TY  - JOUR
AU  - Bianchini, Edoardo
AU  - Rinaldi, Domiziana
AU  - De Carolis, Lanfranco
AU  - Galli, Silvia
AU  - Alborghetti, Marika
AU  - Hansen, Clint
AU  - Suppa, Antonio
AU  - Salvetti, Marco
AU  - Pontieri, Francesco Ernesto
AU  - Vuillerme, Nicolas
PY  - 2025
DA  - 2025/3/18
TI  - Reliability of Average Daily Steps Measured Through a Consumer Smartwatch in Parkinson Disease Phenotypes, Stages, and Severities: Cross-Sectional Study
JO  - JMIR Form Res
SP  - e63153
VL  - 9
KW  - gait
KW  - Parkinson disease
KW  - phenotype
KW  - wearable sensors
KW  - smartwatch
KW  - step count
KW  - reliability
KW  - activity monitor
KW  - digital health technology
KW  - digital outcome measures
KW  - wearable
KW  - mHealth
KW  - motor
KW  - quality of life
KW  - fall
KW  - posture
KW  - mobile health
AB  - Background: Average daily steps (avDS) could be a valuable indicator of real-world ambulation in people with Parkinson disease (PD), and previous studies have reported the validity and reliability of this measure. Nonetheless, no study has considered disease phenotype, stage, and severity when assessing the reliability of consumer wrist-worn devices to estimate daily step count in unsupervised, free-living conditions in PD. Objective: This study aims to assess and compare the reliability of a consumer wrist-worn smartwatch (Garmin Vivosmart 4) in counting avDS in people with PD in unsupervised, free-living conditions among disease phenotypes, stages, and severity groups. Methods: A total of 104 people with PD were monitored through Garmin Vivosmart 4 for 5 consecutive days. Total daily steps were recorded and avDS were calculated. Participants were dichotomized into tremor dominant (TD; n=39) or postural instability and gait disorder (PIGD; n=65), presence (n=57) or absence (n=47) of tremor, and mild (n=65) or moderate (n=39) disease severity. Based on the modified Hoehn and Yahr scale (mHY), participants were further dichotomized into earlier (mHY 1‐2; n=68) or intermediate (mHY 2.5‐3; n=36) disease stages. Intraclass correlation coefficient (ICC; 3,k), standard error of measurement (SEM), and minimal detectable change (MDC) were used to evaluate the reliability of avDS for each subgroup. The threshold for acceptability was set at an ICC ≥0.8 with a lower bound of 95% CI ≥0.75. The 2-tailed Student t tests for independent groups and analysis of 83.4% CI overlap were used to compare ICC between each group pair. Results: Reliability of avDS measured through Garmin Vivosmart 4 for 5 consecutive days in unsupervised, free-living conditions was acceptable in the overall population with an ICC of 0.89 (95% CI 0.85‐0.92), SEM below 10%, and an MDC of 1580 steps per day (27% of criterion). In all investigated subgroups, the reliability of avDS was also acceptable (ICC range 0.84‐0.94). However, ICCs were significantly lower in participants with tremor (P=.03), with mild severity (P=.04), and earlier stage (P=.003). Moreover, SEM was below 10% in participants with PIGD phenotype, without tremor, moderate disease severity, and intermediate disease stage, with an MDC ranging from 1148 to 1687 steps per day (18%‐25% of criterion). Conversely, in participants with TD phenotype, tremor, mild disease severity, and earlier disease stage, SEM was >10% of the criterion and MDC values ranged from 1401 to 2263 steps per day (30%‐33% of the criterion). Conclusions: In mild-to-moderate PD, avDS measured through a consumer smartwatch in unsupervised, free-living conditions for 5 consecutive days are reliable irrespective of disease phenotype, stage, and severity. However, in individuals with TD phenotype, tremor, mild disease severity, and earlier disease stages, reliability could be lower. These findings could facilitate a broader and informed implementation of avDS as an index of ambulatory activity in PD. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2025/1/e63153
UR  - https://doi.org/10.2196/63153
DO  - 10.2196/63153
ID  - info:doi/10.2196/63153
ER  -