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Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) characterized by relapses and progressive disability. The Expanded Disability Status Scale (EDSS), used to quantify disability, is based on single, discretely assessed and potentially inaccurate patient-estimated walking ability, whereas digital health technologies (DHTs) enable continuous activity monitoring and more objective assessment of real-world functional performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective observational study conducted at two German centers, patients with relapsing-remitting MS (RRMS) underwent clinical assessments at baseline (V1) and study completion (V2). Walking distance and step counts were measured using a measuring wheel and pedometer, while continuous physical activity was assessed via smartwatch-derived metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen patients with RRMS were included (median age 57.5 years [interquartile range (IQR) 49.25\u201363.25]; median EDSS 4.5 [IQR 3.5\u20136]). Patient-estimated walking distance at V1 showed moderate correlation with clinically measured distance (Spearman\u2018s \u03c1\u2009=\u20090.60,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), with 12 of 16 patients misjudging distances relative to EDSS thresholds. Walking distance showed intra-individual variability between V1 and V2 (median absolute difference: 113.6\u00a0m). Median daily walking distance (\u03c1 = \u22120.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0123), step count (\u03c1 = \u22120.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0082), and peak steps (\u03c1 = \u22120.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0032) correlated negatively with EDSS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patient-estimated maximum walking distance demonstrated moderate agreement with clinical performance and frequently crossed EDSS thresholds, while clinical assessments varied substantially within individuals over the short study duration, underscoring the limitations of single evaluations. In contrast, smartwatch-derived metrics aligned with clinical measures, reflected EDSS scores, and captured real-world mobility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42466-026-00501-8","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T13:56:05Z","timestamp":1781272565000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Rethinking EDSS-based ambulation assessment in multiple sclerosis using continuous variable monitoring"],"prefix":"10.1186","volume":"8","author":[{"given":"Noah M.","family":"Werner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Schuette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona","family":"Hagler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Voth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bal\u00e1zs","family":"Danajka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Kirschner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Heibel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjalf","family":"Ziemssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe K.","family":"Zettl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven G.","family":"Meuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3080-2277","authenticated-orcid":false,"given":"Marc","family":"Pawlitzki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Masanneck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"501_CR1","doi-asserted-by":"publisher","first-page":"100977","DOI":"10.1016\/j.lanepe.2024.100977","volume":"44","author":"E Portaccio","year":"2024","unstructured":"Portaccio, E., Magyari, M., Havrdova, E. 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The informed consent form was reviewed by the ethics committee for approval of the study, and all trial activities were in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to study participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"NMW reports no conflicts of interests. MS received honoraria for lecturing and travel expenses for attending meetings from Biogen, Hexal, Janssen Cilag, Juvise, Merck Healthcare Germany, Neuraxpharm, Novartis, Roche, Sanofi, Teva and Viatris all outside the scope of this work. Her research is funded by the by the German Multiple Sclerosis Foundation (DMSG), Neuraxpharm and Novartis. RH, JV and BD report no conflicts of interests. PK received honoraria for lectures, consultancy and travel sssupport for attending meetings from German Society of Neurology (DGN), Hexal, Roche, Sanofi, Merck, Neuraxpharm and Viatris. MH received honoraria for lecturing and travel expenses for attending meetings from Bayer Health Care, Biogen, Hexal, Merck Serono, Neuraxpharm, Novartis, Roche, Sanofi-Aventis, Teva, all outside the scope of this work. TZ reports membership of the scientific advisory board and\/or consulting for Biogen, Roche, Novartis, BMS, Sanofi, and Merck; compensation for serving on speakers\u2019 bureaus for Roche, Neuraxpharm, Novartis, Merck, Novo Nordisk, Sanofi, BMS, Viatris, Sandoz, TEVA, and Biogen; and research support from Novartis, TEVA, Neuraxparm, Roche and Sanofi. UKZ has received speaking fees, travel support and\/or financial support for research activities from Alexion, Almirall, Bayer, Biogen, Bristol Myers Squibb, Janssen, Merck Serono, Novartis, Octapharm, Roche, Sanofi Genzyme, Teva as well as EU, BMBF, BMWi and DFG. None resulted in a conflict of interest. SGM reports Honoraria\/travel support from Academy2, Argenx, AstraZeneca, Bayer, Biontech, Celgene, Datamed, Desitin, Diaplan, DIU, Dpmed, Gen Medicine & Healthcare, IGES, Impulze GmbH, KW Medipoint, MedDay, Medmile, MICE, Mylan, Neuraxpharm, Neurapharm, Oxford PharmaGenesis, QuintilesIMS, Sanofi, Springer, STADA, Chugai, UCB, Viatris, Wings for Life int, and Xcenda. Research support from BMBF, BfR, DFG, EKFS, G-BA, Hertie Fdn, IZKF, DGN, Ministry of Culture & Science NRW, Daimler & Benz Fdn, dmsg, Peek & Cloppenburg Fdn, Hempel Fdn, German Alzheimer Society, Bayer, BMS, Demecan, Diamed, Genzyme, Hexal, Janssen, MerckSerono, Novartis, NovoNordisk, ONO Pharma, Roche, and Teva. MP received honoraria for lecturing and travel expenses for attending meetings from Alexion, ArgenX, Bayer Health Care, Biogen, Hexal, Merck Serono, Novartis, Roche, Sanofi-Aventis, Takeda and Teva. His research is funded by ArgenX, Biogen, Demecan, Hexal, Horizon Merck Serono, Novartis, Roche, Viatris, Takeda and Teva, all outside the scope of this work. His research is funded by the by the German Multiple Sclerosis Foundation (DMSG), the B. Braun Foundation and the German Alzheimer Society LM reports no conflicts of interest related to this study. He reports honoraria for lecturing, consulting and travel expenses for attending meetings from Biogen, Merck, argenX, Bial, Roche, Hexal, Neuraxpharm, Sanorfi, Alexion and Novartis, all outside the scope of this work. His research is funded by the by the German Multiple Sclerosis Foundation (DMSG), the B.Braun Foundation and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) \u2013 493659010.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"47"}}