BACKGROUND Clinical measures in multiple sclerosis (MS) face limitations that may be overcome by utilising smartphone keyboard interactions acquired continuously and remotely during regular typing. OBJECTIVE The aim of this study was to determine the reliability and validity of keystroke dynamics to assess clinical aspects of MS. METHODS In total, 102 MS patients and 24 controls were included in this observational study. Keyboard interactions were obtained with the Neurokeys keyboard app. Eight timing-related keystroke features were assessed for reliability with intraclass correlation coefficients (ICCs); construct validity by analysing group differences (in fatigue, gadolinium-enhancing lesions on magnetic resonance imaging (MRI), and patients vs controls); and concurrent validity by correlating with disability measures. RESULTS Reliability was moderate in two (ICC = 0.601 and 0.742) and good to excellent in the remaining six features (ICC = 0.760-0.965). Patients had significantly higher keystroke latencies than controls. Latency between key presses correlated the highest with Expanded Disability Status Scale (r = 0.407) and latency between key releases with Nine-Hole Peg Test and Symbol Digit Modalities Test (ρ = 0.503 and r = -0.553, respectively), ps < 0.001. CONCLUSION Keystroke dynamics were reliable, distinguished patients and controls, and were associated with clinical disability measures. Consequently, keystroke dynamics are a promising valid surrogate marker for clinical disability in MS.

中文翻译：

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真实世界的击键动态是多发性硬化症临床残疾的潜在有效生物标志物

背景技术 多发性硬化症 (MS) 的临床措施面临限制，这些限制可以通过利用在常规打字期间连续和远程获取的智能手机键盘交互来克服。目的 本研究的目的是确定击键动力学在评估 MS 临床方面的可靠性和有效性。方法 本次观察性研究总共包括 102 名 MS 患者和 24 名对照者。键盘交互是通过 Neurokeys 键盘应用程序获得的。使用类内相关系数 (ICC) 评估了八个与时间相关的击键特征的可靠性；通过分析组差异（疲劳、磁共振成像 (MRI) 上的钆增强病变以及患者与对照组）构建有效性；和同时效度通过与残疾措施相关联。结果 两个方面的可靠性中等（ICC = 0.601 和 0.742），其余六个特征的可靠性从好到极好（ICC = 0.760-0.965）。患者的击键延迟显着高于对照组。按键之间的延迟与扩展残疾状态量表 (r = 0.407) 和按键释放之间的延迟与九孔钉测试和符号数字模态测试之间的相关性最高（分别为 ρ = 0.503 和 r = -0.553），ps < 0.001。结论击键动力学是可靠的，区分患者和对照，并与临床残疾措施相关。因此，击键动力学是 MS 临床残疾的一个有前途的有效替代指标。患者的击键延迟显着高于对照组。按键之间的延迟与扩展残疾状态量表 (r = 0.407) 和按键释放之间的延迟与九孔钉测试和符号数字模态测试之间的相关性最高（分别为 ρ = 0.503 和 r = -0.553），ps < 0.001。结论击键动力学是可靠的，区分患者和对照，并与临床残疾措施相关。因此，击键动力学是 MS 临床残疾的一个有前途的有效替代指标。患者的击键延迟显着高于对照组。按键之间的延迟与扩展残疾状态量表 (r = 0.407) 和按键释放之间的延迟与九孔钉测试和符号数字模态测试之间的相关性最高（分别为 ρ = 0.503 和 r = -0.553），ps < 0.001。结论击键动力学是可靠的，区分患者和对照，并与临床残疾措施相关。因此，击键动力学是 MS 临床残疾的一个有前途的有效替代指标。结论击键动力学是可靠的，区分患者和对照，并与临床残疾措施相关。因此，击键动力学是 MS 临床残疾的一个有前途的有效替代指标。结论击键动力学是可靠的，区分患者和对照，并与临床残疾措施相关。因此，击键动力学是 MS 临床残疾的一个有前途的有效替代指标。