Bipolar disorder (BD) is a mood disorder with different phases alternating between euthymia, manic or hypomanic episodes, and depressive episodes. While motor abnormalities are commonly seen during depressive or manic episodes, not much attention has been paid to postural abnormalities during periods of euthymia and their association with illness burden. We collected 24-hour posture data in 32 euthymic participants diagnosed with BD using a shirt-based wearable. We extracted a set of nine time-domain features, and performed unsupervised participant clustering. We investigated the association between posture variables and 12 clinical characteristics of illness burden. Based on their postural dynamics during the daytime, evening, or nighttime, participants clustered in three clusters. Higher illness burden was associated with lower postural variability, in particular during daytime. Participants who exhibited a mostly upright sitting/standing posture during the night with frequent nighttime postural transitions had the highest number of lifetime depressive episodes. Euthymic participants with BD exhibit postural abnormalities that are associated with illness burden, especially with the number of depressive episodes. Our results contribute to understanding the role of illness burden on posture changes and sleep consolidation in periods of euthymia.

Machine learning applications are often plagued with confounders that can impact the generalizability of the learners. In clinical settings, demographic characteristics often play the role of confounders. Confounding is especially problematic in remote digital health studies where the participants self-select to enter the study, thereby making it difficult to balance the demographic characteristics of participants. One effective approach to combat confounding is to match samples with respect to the confounding variables in order to improve the balance of the data. This procedure, however, leads to smaller datasets and hence negatively impact the inferences drawn from the learners. Alternatively, confounding adjustment methods that make more efficient use of the data (such as inverse probability weighting) usually rely on modeling assumptions, and it is unclear how robust these methods are to violations of these assumptions. Here, instead of proposing a new method to control for confounding, we develop novel permutation based statistical tools to detect and quantify the influence of observed confounders, and estimate the unconfounded performance of the learner. Our tools can be used to evaluate the effectiveness of existing confounding adjustment methods. We evaluate the statistical properties of our methods in a simulation study, and illustrate their application using real-life data from a Parkinson's disease mobile health study collected in an uncontrolled environment.