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Lu Z, Signer T, Sylvester R, Gonzenbach R, von Wyl V, Haag C. Implementation of Remote Activity Sensing to Support a Rehabilitation Aftercare Program: Observational Mixed Methods Study With Patients and Health Care Professionals. JMIR Mhealth Uhealth 2023; 11:e50729. [PMID: 38064263 PMCID: PMC10746974 DOI: 10.2196/50729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physical activity is central to maintaining the quality of life for patients with complex chronic conditions and is thus at the core of neurorehabilitation. However, maintaining activity improvements in daily life is challenging. The novel Stay With It program aims to promote physical activity after neurorehabilitation by cultivating self-monitoring skills and habits. OBJECTIVE We examined the implementation of the Stay With It program at the Valens Rehabilitation Centre in Switzerland using the normalization process theory framework, focusing on 3 research aims. We aimed to examine the challenges and facilitators of program implementation from the perspectives of patients and health care professionals. We aimed to evaluate the potential of activity sensors to support program implementation and patient acceptance. Finally, we aimed to evaluate patients' engagement in physical activity after rehabilitation, patients' self-reported achievement of home activity goals, and factors influencing physical activity. METHODS Patients were enrolled if they had a disease that was either chronic or at risk for chronicity and participated in the Stay With It program. Patients were assessed at baseline, the end of rehabilitation, and a 3-month follow-up. The health care professionals designated to deliver the program were surveyed before and after program implementation. We used a mixed methods approach combining standardized questionnaires, activity-sensing data (patients only), and free-text questions. RESULTS This study included 23 patients and 13 health care professionals. The diverse needs of patients and organizational hurdles were major challenges to program implementation. Patients' intrinsic motivation and health care professionals' commitment to refining the program emerged as key facilitators. Both groups recognized the value of activity sensors in supporting program implementation and sustainability. Although patients appreciated the sensor's ability to monitor, motivate, and quantify activity, health care professionals saw the sensor as a motivational tool but expressed concerns about technical difficulties and potential inaccuracies. Physical activity levels after patients returned home varied considerably, both within and between individuals. The self-reported achievement of activity goals at home also varied, in part because of vague definitions. Common barriers to maintaining activity at home were declining health and fatigue often resulting from heat and pain. At the 3-month follow-up, 35% (8/23) of the patients withdrew from the study, with most citing deteriorating physical health as the reason and that monitoring and discussing their low activity would negatively affect their mental health. CONCLUSIONS Integrating aftercare programs like Stay With It into routine care is vital for maintaining physical activity postrehabilitation. Although activity trackers show promise in promoting motivation through monitoring, they may lead to frustration during health declines. Their acceptability may also be influenced by an individual's health status, habits, and technical skills. Our study highlights the importance of considering health care professionals' perspectives when integrating new interventions into routine care.
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Affiliation(s)
- Ziyuan Lu
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Tabea Signer
- Valens Rehabilitation Centre, Valens, Switzerland
| | | | | | - Viktor von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Bland MD, Holleran CL, Newman CA, Fahey M, Nordahl TJ, DeAngelis TR, Ellis TD, Reisman DS, Earhart GM, Lang CE. ICF classification of therapeutic goals for outpatient episodes of neurorehabilitation in post-stroke and Parkinson disease. Disabil Rehabil 2023:1-7. [PMID: 38059563 PMCID: PMC11156790 DOI: 10.1080/09638288.2023.2290201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF). MATERIALS AND METHODS Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life. RESULTS 776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life. CONCLUSIONS While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this.
