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MSLife: Digital Behavioral Phenotyping of Multiple Sclerosis Symptoms in the Wild Using Wearables and Graph-Based Statistical Analysis

Published:30 December 2021Publication History
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Abstract

Treatment for multiple sclerosis (MS) focuses on managing its symptoms (e.g., depression, fatigue, poor sleep quality), varying with specific symptoms experienced. Thus, for optimal treatment, there arises the need to track these symptoms. Towards this goal, there is great interest in finding their relevant phenotypes. Prior research suggests links between activities of daily living (ADLs) and MS symptoms; therefore, we hypothesize that the behavioral phenotype (revealed through ADLs) is closely related to MS symptoms. Traditional approaches to finding behavioral phenotypes which rely on human observation or controlled clinical settings are burdensome and cannot account for all genuine ADLs. Here, we present MSLife, an end-to-end, burden-free approach to digital behavioral phenotyping of MS symptoms in the wild using wearables and graph-based statistical analysis. MSLife is built upon (1) low-cost, unobtrusive wearables (i.e., smartwatches) that can track and quantify ADLs among MS patients in the wild; (2) graph-based statistical analysis that can model the relationships between quantified ADLs (i.e., digital behavioral phenotype) and MS symptoms. We design, implement, and deploy MSLife with 30 MS patients across a one-week home-based IRB-approved clinical pilot study. We use the GENEActiv smartwatch to monitor ADLs and clinical behavioral instruments to collect MS symptoms. Then we develop a graph-based statistical analysis framework to model phenotyping relationships between ADLs and MS symptoms, incorporating confounding demographic factors. We discover 102 significant phenotyping relationships (e.g., later rise times are related to increased levels of depression, history of caffeine consumption is associated with lower fatigue levels, higher relative levels of moderate physical activity are linked with decreased sleep quality). We validate their healthcare implications, using them to track MS symptoms in retrospective analysis. To our best knowledge, this is one of the first practices to digital behavioral phenotyping of MS symptoms in the wild.

References

  1. C. A. Dendrou, L. Fugger, and M. A. Friese, "Immunopathology of multiple sclerosis," Nature Reviews Immunology, vol. 15, no. 9, pp. 545--558, 2015.Google ScholarGoogle ScholarCross RefCross Ref
  2. "Multiple sclerosis," https://www.nccih.nih.gov/health/multiple-sclerosis, accessed: 11/08/2020.Google ScholarGoogle Scholar
  3. "How many people live with ms?" https://www.nationalmssociety.org/What-is-MS/How-Many-People.Google ScholarGoogle Scholar
  4. G. Adelman, S. G. Rane, and K. F. Villa, "The cost burden of multiple sclerosis in the united states: a systematic review of the literature," Journal of medical economics, vol. 16, no. 5, pp. 639--647, 2013.Google ScholarGoogle ScholarCross RefCross Ref
  5. V. Janardhan and R. Bakshi, "Quality of life in patients with multiple sclerosis: the impact of fatigue and depression," Journal of the neurological sciences, vol. 205, no. 1, pp. 51--58, 2002.Google ScholarGoogle ScholarCross RefCross Ref
  6. W. E. Fleming and C. P. Pollak, "Sleep disorders in multiple sclerosis," in Seminars in neurology, vol. 25, no. 01. Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New ..., 2005, pp. 64--68.Google ScholarGoogle Scholar
  7. J. H. Noseworthy, "Progress in determining the causes and treatment of multiple sclerosis," Nature, vol. 399, no. 6738, pp. A40-A47, 1999.Google ScholarGoogle ScholarCross RefCross Ref
  8. D. M. Wingerchuk, C. F. Lucchinetti, and J. H. Noseworthy, "Multiple sclerosis: current pathophysiological concepts," Laboratory investigation, vol. 81, no. 3, pp. 263--281, 2001.Google ScholarGoogle ScholarCross RefCross Ref
  9. "Multiple sclerosis information page," https://www.ninds.nih.gov/Disorders/All-Disorders/Multiple-Sclerosis-Information-Page, accessed: 11/08/2020.Google ScholarGoogle Scholar
  10. R. B. Schiffer and N. M. Wineman, "Antidepressant pharmacotherapy of depression associated with multiple sclerosis." The American journal of psychiatry, 1990.Google ScholarGoogle Scholar
  11. T. Chitnis, B. I. Glanz, C. Gonzalez, B. C. Healy, T. J. Saraceno, N. Sattarnezhad, C. Diaz-Cruz, M. Polgar-Turcsanyi, S. Tummala, R. Bakshi et al., "Quantifying neurologic disease using biosensor measurements in-clinic and in free-living settings in multiple sclerosis," NPJ digital medicine, vol. 2, no. 1, pp. 1--8, 2019.Google ScholarGoogle ScholarCross RefCross Ref
  12. R. Siegert and D. Abernethy, "Depression in multiple sclerosis: a review," Journal of Neurology, Neurosurgery & Psychiatry, vol. 76, no. 4, pp. 469--475, 2005.Google ScholarGoogle ScholarCross RefCross Ref
