 DOI: 10.1101/2024.05.31.24308140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative motor neuron disease that causes progressive muscle weakness. Progressive bulbar dysfunction causes dysarthria and thus social isolation, reducing quality of life. The Everything ALS Speech Study obtained longitudinal clinical information and speech recordings from 292 participants. In a subset of 120 participants, we measured speaking rate (SR) and listener effort (LE), a measure of dysarthria severity rated by speech pathologists from recordings. LE intra- and inter-rater reliability was very high (ICC 0.88 to 0.92). LE correlated with other measures of dysarthria at baseline. LE changed over time in participants with ALS (slope 0.77 pts/month; p<0.001) but not controls (slope 0.005 pts/month; p=0.807). The slope of LE progression was similar in all participants with ALS who had bulbar dysfunction at baseline, regardless of ALS site of onset. LE could be a remotely collected clinically meaningful clinical outcome assessment for ALS clinical trials.
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Affiliation(s)
- Indu Navar Bingham
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | | | - Esteban G. Roitberg
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Julián Peller
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Laboratorio de Neurociencias Cognitivas Computacionales, Humai, Buenos Aires, Argentina
| | - Marcos A Trevisan
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física - CONICET – Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA). Buenos Aires, Argentina
| | | | - Diego E. Shalom
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física - CONICET – Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA). Buenos Aires, Argentina
| | - Felipe Aguirre
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Iair Embon
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Alan Taitz
- SRI International, Menlo Park, CA, USA. This work was performed working at
| | - Donna Harris
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, PA, USA
| | - Amy Wright
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
| | - Katie Seaver
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- MGH Institute of Health Professions, Charlestown Massachusetts, MA, USA
| | - Stacey Sullivan
- Peter Cohen Foundation dba Everything ALS, Seattle, Washington and Los Altos, California, USA
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Jordan R. Green
- MGH Institute of Health Professions, Charlestown Massachusetts, MA, USA
| | - Lyle W. Ostrow
- Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, PA, USA
| | - Ernest Fraenkel
- Massachusetts Institute of Technology, Department of Biological Engineering, Cambridge, MA, USA
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
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4
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Genge A, Cedarbaum JM, Shefner J, Chio A, Al-Chalabi A, Van Damme P, McDermott C, Glass J, Berry J, van Eijk RPA, Fournier C, Grosskreutz J, Andrews J, Bertone V, Bunte TM, Couillard M, Cummings C, Kittle G, Polzer J, Salmon K, Straub C, van den Berg LH. The ALSFRS-R Summit: a global call to action on the use of the ALSFRS-R in ALS clinical trials. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:382-387. [PMID: 38396337 DOI: 10.1080/21678421.2024.2320880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) was developed more than 25 years ago as an instrument to monitor functional change over time in patients with ALS. It has since been revised and extended to meet the needs of high data quality in ALS trials (ALSFRS-R), however a full re-validation of the scale was not completed. Despite this, the scale has remained a primary outcome measure in clinical trials. We convened a group of clinical trialists to discuss and explore opportunities to improve the scale and propose alternative measures. In this meeting report, we present a call to action on the use of the ALSFRS-Revised scale in clinical trials, focusing on the need for (1) harmonization of the ALSFRS-R administration globally, (2) alignment on a set of recommendations for clinical trial design and statistical analysis plans (SAPs), and (3) use of additional outcome measures.