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Affiliation(s)
- Marghuretta D Bland
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Carey L Holleran
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | - Teresa D Ellis
- Department of Physical Therapy, Boston University, Boston, MA
| | - Darcy S Reisman
- Department of Physical Therapy, University of DE, Newark, Delaware
| | - Gammon M Earhart
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, WA University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Bianchini E, Galli S, Alborghetti M, De Carolis L, Zampogna A, Hansen C, Vuillerme N, Suppa A, Pontieri FE. Four Days Are Enough to Provide a Reliable Daily Step Count in Mild to Moderate Parkinson's Disease through a Commercial Smartwatch. SENSORS (BASEL, SWITZERLAND) 2023; 23:8971. [PMID: 37960670 PMCID: PMC10649244 DOI: 10.3390/s23218971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
Daily steps could be a valuable indicator of real-world ambulation in Parkinson's disease (PD). Nonetheless, no study to date has investigated the minimum number of days required to reliably estimate the average daily steps through commercial smartwatches in people with PD. Fifty-six patients were monitored through a commercial smartwatch for 5 consecutive days. The total daily steps for each day was recorded and the average daily steps was calculated as well as the working and weekend days average steps. The intraclass correlation coefficient (ICC) (3,k), standard error of measurement (SEM), Bland-Altman statistics, and minimum detectable change (MDC) were used to evaluate the reliability of the step count for every combination of 2-5 days. The threshold for acceptability was set at an ICC ≥ 0.8 with a lower bound of CI 95% ≥ 0.75 and a SAM < 10%. ANOVA and Mann-Whitney tests were used to compare steps across the days and between the working and weekend days, respectively. Four days were needed to achieve an acceptable reliability (ICC range: 0.84-0.90; SAM range: 7.8-9.4%). In addition, daily steps did not significantly differ across the days and between the working and weekend days. These findings could support the use of step count as a walking activity index and could be relevant to developing monitoring, preventive, and rehabilitation strategies for people with PD.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
| | - Silvia Galli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Lanfranco De Carolis
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
- IRCCS Neuromed Institute, 86077 Pozzilli, Italy
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
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Brandenbarg P, Hoekstra F, Barakou I, Seves BL, Hettinga FJ, Hoekstra T, van der Woude LHV, Dekker R, Krops LA. Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:115. [PMID: 37735403 PMCID: PMC10512652 DOI: 10.1186/s13102-023-00717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.
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Affiliation(s)
- Pim Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Femke Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ioulia Barakou
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Bregje L Seves
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Florentina J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, NE1 8ST, UK
| | - Trynke Hoekstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 BT, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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Holleran CL, Bland MD, Lang CE. Comprehensive Assessment of the Activity Level of the ICF Using Both Capacity and Performance Measures: A Case Report. Arch Rehabil Res Clin Transl 2023; 5:100277. [PMID: 37744190 PMCID: PMC10517369 DOI: 10.1016/j.arrct.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Individuals with neurologic conditions seek physical therapy services to improve mobility in their daily lives. While clinicians commonly track activity capacity, measurement of activity performance in daily life is an emerging yet unstandardized practice within routine clinical physical therapy. The purpose of this case report is to (1) provide an example of the structure, clinical reasoning, and implementation of both activity capacity and activity performance level assessments across an episode of outpatient physical therapy and (2) to describe how objective activity performance in daily life tracking supported the physical therapy intervention and education plan. A 42-year-old woman presented to outpatient neurologic physical therapy with a rare autoimmune-mediated disorder with primary goals of independently caring for her youngest child and grandchild, walking without limitations in the home and community, participating in exercise, and returning to work due to deconditioning and dizziness. The patient participated in 12 visits across a span of 4.5 months targeting performance in daily life (steps per day), aerobic conditioning, and vestibular habituation. Activity capacity measurement served as a standardized assessment of what the patient was able to do in the clinic, and activity performance in daily life tracking via a Samsung wrist worn consumer-grade device provided a quantitative assessment of real-world daily stepping activity. Tracking of activity performance in daily life was an essential component of physical therapy management that provided an objective quantification of daily stepping activity to identify barriers and facilitators to increasing daily performance in an individual with a medical diagnosis of Susac syndrome.
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Affiliation(s)
- Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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Ginis P, Goris M, De Groef A, Blondeel A, Gilat M, Demeyer H, Troosters T, Nieuwboer A. Validation of Commercial Activity Trackers in Everyday Life of People with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4156. [PMID: 37112496 PMCID: PMC10144957 DOI: 10.3390/s23084156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
Maintaining physical activity is an important clinical goal for people with Parkinson's disease (PwPD). We investigated the validity of two commercial activity trackers (ATs) to measure daily step counts. We compared a wrist- and a hip-worn commercial AT against the research-grade Dynaport Movemonitor (DAM) during 14 days of daily use. Criterion validity was assessed in 28 PwPD and 30 healthy controls (HCs) by a 2 × 3 ANOVA and intraclass correlation coefficients (ICC2,1). The ability to measure daily step fluctuations compared to the DAM was studied by a 2 × 3 ANOVA and Kendall correlations. We also explored compliance and user-friendliness. Both the ATs and the DAM measured significantly fewer steps/day in PwPD compared to HCs (p < 0.01). Step counts derived from the ATs showed good to excellent agreement with the DAM in both groups (ICC2,1 > 0.83). Daily fluctuations were detected adequately by the ATs, showing moderate associations with DAM-rankings. While compliance was high overall, 22% of PwPD were disinclined to use the ATs after the study. Overall, we conclude that the ATs had sufficient agreement with the DAM for the purpose of promoting physical activity in mildly affected PwPD. However, further validation is needed before clinical use can be widely recommended.