  13. H. Hasselmann, J. Bellmann-Strobl, R. Ricken, T. Oberwahrenbrock, M. Rose, C. Otte, M. Adli, F. Paul, A. U. Brandt, C. Finke et al., "Characterizing the phenotype of multiple sclerosis-associated depression in comparison with idiopathic major depression," Multiple Sclerosis Journal, vol. 22, no. 11, pp. 1476--1484, 2016.Google ScholarGoogle ScholarCross RefCross Ref
  14. V. M. Leavitt, R. Brandstadter, M. Fabian, I. Katz Sand, S. Klineova, S. Krieger, C. Lewis, F. Lublin, A. Miller, G. Pelle et al., "Dissociable cognitive patterns related to depression and anxiety in multiple sclerosis," Multiple Sclerosis Journal, vol. 26, no. 10, pp. 1247--1255, 2020.Google ScholarGoogle ScholarCross RefCross Ref
  15. E. De Meo, E. Portaccio, A. Giorgio, L. Ruano, B. Goretti, C. Niccolai, F. Patti, C. G. Chisari, P. Gallo, P. Grossi et al., "Identifying the distinct cognitive phenotypes in multiple sclerosis," JAMA neurology, vol. 78, no. 4, pp. 414--425, 2021.Google ScholarGoogle ScholarCross RefCross Ref
  16. K. Radhakrishnan, M. T. Kim, M. Burgermaster, R. A. Brown, B. Xie, M. S. Bray, and C. A. Fournier, "The potential of digital phenotyping to advance the contributions of mobile health to self-management science," Nursing outlook, vol. 68, no. 5, pp. 548--559, 2020.Google ScholarGoogle ScholarCross RefCross Ref
  17. D. Kos, E. Kerckhofs, G. Nagels, M. D'hooghe, and S. Ilsbroukx, "Origin of fatigue in multiple sclerosis: review of the literature," Neurorehabilitation and neural repair, vol. 22, no. 1, pp. 91--100, 2008.Google ScholarGoogle Scholar
  18. H. Kaynak, A. Altintaş, D. Kaynak, Ö. Uyanik, S. Saip, J. Ağaoğlu, G. Önder, and A. Siva, "Fatigue and sleep disturbance in multiple sclerosis," European Journal of Neurology, vol. 13, no. 12, pp. 1333--1339, 2006.Google ScholarGoogle ScholarCross RefCross Ref
  19. "Phenotype," https://www.genome.gov/genetics-glossary/Phenotype, accessed 05/09/21.Google ScholarGoogle Scholar
  20. T. Olsson, L. F. Barcellos, and L. Alfredsson, "Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis," Nature Reviews Neurology, vol. 13, no. 1, p. 25, 2017.Google ScholarGoogle ScholarCross RefCross Ref
  21. M. W. Nortvedt, T. Riise, and J. Maeland, "Multiple sclerosis and lifestyle factors: the hordaland health study," Neurological Sciences, vol. 26, no. 5, pp. 334--339, 2005.Google ScholarGoogle ScholarCross RefCross Ref
  22. D. Jakimovski, Y. Guan, M. Ramanathan, B. Weinstock-Guttman, and R. Zivadinov, "Lifestyle-based modifiable risk factors in multiple sclerosis: review of experimental and clinical findings," Neurodegenerative Disease Management, vol. 9, no. 3, pp. 149--172, 2019, pMID: 31116081. [Online]. Available: https://doi.org/10.2217/nmt-2018-0046Google ScholarGoogle ScholarCross RefCross Ref
  23. L. J. White and R. H. Dressendorfer, "Exercise and multiple sclerosis," Sports medicine, vol. 34, no. 15, pp. 1077--1100, 2004.Google ScholarGoogle ScholarCross RefCross Ref
  24. J. J. Veldhuijzen van Zanten, L. A. Pilutti, J. L. Duda, and R. W. Motl, "Sedentary behaviour in people with multiple sclerosis: Is it time to stand up against ms?" Multiple Sclerosis Journal, vol. 22, no. 10, pp. 1250--1256, 2016.Google ScholarGoogle ScholarCross RefCross Ref
  25. S. D. Brass, P. Duquette, J. Proulx-Therrien, and S. Auerbach, "Sleep disorders in patients with multiple sclerosis," Sleep medicine reviews, vol. 14, no. 2, pp. 121--129, 2010.Google ScholarGoogle ScholarCross RefCross Ref
  26. A. Andreasen, E. Stenager, and U. Dalgas, "The effect of exercise therapy on fatigue in multiple sclerosis," Multiple Sclerosis Journal, vol. 17, no. 9, pp. 1041--1054, 2011.Google ScholarGoogle ScholarCross RefCross Ref
  27. M. B. Rietberg, D. Brooks, B. M. Uitdehaag, and G. Kwakkel, "Exercise therapy for multiple sclerosis," Cochrane database of systematic reviews, no. 1, 2005.Google ScholarGoogle Scholar
  28. P.-Y. Yang, K.-H. Ho, H.-C. Chen, and M.-Y. Chien, "Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review," Journal of physiotherapy, vol. 58, no. 3, pp. 157--163, 2012.Google ScholarGoogle ScholarCross RefCross Ref
  29. J. Torous, M. V. Kiang, J. Lorme, and J.-P. Onnela, "New tools for new research in psychiatry: a scalable and customizable platform to empower data driven smartphone research," JMIR mental health, vol. 3, no. 2, p. e16, 2016.Google ScholarGoogle ScholarCross RefCross Ref
  30. O. Lab, "Research areas," https://www.hsph.harvard.edu/onnela-lab/research/.Google ScholarGoogle Scholar
  31. P. Spirtes and K. Zhang, "Causal discovery and inference: concepts and recent methodological advances," in Applied informatics, vol. 3, no. 1. Springer, 2016, p. 3.Google ScholarGoogle Scholar
  32. L. Yao, Z. Chu, S. Li, Y. Li, J. Gao, and A. Zhang, "A survey on causal inference," 2020.Google ScholarGoogle Scholar
  33. H. Lassmann, W. Brück, and C. F. Lucchinetti, "The immunopathology of multiple sclerosis: an overview," Brain pathology, vol. 17, no. 2, pp. 210--218, 2007.Google ScholarGoogle ScholarCross RefCross Ref
  34. R. T. Joffe, G. P. Lippert, T. A. Gray, G. Sawa, and Z. Horvath, "Mood disorder and multiple sclerosis," Archives of Neurology, vol. 44, no. 4, pp. 376--378, 1987.Google ScholarGoogle ScholarCross RefCross Ref