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Affiliation(s)
- Angela Genge
- Montreal Neurological Institute-Hospital, ALS Center of Excellence, Montreal, Quebec, Canada
| | - Jesse M Cedarbaum
- Yale School of Medicine, Section of Movement Disorders, Coeruleus Clinical Sciences LLC, Woodbridge, CT, USA
| | | | - Adriano Chio
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK
| | | | - Chris McDermott
- Department of Neurology, The University of Sheffield, Sheffield, UK
| | - Jonathan Glass
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - James Berry
- Massachusetts General Hospital, Neurology, Boston, MA, USA
| | - Ruben P A van Eijk
- Department of Neurology and Biostatistics, UMC Utrecht Hersencentrum Rudolf Magnus, Utrecht, Netherlands
| | | | - Julian Grosskreutz
- Precision Neurology of Neuromuscular and Motoneuron Diseases, University of Lübeck, Lübeck, Germany
| | - Jinsy Andrews
- Columbia Presbyterian Medical Center, Neurology, New York, NY, USA
| | - Vanessa Bertone
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Tommy M Bunte
- Department of Neurology, UMC Utrecht Hersencentrum Rudolf Magnus, Utrecht, Netherlands
| | - Mathias Couillard
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Cathy Cummings
- International Alliance of ALS/MND Associations, Northampton, Northamptonshire, UK, and
| | - Gale Kittle
- Barrow Neurological Institute, Phoenix, AZ, USA
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Din Abdul Jabbar MA, Guo L, Guo Y, Simmons Z, Pioro EP, Ramasamy S, Yeo CJJ. Describing and characterising variability in ALS disease progression. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:34-45. [PMID: 37794802 DOI: 10.1080/21678421.2023.2260838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND, OBJECTIVES Decrease in the revised ALS Functional Rating Scale (ALSFRS-R) score is currently the most widely used measure of disease progression. However, it does not sufficiently encompass the heterogeneity of ALS. We describe a measure of variability in ALSFRS-R scores and demonstrate its utility in disease characterization. METHODS We used 5030 ALS clinical trial patients from the Pooled Resource Open-Access ALS Clinical Trials database to calculate variability in disease progression employing a novel measure and correlated variability with disease span. We characterized the more and less variable populations and designed a machine learning model that used clinical, laboratory and demographic data to predict class of variability. The model was validated with a holdout clinical trial dataset of 84 ALS patients (NCT00818389). RESULTS Greater variability in disease progression was indicative of longer disease span on the patient-level. The machine learning model was able to predict class of variability with accuracy of 60.1-72.7% across different time periods and yielded a set of predictors based on clinical, laboratory and demographic data. A reduced set of 16 predictors and the holdout dataset yielded similar accuracy. DISCUSSION This measure of variability is a significant determinant of disease span for fast-progressing patients. The predictors identified may shed light on pathophysiology of variability, with greater variability in fast-progressing patients possibly indicative of greater compensatory reinnervation and longer disease span. Increasing variability alongside decreasing rate of disease progression could be a future aim of trials for faster-progressing patients.
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Affiliation(s)
- Muzammil Arif Din Abdul Jabbar
- University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Ling Guo
- Institute for Infocomm Research (I2R), A*STAR, Singapore, Singapore
| | - Yang Guo
- Institute for Infocomm Research (I2R), A*STAR, Singapore, Singapore
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University College of Medicine, University Park, USA
| | - Erik P Pioro
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Savitha Ramasamy
- Institute for Infocomm Research (I2R), A*STAR, Singapore, Singapore
| | - Crystal Jing Jing Yeo
- Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Lee Kong Chian School of Medicine, Imperial College London and NTU, Singapore, Singapore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- National Neuroscience Institute, Singapore, Singapore, and
- Duke-NUS Medical School, Singapore, Singapore
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6
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Wearable device and smartphone data quantify ALS progression and may provide novel outcome measures. NPJ Digit Med 2023; 6:34. [PMID: 36879025 PMCID: PMC9987377 DOI: 10.1038/s41746-023-00778-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) therapeutic development has largely relied on staff-administered functional rating scales to determine treatment efficacy. We sought to determine if mobile applications (apps) and wearable devices can be used to quantify ALS disease progression through active (surveys) and passive (sensors) data collection. Forty ambulatory adults with ALS were followed for 6-months. The Beiwe app was used to administer the self-entry ALS functional rating scale-revised (ALSFRS-RSE) and the Rasch Overall ALS Disability Scale (ROADS) surveys every 2-4 weeks. Each participant used a wrist-worn activity monitor (ActiGraph Insight Watch) or an ankle-worn activity monitor (Modus StepWatch) continuously. Wearable device wear and app survey compliance were adequate. ALSFRS-R highly correlated with ALSFRS-RSE. Several wearable data daily physical activity measures demonstrated statistically significant change over time and associations with ALSFRS-RSE and ROADS. Active and passive digital data collection hold promise for novel ALS trial outcome measure development.
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