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Affiliation(s)
- Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - Maaike Goris
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - An De Groef
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Astrid Blondeel
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Pulmonary Rehabilitation, Respiratory Department, University Hospitals Gasthuisberg, 3000 Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders (GRID), 3000 Leuven, Belgium
- Pulmonary Rehabilitation, Respiratory Department, University Hospitals Gasthuisberg, 3000 Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), 3000 Leuven, Belgium
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Bianchini E, Caliò B, Alborghetti M, Rinaldi D, Hansen C, Vuillerme N, Maetzler W, Pontieri FE. Step-Counting Accuracy of a Commercial Smartwatch in Mild-to-Moderate PD Patients and Effect of Spatiotemporal Gait Parameters, Laterality of Symptoms, Pharmacological State, and Clinical Variables. SENSORS (BASEL, SWITZERLAND) 2022; 23:214. [PMID: 36616812 PMCID: PMC9823757 DOI: 10.3390/s23010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Commercial smartwatches could be useful for step counting and monitoring ambulatory activity. However, in Parkinson's disease (PD) patients, an altered gait, pharmacological condition, and symptoms lateralization may affect their accuracy and potential usefulness in research and clinical routine. Steps were counted during a 6 min walk in 47 patients with PD and 47 healthy subjects (HS) wearing a Garmin Vivosmart 4 (GV4) on each wrist. Manual step counting was used as a reference. An inertial sensor (BTS G-Walk), placed on the lower back, was used to compute spatial-temporal gait parameters. Intraclass correlation coefficient (ICC) and mean absolute percentage error (MAPE) were used for accuracy evaluation and the Spearman test was used to assess the correlations between variables. The GV4 overestimated steps in PD patients with only a poor-to-moderate agreement. The OFF pharmacological state and wearing the device on the most-affected body side led to an unacceptable accuracy. The GV4 showed an excellent agreement and MAPE in HS at a self-selected speed, but an unacceptable performance at a slow speed. In PD patients, MAPE was not associated with gait parameters and clinical variables. The accuracy of commercial smartwatches for monitoring step counting might be reduced in PD patients and further influenced by the pharmacological condition and placement of the device.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Bianca Caliò
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Santa Lucia Foundation, IRCCS, 00179 Rome, Italy
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24105 Kiel, Germany
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Santa Lucia Foundation, IRCCS, 00179 Rome, Italy
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Harro CC, Shoemaker MJ, Coatney CM, Lentine VE, Lieffers LR, Quigley JJ, Rollins SG, Stewart JD, Hall J, Khoo SK. Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1010097. [PMID: 36311206 PMCID: PMC9614339 DOI: 10.3389/fresc.2022.1010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
Objective The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD. Methods Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied. Results Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration. Conclusions This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial. Impact Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities. Clinical Trials Registry ID 20-101-H.