  35. J. Rooksby, A. Morrison, and D. Murray-Rust, "Student perspectives on digital phenotyping: The acceptability of using smartphone data to assess mental health," in Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, 2019, pp. 1--14.Google ScholarGoogle Scholar
  36. V. W.-S. Tseng, N. Valliappan, V. Ramachandran, T. Choudhury, and V. Navalpakkam, "Digital biomarker of mental fatigue," NPJ digital medicine, vol. 4, no. 1, pp. 1--5, 2021.Google ScholarGoogle ScholarCross RefCross Ref
  37. L. C. Kourtis, O. B. Regele, J. M. Wright, and G. B. Jones, "Digital biomarkers for alzheimer's disease: the mobile/wearable devices opportunity," NPJ digital medicine, vol. 2, no. 1, pp. 1--9, 2019.Google ScholarGoogle ScholarCross RefCross Ref
  38. R. Wang, F. Chen, Z. Chen, T. Li, G. Harari, S. Tignor, X. Zhou, D. Ben-Zeev, and A. T. Campbell, "Studentlife: assessing mental health, academic performance and behavioral trends of college students using smartphones," in Proceedings of the 2014 ACM international joint conference on pervasive and ubiquitous computing, 2014, pp. 3--14.Google ScholarGoogle Scholar
  39. "Compare products," https://www.activinsights.com/products/geneactiv/compare-products/.Google ScholarGoogle Scholar
  40. "Geneactiv original," https://www.activinsights.com/products/geneactiv/, Accessed 07/08/21.Google ScholarGoogle Scholar
  41. https://www.activinsights.com/wp-content/uploads/2015/11/GENEActiv-Brochure-2015.pdf, https://www.activinsights.com/wp-content/uploads/2015/11/GENEActiv-Brochure-2015.pdf, Accessed 07/20/21.Google ScholarGoogle Scholar
  42. D. Eslinger, A. V. Rowlands, T. L. Hurst, M. Catt, P. Murray, and R. G. Eston, "Validation of the genea accelerometer," 2011.Google ScholarGoogle Scholar
  43. "How geneactiv accelerometer research watches work," https://www.activinsights.com/technology/geneactiv/how-it-works/, accessed 07/20/21.Google ScholarGoogle Scholar
  44. "Geneactiv," https://www.activinsights.com/products/geneactiv/, Accessed 07/20/21.Google ScholarGoogle Scholar
  45. https://help.fitbit.com/articles/en_US/Help_article/1136.htm, title=How accurate are Fitbit devices?, note=Accessed 07/08/21.Google ScholarGoogle Scholar
  46. "Watch - apple," https://www.apple.com/watch/, accessed 07/08/21.Google ScholarGoogle Scholar
  47. O. Kantarci, A. Siva, M. Eraksoy, R. Karabudak, N. Sütlaş, J. Ağaoğlu, F. Turan, M. Özmenoğlu, E. Toğrul, M. Demirkiran et al., "Survival and predictors of disability in turkish ms patients," Neurology, vol. 51, no. 3, pp. 765--772, 1998.Google ScholarGoogle ScholarCross RefCross Ref
  48. J. C. Bot, F. Barkhof, C. H. Polman, G. L. à. Nijeholt, V. de Groot, E. Bergers, H. J. Ader, and J. A. Castelijns, "Spinal cord abnormalities in recently diagnosed ms patients," Neurology, vol. 62, no. 2, pp. 226--233, 2004. [Online]. Available: https://n.neurology.org/content/62/2/226Google ScholarGoogle ScholarCross RefCross Ref
  49. U. Dalgas, E. Stenager, J. Jakobsen, T. Petersen, H. Hansen, C. Knudsen, K. Overgaard, and T. Ingemann-Hansen, "Fatigue, mood and quality of life improve in ms patients after progressive resistance training," Multiple Sclerosis Journal, vol. 16, no. 4, pp. 480--490, 2010.Google ScholarGoogle ScholarCross RefCross Ref
  50. C. Christodoulou, L. Krupp, Z. Liang, W. Huang, P. Melville, C. Roque, W. Scherl, T. Morgan, W. MacAllister, L. Li et al., "Cognitive performance and mr markers of cerebral injury in cognitively impaired ms patients," Neurology, vol. 60, no. 11, pp. 1793--1798, 2003.Google ScholarGoogle ScholarCross RefCross Ref
  51. A. Mehrotra, F. Tsapeli, R. Hendley, and M. Musolesi, "Mytraces: Investigating correlation and causation between users' emotional states and mobile phone interaction," Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, vol. 1, no. 3, pp. 1--21, 2017.Google ScholarGoogle ScholarDigital LibraryDigital Library
  52. R. Wang, M. S. Aung, S. Abdullah, R. Brian, A. T. Campbell, T. Choudhury, M. Hauser, J. Kane, M. Merrill, E. A. Scherer et al., "Crosscheck: toward passive sensing and detection of mental health changes in people with schizophrenia," in Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing, 2016, pp. 886--897.Google ScholarGoogle Scholar
  53. "Who gets ms? (epidemiology)," https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS, accessed 05/07/21.Google ScholarGoogle Scholar
  54. M. A. Hernán, S.S. Jick, G. Logroscino, M. J. Olek, A. Ascherio, and H. Jick, "Cigarette smoking and the progression of multiple sclerosis," Brain, vol. 128, no. 6, pp. 1461--1465, 2005.Google ScholarGoogle ScholarCross RefCross Ref
  55. J. M. Greer and P. A. McCombe, "Role of gender in multiple sclerosis: clinical effects and potential molecular mechanisms," Journal of neuroimmunology, vol. 234, no. 1--2, pp. 7--18, 2011.Google ScholarGoogle Scholar
