Digital, Remote, and Ecological Assessment of Fatigue/Fatigability, Mobility, and Functional Activity in Multiple Sclerosis: A Scoping Review

Background/Objectives: Digital, remote, and ecological tools may complement clinic-based assessment in multiple sclerosis (MS), but the distribution of evidence across fatigue/fatigability, mobility, and real-world functional activity remains unclear. This scoping review mapped tools, metrics, constructs, contexts of use, and reported clinical utility in adults with MS, with attention given to whether the evidence was balanced across domains. Methods: Following Joanna Briggs Institute guidance and PRISMA-ScR/PRISMA-S reporting standards, five databases were searched on 14 March 2026. After deduplication, title/abstract screening, full-text assessment, and manual extraction and verification, the findings were synthesized descriptively without formal critical appraisal. Results: Of 3100 records identified, 1433 unique records were screened and 125 sources were included. Gait was the most frequently assessed domain (105/125), followed by fatigue/fatigability (33/125), physical activity (29/125), and sleep (2/125). The most frequent technologies were wearable devices (60/125), accelerometry (54/125), remote/home-based/telemonitoring modalities (52/125), and inertial measurement units (42/125). Conclusions: The evidence is predominantly gait- and mobility-focused, while fatigue/fatigability and broader real-world functional activity are less consistently represented. Reported clinical utility was usually framed around functional assessment, longitudinal/remote monitoring, rehabilitation planning, patient stratification, and decision support, but these characteristics were extracted as reported and were not independently appraised.