Using wearables to screen motor performance deterioration because of cancer and chemotherapy-induced peripheral neuropathy (CIPN) in adults - Toward an early diagnosis of CIPN

Abstract

Objective: An essential component for optimizing quality of life in adults with cancer is determining the degree to which therapy may negatively impact motor-performance, so that patients can maintain their quality of life and independence. This study examined whether instrumented gait and balance could determine the magnitude of deterioration in motor-performance from chemotherapy-induced peripheral neuropathy (CIPN).

Methods: We recruited 84 adults with cancer (age = 71.1 ± 9.7 years old, BMI = 26.8 ± 6.2 kg/m2, gender = 56%female) and 57 age-matched non-cancer patients (age = 69.5 ± 9.8 years old, BMI = 27.1 ± 6.0 kg/m2, gender = 79%female). Based on clinical screening, the group with cancer was classified into two groups: participants with CIPN (CIPN+) and without CIPN (CIPN-). Gait and balance were quantified using validated wearables. The Vibration Perception Threshold (VPT) test was used to stratify the CIPN+ group into mild (Mild-CIPN) and severe (Severe-CIPN) subgroups.

Results: All gait and balance parameters were deteriorated in the group with cancer compared to non-cancer group with the largest effects observed for stride-time (11%, Cohen's effect size d = 1.00, p < 0.001) and eyes-closed ankle sway (94%, d = 0.49, p = 0.001). The same trend was observed when the Severe-CIPN subgroup was compared to the Mild-CIPN. VPT correlates significantly with motor deterioration, with the largest correlation found in stride-time (Rho = 0.37, p = 0.007). Severe-CIPN subjects were significantly older and overall had more deterioration in the majority of motor-performance parameters after adjusting for age (p < 0.050).

Conclusion: These results confirmed the negative impact of CIPN on motor-performance with the largest effects on ankle stability and stride-time. VPT is a predictor of motor deterioration and may be used to determine the severity of CIPN symptom.

Keywords: Adults with cancer; Balance; Chemotherapy-Induced Peripheral Neuropathy; Falls; Gait; Motor performance; Neuropathy; Plantar numbness; Wearables.

Conflict of interest statement

Conflict of Interest:

None

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1.

(a) Stride velocity in non-cancer control (green color), patients with cancer and without chemotherapy induced peripheral neuropathy (CIPN) diagnosis, CIPN- (yellow color), and patients with cancer and with CIPN diagnosis, CIPN+ (red color) group. CIPN+ had 18% and 8% slower gait compared to controls and CIPN-, respectively. (b) Ankle sway during eyes closed for non-cancer control (green color), CIPN- (yellow), and CIPN+ (red color). ‘*’ denotes statistical significant difference.

Figure 2.

Association between plantar numbness (surrogate of chemotherapy induced peripheral neuropathy (CIPN) severity) and stride time (Fig. 2a), center of mass sway during eyes-open (Fig. 2b) and eyes-closed (Fig 2.c) conditions; and concerns for falls (Fig 2d). Results suggest by increase in plantar numbness as quantified by vibratory perception threshold test (higher value means higher numbness), gait and balance are deteriorated and fear of fall is increasing.