  56. L. J. Julian, L. Vella, T. Vollmer, O. Hadjimichael, and D. C. Mohr, "Employment in multiple sclerosis," Journal of neurology, vol. 255, no. 9, pp. 1354--1360, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  57. M. Catanzaro and C. Weinert, "Economic status of families living with multiple sclerosis." International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation, vol. 15, no. 3, pp. 209--218, 1992.Google ScholarGoogle Scholar
  58. W. Wang, G. M. Harari, R. Wang, S. R. Müller, S. Mirjafari, K. Masaba, and A. T. Campbell, "Sensing behavioral change over time: Using within-person variability features from mobile sensing to predict personality traits," Proc. ACM Interact. Mob. Wearable Ubiquitous Technol., vol. 2, no. 3, Sep. 2018. [Online]. Available: https://doi.org/10.1145/3264951Google ScholarGoogle ScholarDigital LibraryDigital Library
  59. W. Gu, Y. Zhou, Z. Zhou, X. Liu, H. Zou, P. Zhang, C. J. Spanos, and L. Zhang, "Sugarmate: Non-intrusive blood glucose monitoring with smartphones," Proc. ACM Interact. Mob. Wearable Ubiquitous Technol., vol. 1, no. 3, Sep. 2017. [Online]. Available: https://doi.org/10.1145/3130919Google ScholarGoogle ScholarDigital LibraryDigital Library
  60. "Tetrad manual," http://cmu-phil.github.io/tetrad/manual/, 2019.Google ScholarGoogle Scholar
  61. "DoWhy: A Python package for causal inference," https://github.com/microsoft/dowhy, 2019.Google ScholarGoogle Scholar
  62. M. Littner, C. A. Kushida, W. M. Anderson, D. Bailey, R. B. Berry, D. G. Davila, M. Hirshkowitz, S. Kapen, M. Kramer, D. Loube, M. Wise, and S. F. Johnson, "Practice Parameters for the Role of Actigraphy in the Study of Sleep and Circadian Rhythms: An Update for 2002," Sleep, vol. 26, no. 3, pp. 337--341, 05 2003. [Online]. Available: https://doi.org/10.1093/sleep/26.3337Google ScholarGoogle ScholarCross RefCross Ref
  63. S. Ancoli-Israel, R. Cole, C. Alessi, M. Chambers, W. Moorcroft, and C. P. Pollak, "The role of actigraphy in the study of sleep and circadian rhythms," Sleep, vol. 26, no. 3, pp. 342--392, 2003.Google ScholarGoogle ScholarCross RefCross Ref
  64. J. L. Martin and A. D. Hakim, "Wrist actigraphy," Chest, vol. 139, no. 6, pp. 1514--1527, 2011.Google ScholarGoogle ScholarCross RefCross Ref
  65. M. E. Rosenberger, M. P. Buman, W. L. Haskell, M. V. McConnell, and L. L. Carstensen, "24 hours of sleep, sedentary behavior, and physical activity with nine wearable devices," Medicine and science in sports and exercise, vol. 48, no. 3, p. 457, 2016.Google ScholarGoogle Scholar
  66. T. G. Pavey, S. R. Gomersall, B. K. Clark, and W. J. Brown, "The validity of the geneactiv wrist-worn accelerometer for measuring adult sedentary time in free living," Journal of science and medicine in sport, vol. 19, no. 5, pp. 395--399, 2016.Google ScholarGoogle ScholarCross RefCross Ref
  67. M. Hildebrand, B. H. Hansen, V. T. van Hees, and U. Ekelund, "Evaluation of raw acceleration sedentary thresholds in children and adults," Scandinavian journal of medicine & science in sports, vol. 27, no. 12, pp. 1814--1823, 2017.Google ScholarGoogle Scholar
  68. F. Fraysse, D. Post, R. Eston, D. Kasai, A. V. Rowlands, and G. Parfitt, "Physical activity intensity cut-points for wrist-worn geneactiv in older adults," Frontiers in Sports and Active Living, vol. 2, 2020.Google ScholarGoogle Scholar
  69. "Physical activity guidelines for americans," https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf.Google ScholarGoogle Scholar
  70. "General physical activities defined by level of intensity," https://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Intensiry_table_2_1.pdf.Google ScholarGoogle Scholar
  71. A. Sadeh, "The role and validity of actigraphy in sleep medicine: an update," Sleep medicine reviews, vol. 15, no. 4, pp. 259--267, 2011.Google ScholarGoogle ScholarCross RefCross Ref
  72. A. Sadeh, M. Sharkey, and M. A. Carskadon, "Activity-based sleep-wake identification: an empirical test of methodological issues," Sleep, vol. 17, no. 3, pp. 201--207, 1994.Google ScholarGoogle ScholarCross RefCross Ref
  73. A. Bamer, K. Johnson, D. Amtmann, and G. Kraft, "Prevalence of sleep problems in individuals with multiple sclerosis," Multiple Sclerosis Journal, vol. 14, no. 8, pp. 1127--1130, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  74. L. B. Krupp, L. A. Alvarez, N. G. LaRocca, and L. C. Scheinberg, "Fatigue in multiple sclerosis," Archives of neurology, vol. 45, no. 4, pp. 435--437, 1988.Google ScholarGoogle ScholarCross RefCross Ref
  75. R. H. Benedict, E. Wahlig, R. Bakshi, I. Fishman, F. Munschauer, R. Zivadinov, and B. Weinstock-Guttman, "Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change," Journal of the neurological sciences, vol. 231, no. 1--2, pp. 29--34, 2005.Google ScholarGoogle Scholar
  76. J. F. Kurtzke, "Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (edss)," Neurology, vol. 33, no. 11, pp. 1444--1444, 1983.Google ScholarGoogle ScholarCross RefCross Ref
  77. J. H. Petajan and A. T. White, "Recommendations for physical activity in patients with multiple sclerosis," Sports medicine, vol. 27, no. 3, pp. 179--191, 1999.Google ScholarGoogle ScholarCross RefCross Ref
