Personalized prediction of rehabilitation outcomes in multiple sclerosis: a proof-of-concept using clinical data, digital health metrics, and machine learning

Background A personalized prediction of upper limb neurorehabilitation outcomes in persons with multiple sclerosis (pwMS) promises to optimize the allocation of therapy and to stratify individuals for resource-demanding clinical trials. Previous research identified predictors on a population level through linear models and clinical data, including conventional assessments describing sensorimotor impairments. The objective of this work was to explore the feasibility of providing an individualized and more accurate prediction of rehabilitation outcomes in pwMS by leveraging non-linear machine learning models, clinical data, and digital health metrics characterizing sensorimotor impairments. Methods Clinical data and digital health metrics were recorded from eleven pwMS undergoing neurorehabilitation. Machine learning models were trained on data recorded pre-intervention. The dependent variables indicated whether a considerable improvement on the activity level was observed across the intervention or not (binary classification), as defined by the Action Research Arm Test (ARAT), Box and Block Test (BBT), or Nine Hole Peg Test (NHPT). Results In a cross-validation, considerable improvements in ARAT or BBT could be accurately predicted (94% balanced accuracy) by only relying on patient master data. Considerable improvements in NHPT could be accurately predicted (89% balanced accuracy), but required knowledge about sensorimotor impairments. Assessing these with digital health metrics instead of conventional scales allowed increasing the balanced accuracy by +17% . Non-linear machine-learning models improved the predictive accuracy for the NHPT by +25% compared to linear models. Conclusions This work demonstrates the feasibility of a personalized prediction of upper limb neurorehabilitation outcomes in pwMS using multi-modal data collected before neurorehabilitation and machine learning. Information from digital health metrics about sensorimotor impairment was necessary to predict changes in dexterous hand control, thereby underlining their potential to provide a more sensitive and fine-grained assessment than conventional scales. Non-linear models outperformed ones, suggesting that the commonly assumed linearity of neurorehabilitation is oversimplified. clinicaltrials.gov registration number: NCT02688231