In Patient-led development of digital endpoints and the use of computer vision analysis in assessment of motor function in rare diseases, we showed the feasibility of home video capture and computer vision analysis, using an integrated data platform, for the assessment of outcomes related to lower and upper limb function in Duchenne Muscular Dystrophy (DMD) patients.
We showed the usability of the DMD Home app as a method to video record motor tasks, deliver instructions to participants, and to collect patient-reported outcomes (e.g., DMD-QoL).
We also demonstrated that computer vision analysis with OpenPose allowed us to characterise movement in an objective manner and using parameters other than conventional clinical assessments. While the sample size was small and participants were self-assigned to the different cohorts, hence not having a representative sample of all DMD stages, we could still extract highly relevant information particularly from upper body tasks from participants who were in the ambulant and non-ambulant stages of the disease.
Abstract
Digital health technologies are transforming the way health outcomes are captured and measured. Digital biomarkers may provide more objective measurements than traditional approaches as they encompass continuous and longitudinal data collection and use of automated analysis for data interpretation. In addition, the use of digital health technology allows for home-based disease assessments, which in addition to reducing patient burden from on-site hospital visits, provides a more holistic picture of how the patient feels and functions in the real world.
Tools that can robustly capture drug efficacy based on disease-specific outcomes that are meaningful to patients, are going to be key to the successful development of new treatments. This is particularly important for people living with rare and chronic complex conditions, where therapeutic options are limited and need to be developed using a patient-focused approach to achieve the biggest impact. Working in partnership with patient Organisation Duchenne UK, we co-developed a video-based approach, delivered through a new mobile health platform (DMD Home), to assess motor function in patients with Duchenne muscular dystrophy (DMD), a genetic, rare, muscular disease characterized by the progressive loss of muscle function and strength.
Motor function tasks were selected to reflect the “transfer stage” of the disease, when patients are no longer able to walk independently but can stand and weight-bear to transfer. This stage is important for patients and families as it represents a significant milestone in the progression of DMD but it is not routinely captured and/or scored by standard DMD clinical and physiotherapy assessments.
A total of 62 videos were submitted by eight out of eleven participants who onboarded the app and were analysed with pose estimation software (OpenPose) that led to the extraction of objective, quantitative measures, including time, pattern of movement trajectory, and smoothness and symmetry of movement. Computer vision analysis of video tasks to identify voluntary or compensatory movements within the transfer stage merits further investigation.
Longitudinal studies to validate DMD home as a new methodology to predict progression to the non-ambulant stage will be pursued.