  78. R. W. Motl, E. McAuley, and E. M. Snook, "Physical activity and multiple sclerosis: a meta-analysis," Multiple Sclerosis Journal, vol. 11, no. 4, pp. 459--463, 2005.Google ScholarGoogle ScholarCross RefCross Ref
  79. A. Ng and J. KENT-BRAUN, "Quantitation of lower physical activity in persons with multiple sclerosis," Medicine & Science in Sports & Exercise, vol. 29, no. 4, pp. 517--523, 1997.Google ScholarGoogle ScholarCross RefCross Ref
  80. L. S. Radloff, "The ces-d scale: A self-report depression scale for research in the general population," Applied psychological measurement, vol. 1, no. 3, pp. 385--401, 1977.Google ScholarGoogle ScholarCross RefCross Ref
  81. L. B. Krupp, N. G. LaRocca, J. Muir-Nash, and A. D. Steinberg, "The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus," Archives of neurology, vol. 46, no. 10, pp. 1121--1123, 1989.Google ScholarGoogle ScholarCross RefCross Ref
  82. "What is depression?" https://www.psychiatry.org/patients-families/depression/what-is-depression, accessed 07/24/21, https://www.psychiatry.org/patients-families/depression/what-is-depression.Google ScholarGoogle Scholar
  83. D. J. Buysse, C. F. Reynolds III, T. H. Monk, S. R. Berman, and D. J. Kupfer, "The pittsburgh sleep quality index: a new instrument for psychiatric practice and research," Psychiatry research, vol. 28, no. 2, pp. 193--213, 1989.Google ScholarGoogle ScholarCross RefCross Ref
  84. E. R. Chasens, S. J. Ratcliffe, and T. E. Weaver, "Development of the fosq-10: a short version of the functional outcomes of sleep questionnaire," Sleep, vol. 32, no. 7, pp. 915--919, 2009.Google ScholarGoogle ScholarCross RefCross Ref
  85. https://www.serenitymedicalservices.com/wp-content/uploads/2020/01/CEREVES_FOSQ_10_ENG.pdf, Accessed 07/16/21.Google ScholarGoogle Scholar
  86. M. Westberg, M. Feychting, F. Jonsson, G. Nise, and P. Gustavsson, "Occupational exposure to uv light and mortality from multiple sclerosis," American journal of industrial medicine, vol. 52, no. 5, pp. 353--357, 2009.Google ScholarGoogle Scholar
  87. B. K. Mehta, "New hypotheses on sunlight and the geographic variability of multiple sclerosis prevalence," Journal of the neurological sciences, vol. 292, no. 1--2, pp. 5--10, 2010.Google ScholarGoogle Scholar
  88. N. M. Wineman, "Adaptation to multiple sclerosis: the role of social support, functional disability, and perceived uncertainty." Nursing research, 1990.Google ScholarGoogle Scholar
  89. M. Krokavcova, J. P. van Dijk, I. Nagyova, J. Rosenberger, M. Gavelova, B. Middel, Z. Gdovinova, and J. W. Groothoff, "Social support as a predictor of perceived health status in patients with multiple sclerosis," Patient Education and Counseling, vol. 73, no. 1, pp. 159--165, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  90. HealthCare.gov, "The 'metal' categories: Bronze, silver, gold platinum," https://www.healthcare.gov/choose-a-plan/plans-categories/, accessed 08/04/21, https://www.healthcare.gov/choose-a-plan/plans-categories/.Google ScholarGoogle Scholar
  91. X. Shen, S. Ma, P. Vemuri, and G. Simon, "challenges and opportunities with causal discovery algorithms: Application to alzheimer's pathophysiology," Scientific reports, vol. 10, no. 1, pp. 1--12, 2020.Google ScholarGoogle Scholar
  92. W. Chen, Y. Hu, X. Zhang, L. Wu, K. Liu, J. He, Z. Tang, X. Song, L. R. Waitman, and M. Liu, "Causal risk factor discovery for severe acute kidney injury using electronic health records," BMC medical informatics and decision making, vol. 18, no. 1, p. 13, 2018.Google ScholarGoogle Scholar
  93. D. M. Chickering, "Optimal structure identification with greedy search," Journal of machine learning research, vol. 3, no. Nov, pp. 507--554, 2002.Google ScholarGoogle ScholarDigital LibraryDigital Library
  94. C. Meek, "Graphical models: Selecting causal and statistical models," Ph.D. dissertation, PhD thesis, Carnegie Mellon University, 1997.Google ScholarGoogle Scholar
  95. C. for Causal Discovery, "Fast greedy equivalence search (fges) algorithm for continuous variables," https://www.ccd.pitt.edu//wiki/index.php?title=Fast_Greedy_Equivalence_Search_(FGES)_Algorithm_for_Continuous_Variables.Google ScholarGoogle Scholar
  96. R. Tu, K. Zhang, B. Bertilson, H. Kjellstrom, and C. Zhang, "Neuropathic pain diagnosis simulator for causal discovery algorithm evaluation," in Advances in Neural Information Processing Systems, 2019, pp. 12 793-12 804.Google ScholarGoogle Scholar
  97. G. Schwarz, "Estimating the dimension of a model," Ann. Statist., vol. 6, no. 2, pp. 461--464, 03 1978. [Online]. Available: https://doi.org/10.1214/aos/1176344136Google ScholarGoogle ScholarCross RefCross Ref
  98. A. E. Raftery, "Bayesian model selection in social research," Sociological methodology, pp. 111--163, 1995.Google ScholarGoogle ScholarCross RefCross Ref
  99. E. Wit, E. v. d. Heuvel, and J.-W. Romeijn, "'all models are wrong...': an introduction to model uncertainty," Statistica Neerlandica, vol. 66, no. 3, pp. 217--236, 2012. [Online]. Available: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-9574.2012.00530.xGoogle ScholarGoogle ScholarCross RefCross Ref
