A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study

Pim van Oirschot; Marco Heerings; Karine Wendrich; Bram den Teuling; Frank Dorssers; René van Ee; Marijn Bart Martens; Peter Joseph Jongen

doi:10.2196/29128

A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study

JMIR Form Res. 2021 Nov 17;5(11):e29128. doi: 10.2196/29128.

Authors

Pim van Oirschot^#¹, Marco Heerings^{2

3}, Karine Wendrich⁴, Bram den Teuling¹, Frank Dorssers¹, René van Ee^{1

5}, Marijn Bart Martens^{6

7}, Peter Joseph Jongen^{8

9}

Affiliations

¹ Orikami Digital Health Products, Nijmegen, Netherlands.
² Dutch National Multiple Sclerosis Foundation, Rotterdam, Netherlands.
³ Radboud University Medical Center, Nijmegen, Netherlands.
⁴ Faculty of Science, Institute for Science in Society, Radboud University, Nijmegen, Netherlands.
⁵ Sint Maartenskliniek, Nijmegen, Netherlands.
⁶ Drug Target ID, Nijmegen, Netherlands.
⁷ NeuroDrug Research BV, Nijmegen, Netherlands.
⁸ Department of Community & Occupational Medicine, University Medical Centre Groningen, Groningen, Netherlands.
⁹ MS4 Research Institute, Nijmegen, Netherlands.

^# Contributed equally.

PMID: 34787581
PMCID: PMC8663688
DOI: 10.2196/29128

Abstract

Background: Walking disturbances are a common dysfunction in persons with multiple sclerosis (MS). The 2-Minute Walking Test (2MWT) is widely used to quantify walking speed. We implemented a smartphone-based 2MWT (s2MWT) in MS sherpa, an app for persons with MS. When performing the s2MWT, users of the app are instructed to walk as fast as safely possible for 2 minutes in the open air, while the app records their movement and calculates the distance walked.

Objective: The aim of this study is to investigate the concurrent validity and test-retest reliability of the MS sherpa s2MWT.

Methods: We performed a validation study on 25 persons with relapsing-remitting MS and 79 healthy control (HC) participants. In the HC group, 21 participants were matched to the persons with MS based on age, gender, and education and these followed the same assessment schedule as the persons with MS (the HC-matched group), whereas 58 participants had a less intense assessment schedule to determine reference values (the HC-normative group). Intraclass correlation coefficients (ICCs) were determined between the distance measured by the s2MWT and the distance measured using distance markers on the pavement during these s2MWT assessments. ICCs were also determined for test-retest reliability and derived from 10 smartphone tests per study participant, with 3 days in between each test. We interviewed 7 study participants with MS regarding their experiences with the s2MWT.

Results: In total, 755 s2MWTs were completed. The adherence rate for the persons with MS and the participants in the HC-matched group was 92.4% (425/460). The calculated distance walked on the s2MWT was, on average, 8.43 m or 5% (SD 18.9 m or 11%) higher than the distance measured using distance markers (n=43). An ICC of 0.817 was found for the concurrent validity of the s2MWT in the combined analysis of persons with MS and HC participants. Average ICCs of 9 test-retest reliability analyses of the s2MWT for persons with MS and the participants in the HC-matched group were 0.648 (SD 0.150) and 0.600 (SD 0.090), respectively, whereas the average ICC of 2 test-retest reliability analyses of the s2MWT for the participants in the HC-normative group was 0.700 (SD 0.029). The interviewed study participants found the s2MWT easy to perform, but they also expressed that the test results can be confronting and that a pressure to reach a certain distance can be experienced.

Conclusions: The high correlation between s2MWT distance and the conventional 2MWT distance indicates a good concurrent validity. Similarly, high correlations underpin a good test-retest reliability of the s2MWT. We conclude that the s2MWT can be used to measure the distance that the persons with MS walk in 2 minutes outdoors near their home, from which both clinical studies and clinical practice can benefit.

Keywords: 2-Minute Walking Test; mobile phone; mobility; multiple sclerosis; relapsing remitting.

©Pim van Oirschot, Marco Heerings, Karine Wendrich, Bram den Teuling, Frank Dorssers, René van Ee, Marijn Bart Martens, Peter Joseph Jongen. Originally published in JMIR Formative Research (https://formative.jmir.org), 17.11.2021.