Characterization of activity behavior using a digital medicine system and comparison to medication ingestion in patients with serious mental illness

Activity patterns can be important indicators in patients with serious mental illness. Here, we utilized an accelerometer and electrocardiogram incorporated within a digital medicine system, which also provides objective medication ingestion records, to explore markers of patient activity and investigate whether these markers of behavioral change are related to medication adherence. We developed an activity rhythm score to measure the consistency of step count patterns across the treatment regimen and explored the intensity of activity during active intervals. We then compared these activity features to ingestion behavior, both on a daily basis, using daily features and single-day ingestion behavior, and at the patient-level, using aggregate features and overall ingestion rates. Higher values of the single-day features for both the activity rhythm and activity intensity scores were associated with higher rates of ingestion on the following day. Patients with a mean activity rhythm score greater than the patient-level median were also shown to have higher overall ingestion rates than patients with lower activity rhythm scores (p = 0.004). These initial insights demonstrate the ability of digital medicine to enable the development of digital behavioral markers that can be compared to previously unavailable objective ingestion information to improve medication adherence.