  100. P. R. Rosenbaum and D. B. Rubin, "The central role of the propensity score in observational studies for causal effects," Biometrika, vol. 70, no. 1, pp. 41--55, 1983.Google ScholarGoogle ScholarCross RefCross Ref
  101. R. Swindle, K. Kroenke, and L. Braun, "Energy and improved workplace productivity in depression," Investing in health: The social and economic benefits of health care innovation, 2001.Google ScholarGoogle Scholar
  102. A. Gardner and R. G. Boles, "Mitochondrial energy depletion in depression with somatization," Psychotherapy and psychosomatics, vol. 77, no. 2, pp. 127--129, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  103. T. Roehrs and T. Roth, "Caffeine: sleep and daytime sleepiness," Sleep medicine reviews, vol. 12, no. 2, pp. 153--162, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  104. E. Horwath, J. Johnson, M. M. Weissman, and C. D. Hornig, "The validity of major depression with atypical features based on a community study," Journal of affective disorders, vol. 26, no. 2, pp. 117--125, 1992.Google ScholarGoogle ScholarCross RefCross Ref
  105. F. M. Quitkin, "Depression with atypical features: diagnostic validity, prevalence, and treatment," Primary care companion to the Journal of clinical psychiatry, vol. 4, no. 3, p. 94, 2002.Google ScholarGoogle ScholarCross RefCross Ref
  106. D. Dooley, R. Catalano, and G. Wilson, "Depression and unemployment: panel findings from the epidemiologic catchment area study," American journal of community psychology, vol. 22, no. 6, pp. 745--765, 1994.Google ScholarGoogle Scholar
  107. N. Tsuno, A. Besset, and K. Ritchie, "Sleep and depression." The Journal of clinical psychiatry, 2005.Google ScholarGoogle ScholarCross RefCross Ref
  108. A. Lerdal, E. Celius, and T. Moum, "Fatigue and its association with sociodemographic variables among multiple sclerosis patients," Multiple Sclerosis Journal, vol. 9, no. 5, pp. 509--514, 2003.Google ScholarGoogle ScholarCross RefCross Ref
  109. K. Gebel, D. Ding, T. Chey, E. Stamatakis, W. J. Brown, and A. E. Bauman, "Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older australians," JAMA internal medicine, vol. 175, no. 6, pp. 970--977, 2015.Google ScholarGoogle ScholarCross RefCross Ref
  110. T. G. Pavey, G. Peeters, A. E. Bauman, and W. J. Brown, "Does vigorous physical activity provide additional benefits beyond those of moderate?" Medicine and science in sports and exercise, vol. 45, no. 10, pp. 1948--1955, 2013.Google ScholarGoogle Scholar
  111. M. H. Vitaterna, J. S. Takahashi, and F. W. Turek, "Overview of circadian rhythms," Alcohol Research & Health, vol. 25, no. 2, p. 85, 2001.Google ScholarGoogle Scholar
  112. N. L. Benowitz, P. Jacob, R. T. Jones, and J. Rosenberg, "Interindividual variability in the metabolism and cardiovascular effects of nicotine in man." Journal of Pharmacology and Experimental Therapeutics, vol. 221, no. 2, pp. 368--372, 1982.Google ScholarGoogle Scholar
  113. N. L. Benowitz, H. Porchet, L. Sheiner, and P. Jacob III, "Nicotine absorption and cardiovascular effects with smokeless tobacco use: comparison with cigarettes and nicotine gum," Clinical Pharmacology & Therapeutics, vol. 44, no. 1, pp. 23--28, 1988.Google ScholarGoogle ScholarCross RefCross Ref
  114. M. Hirshkowitz, K. Whiton, S. M. Albert, C. Alessi, O. Bruni, L. DonCarlos, N. Hazen, J. Herman, E. S. Katz, L. Kheirandish-Gozal et al., "National sleep foundation's sleep time duration recommendations: methodology and results summary," Sleep health, vol. 1, no. 1, pp. 40--43, 2015.Google ScholarGoogle ScholarCross RefCross Ref
  115. S. D. Barbara Illowsky, Introductory Statistics. OpenStax, 2013, https://openstax.org/books/introductory-statistics/pages/12-4-testing-the-significance-of-the-correlation-coefficient.Google ScholarGoogle Scholar
  116. J. Haines, M. Ter-Minassian, A. Bazyk, J. Gusella, D. Kim, H. Terwedow, M. A. PericakVance, J. Rimmler, C. Haynes, A. Roses et al., "A complete genomic screen for multiple sclerosis underscores a role for the major histocompatability complex," Nature genetics, vol. 13, no. 4, pp. 469--471, 1996.Google ScholarGoogle ScholarCross RefCross Ref
  117. M. Debouverie, S. Pittion-Vouyovitch, S. Louis, F. Guillemin, and L. Group, "Natural history of multiple sclerosis in a population-based cohort," European Journal of Neurology, vol. 15, no. 9, pp. 916--921, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  118. S. D. Barbara Illowsky, Introductory Statistics. OpenStax, 2013, https://openstax.org/books/introductory-statistics/pages/12-3-the-regression-equation.Google ScholarGoogle Scholar
  119. N. Losseff, S. Webb, J. O'riordan, R. Page, L. Wang, G. Barker, P. S. Tofts, W. I. McDonald, D. H. Miller, and A. J. Thompson, "Spinal cord atrophy and disability in multiple sclerosis: a new reproducible and sensitive mri method with potential to monitor disease progression," Brain, vol. 119, no. 3, pp. 701--708, 1996.Google ScholarGoogle ScholarCross RefCross Ref
  120. D. L. Arnold, G. T. Riess, P. M. Matthews, G. S. Francis, D. L. Collins, C. Wolfson, and J. P. Antel, "Use of proton magnetic resonance spectroscopy for monitoring disease progression in multiple sclerosis," Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, vol. 36, no. 1, pp. 76--82, 1994.Google ScholarGoogle Scholar
  121. N. Sola-Valls, Y. Blanco, M. Sepúlveda, E. Martinez-Hernandez, and A. Saiz, "Telemedicine for monitoring ms activity and progression," Current treatment options in neurology, vol. 17, no. 11, pp. 1--13, 2015.Google ScholarGoogle Scholar
  122. C. E. Schwartz, B. R. Quaranto, B. C. Healy, R. H. Benedict, and T. L. Vollmer, "Cognitive reserve and symptom experience in multiple sclerosis: a buffer to disability progression over time?" Archives of physical medicine and rehabilitation, vol. 94, no. 10, pp. 1971--1981, 2013.Google ScholarGoogle Scholar
  123. I. Kister, T. E. Bacon, E. Chamot, A. R. Salter, G. R. Cutter, J. T. Kalina, and J. Herbert, "Natural history of multiple sclerosis symptoms," International journal of MS care, vol. 15, no. 3, pp. 146--156, 2013.Google ScholarGoogle ScholarCross RefCross Ref
  124. B.J. Feir-Walsh and L. E. Toothaker, "An empirical comparison of the anova f-test, normal scores test and kruskal-wallis test under violation of assumptions," Educational and Psychological Measurement, vol. 34, no. 4, pp. 789--799, 1974.Google ScholarGoogle ScholarCross RefCross Ref
  125. "Anova for regression," http://www.stat.yale.edu/Courses/1997-98/101/anovareg.htm, http://www.stat.yale.edu/Courses/1997-98/101/anovareg.htm, Accessed 07/20/21.Google ScholarGoogle Scholar
  126. "2.6 - the analysis of variance (anova) table and the f-test," https://online.stat.psu.edu/stat501/lesson/2/2.6, https://online.stat.psu.edu/stat501/lesson/2/2.6, Accessed 07/20/21.Google ScholarGoogle Scholar
  127. "Analysis of variance (anova)," https://www.investopedia.com/terms/a/anova.asp, https://www.investopedia.com/terms/a/anova.asp, Accessed 07/20/21.Google ScholarGoogle Scholar
  128. scikit-learn developers, "1.13. feature selection." [Online]. Available: https://scikit-learn.org/stable/modules/feature_selection.html#univariate-feature-selectionGoogle ScholarGoogle Scholar
  129. R. A. Lorenz, J. Koedbangkham, S. Auerbach, N. S. Alanazi, H. Lach, P. Newland, K. Pandey, and F. P. Thomas, "0949 The Relationships between Circadian Rhythm, Sleep Quality, Fatigue, and Depressive Symptoms Among Adults with Multiple Sclerosis (MS)," Sleep, vol. 42, no. Supplement_1, pp. A381-A382, 04 2019. [Online]. Available: https://doi.org/10.1093/sleep/zsz067.947Google ScholarGoogle ScholarCross RefCross Ref
  130. A. J. Dittner, S. C. Wessely, and R. G. Brown, "The assessment of fatigue: a practical guide for clinicians and researchers," Journal of psychosomatic research, vol. 56, no. 2, pp. 157--170, 2004.Google ScholarGoogle ScholarCross RefCross Ref
  131. J. Backhaus, K. Junghanns, A. Broocks, D. Riemann, and F. Hohagen, "Test-retest reliability and validity of the pittsburgh sleep quality index in primary insomnia," Journal of psychosomatic research, vol. 53, no. 3, pp. 737--740, 2002.Google ScholarGoogle ScholarCross RefCross Ref
  132. S. B. Patten, J. M. Burton, K. M. Fiest, S. Wiebe, A. G. Bulloch, M. Koch, K. S. Dobson, L. M. Metz, C. J. Maxwell, and N. Jetté, "Validity of four screening scales for major depression in ms," Multiple Sclerosis Journal, vol. 21, no. 8, pp. 1064--1071, 2015.Google ScholarGoogle ScholarCross RefCross Ref
  133. L. B. Strober and P. A. Arnett, "Depression in multiple sclerosis: The utility of common self-report instruments and development of a disease-specific measure," Journal of clinical and experimental neuropsychology, vol. 37, no. 7, pp. 722--732, 2015.Google ScholarGoogle ScholarCross RefCross Ref
  134. J. R. Berger, J. Pocoski, R. Preblick, and S. Boklage, "Fatigue heralding multiple sclerosis," Multiple Sclerosis Journal, vol. 19, no. 11, pp. 1526--1532, 2013.Google ScholarGoogle ScholarCross RefCross Ref
  135. P. O. Valko, C. L. Bassetti, K. E. Bloch, U. Held, and C. R. Baumann, "Validation of the fatigue severity scale in a swiss cohort," Sleep, vol. 31, no. 11, pp. 1601--1607, 2008.Google ScholarGoogle ScholarCross RefCross Ref
  136. H. M. Bøe Lunde, T. F. Aae, W. Indrevåg, J. Aarseth, B. Bjorvatn, K.-M. Myhr, and L. Bø, "Poor sleep in patients with multiple sclerosis," PloS one, vol. 7, no. 11, p. e49996, 2012.Google ScholarGoogle ScholarCross RefCross Ref
  137. H. Zhang, G. Guo, C. Song, C. Xu, K. Cheung, J. Alexis, H. Li, D. Li, K. Wang, and W. Xu, "Pdlens: smartphone knows drug effectiveness among parkinson's via daily-life activity fusion," in Proceedings of the 26th Annual International Conference on Mobile Computing and Networking, 2020, pp. 1--14.Google ScholarGoogle Scholar
  138. H. Zhang, C. Song, A. Wang, C. Xu, D. Li, and W. Xu, "Pdvocal: Towards privacy-preserving parkinson's disease detection using non-speech body sounds," in The 25th Annual International Conference on Mobile Computing and Networking, 2019, pp. 1--16.Google ScholarGoogle Scholar
  139. L. Midaglia, P. Mulero, X. Montalban, J. Graves, S. L. Hauser, L. Julian, M. Baker, J. Schadrack, C. Gossens, A. Scotland, F. Lipsmeier, J. van Beek, C. Bernasconi, S. Belachew, and M. Lindemann, "Adherence and satisfaction of smartphone- and smartwatch-based remote active testing and passive monitoring in people with multiple sclerosis: Nonrandomized interventional feasibility study," J Med Internet Res, vol. 21, no. 8, p. e14863, Aug 2019. [Online]. Available: http://www.jmir.org/2019/8/e14863/Google ScholarGoogle ScholarCross RefCross Ref
  140. C. Tong, M. Craner, M. Vegreville, and N. D. Lane, "Tracking fatigue and health state in multiple sclerosis patients using connnected wellness devices," Proc. ACM Interact. Mob. Wearable Ubiquitous Technol., vol. 3, no. 3, Sep. 2019. [Online]. Available: https://doi.org/10.1145/3351264Google ScholarGoogle ScholarDigital LibraryDigital Library
  141. R. Tibshirani, "Regression shrinkage and selection via the lasso," Journal of the Royal Statistical Society: Series B (Methodological), vol. 58, no. 1, pp. 267--288, 1996.Google ScholarGoogle ScholarCross RefCross Ref
  142. R. Wang, G. Harari, P. Hao, X. Zhou, and A. T. Campbell, "Smartgpa: how smartphones can assess and predict academic performance of college students," in Proceedings of the 2015 ACM international joint conference on pervasive and ubiquitous computing, 2015, pp. 295--306.Google ScholarGoogle Scholar
  143. C. E. Mcculloch and J. M. Neuhaus, Generalized Linear Mixed Models Based in part on the article "Generalized linear mixed models" by Charles E. McCulloch, which appeared in the Encyclopedia of Environmetrics. American Cancer Society, 2013. [Online]. Available: https://www.onlinelibrary.wiley.com/doi/abs/10.1002/9780470057339.vag009.pub2Google ScholarGoogle Scholar
  144. R. Wang, W. Wang, A. DaSilva, J. F. Huckins, W. M. Kelley, T. F. Heatherton, and A. T. Campbell, "Tracking depression dynamics in college students using mobile phone and wearable sensing," Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, vol. 2, no. 1, pp. 1--26, 2018.Google ScholarGoogle ScholarDigital LibraryDigital Library
  145. F. Pedregosa, G. Varoquaux, A. Gramfort, V. Michel, B. Thirion, O. Grisel, M. Blondel, P. Prettenhofer, R. Weiss, V. Dubourg et al., "Scikit-learn: Machine learning in python," the Journal of machine Learning research, vol. 12, pp. 2825--2830, 2011.Google ScholarGoogle Scholar
  146. J. W. Hardin and J. M. Hilbe, Generalized estimating equations. chapman and hall/CRC, 2002.Google ScholarGoogle ScholarCross RefCross Ref
  147. F. Tsapeli and M. Musolesi, "Investigating causality in human behavior from smartphone sensor data: a quasi-experimental approach," EPJ Data Science, vol. 4, no. 1, p. 24, 2015.Google ScholarGoogle ScholarCross RefCross Ref
  148. M. G. Kendall, "A new measure of rank correlation," Biometrika, vol. 30, no. 1/2, pp. 81--93, 1938.Google ScholarGoogle ScholarCross RefCross Ref
  149. J. H. Zar, "Spearman rank correlation," Encyclopedia of biostatistics, vol. 7, 2005.Google ScholarGoogle Scholar
  150. Y. Freund, R. E. Schapire et al., "Experiments with a new boosting algorithm," in icml, vol. 96. Citeseer, 1996, pp. 148--156.Google ScholarGoogle Scholar
  151. "Neurodegenerative diseases," https://www.niehs.nih.gov/research/supported/health/neurodegenerative/index.cfm, accessed 07/26/21, https://www.niehs.nih.gov/research/supported/health/neurodegenerative/index.cfm.Google ScholarGoogle Scholar
  152. "The promise of precision medicine," https://www.nih.gov/about-nih/what-we-do/nih-turning-discovery-into-health/promise-precision-medicine, accessed: 05/04/2021.Google ScholarGoogle Scholar
  153. G. Bose and M. S. Freedman, "Precision medicine in the multiple sclerosis clinic: Selecting the right patient for the right treatment," Multiple Sclerosis Journal, vol. 26, no. 5, pp. 540--547, 2020.Google ScholarGoogle ScholarCross RefCross Ref
  154. M. R. Hansen and D. T. Okuda, "Precision medicine for multiple sclerosis promotes preventative medicine," Annals of the New York Academy of Sciences, vol. 1420, no. 1, pp. 62--71, 2018.Google ScholarGoogle ScholarCross RefCross Ref
  155. T. Chitnis and A. Prat, "A roadmap to precision medicine for multiple sclerosis," Multiple Sclerosis Journal, vol. 26, no. 5, pp. 522--532, 2020.Google ScholarGoogle ScholarCross RefCross Ref

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  1. MSLife: Digital Behavioral Phenotyping of Multiple Sclerosis Symptoms in the Wild Using Wearables and Graph-Based Statistical Analysis

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      cover image Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies
      Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies  Volume 5, Issue 4
      Dec 2021
      1307 pages
      EISSN:2474-9567
      DOI:10.1145/3508492
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