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Affiliation(s)
- Cathy C. Harro
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States,Correspondence: Cathy Harro
| | - Michael J Shoemaker
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Cassandra M. Coatney
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Valerie E. Lentine
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Lillian R. Lieffers
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jessica J. Quigley
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Shannon G. Rollins
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jonathan D. Stewart
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Julie Hall
- Department of Medical Laboratory Science, Grand Valley State University, Grand Rapids, MI, United States
| | - Sok Kean Khoo
- Department of Cell and Molecular Biology, Grand Valley State University, Grand Rapids, MI, United States
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9
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Holubová A, Malá E, Hoidekrová K, Pětioký J, Ďuriš A, Mužík J. The Accuracy of Commercially Available Fitness Trackers in Patients after Stroke. SENSORS (BASEL, SWITZERLAND) 2022; 22:7392. [PMID: 36236491 PMCID: PMC9573007 DOI: 10.3390/s22197392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Background: Fitness trackers could represent an easy-to-use and cheap tool for continuous tracking of physical activity of stroke survivors during the period of their recovery at home. The aim of the study was to examine the accuracy of the Fitbit activity tracker in locomotor activity monitoring of stroke survivors with respect to gait disorders, walking speed, walking aid, and placement of the tracker on body. Methods: Twenty-four ambulatory stroke survivors (15 men and 9 women) with locomotion/gait disorder were involved in the study. Patients underwent two walking tests with the Fitbit Alta HR trackers attached on 5 different places on body. The accuracy of the trackers has been analyzed on 3 groups of patients-those walking without any walking aid, those using a single-point stick and those using a rolling walker. Results: For no-aid patients, the most accurate place was the waist. Patients with a single-point stick revealed the smallest deviations for a tracker attached to a healthy lower limb, and patients with a rolling walker revealed the smallest deviations for a tracker attached on the paretic lower limb. Conclusions: An accuracy comparable with the healthy population can be reached for all of the three groups of patients, while fulfilling the conditions for minimum speed of 2 km/h and optimal placement of the trackers with respect to a walking aid and aspect to impairment.
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Affiliation(s)
- Anna Holubová
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Eliška Malá
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Kristýna Hoidekrová
- First Faculty of Medicine, Charles University and General University Hospital, 128 00 Prague, Czech Republic
- Rehabilitation Centre Kladruby, 257 62 Kladruby, Czech Republic
| | - Jakub Pětioký
- Rehabilitation Centre Kladruby, 257 62 Kladruby, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, 100 00 Prague, Czech Republic
| | - Andrea Ďuriš
- Rehabilitation Centre Kladruby, 257 62 Kladruby, Czech Republic
| | - Jan Mužík
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
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10
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Quinn L, Playle R, Drew CJG, Taiyari K, Williams-Thomas R, Muratori LM, Hamana K, Griffin BA, Kelson M, Schubert R, Friel C, Morgan-Jones P, Rosser A, Busse M. Physical activity and exercise outcomes in Huntington's disease (PACE-HD): results of a 12-month trial-within-cohort feasibility study of a physical activity intervention in people with Huntington's disease. Parkinsonism Relat Disord 2022; 101:75-89. [PMID: 35809488 DOI: 10.1016/j.parkreldis.2022.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/02/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION While physical activity (PA) is recognized as important in Huntington's disease (HD) disease management, there has been no long-term evaluation undertaken. We aimed to evaluate the feasibility of a nested (within cohort) randomized controlled trial (RCT) of a physical therapist-led PA intervention. METHODS Participants were recruited from six HD specialist centers participating in the Enroll-HD cohort study in Germany, Spain and U.S. Assessments were completed at baseline and 12 months and linked to Enroll-HD cohort data. Participants at three sites (cohort) received no contact between baseline and 12 month assessments. Participants at three additional sites (RCT) were randomized to PA intervention or control group. The intervention consisted of 18 sessions delivered over 12 months; control group participants received no intervention, however both groups completed monthly exercise/falls diaries and 6-month assessments. RESULTS 274 participants were screened, 204 met inclusion criteria and 116 were enrolled (59 in cohort; 57 in RCT). Retention rates at 12-months were 84.7% (cohort) and 79.0% (RCT). Data completeness at baseline ranged from 42.3 to 100% and at 12-months 19.2-85.2%. In the RCT, there was 80.5% adherence, high intervention fidelity, and similar adverse events between groups. There were differences in fitness, walking endurance and self-reported PA at 12 months favoring the intervention group, with data completeness >60%. Participants in the cohort had motor and functional decline at rates comparable to previous studies. CONCLUSION Predefined progression criteria indicating feasibility were met. PACE-HD lays the groundwork for a future, fully-powered within cohort trial, but approaches to ensure data completeness must be considered. CLINICALTRIALS GOV: NCT03344601.
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Affiliation(s)
- Lori Quinn
- Dept of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, USA; Centre for Trials Research, Cardiff University, UK
| | | | | | | | | | - Lisa M Muratori
- George-Huntington-Institute and Institute for Clinical Radiology, University of Münster, Münster, Germany; Stony Brook University, Stony Brook, NY, USA
| | - Katy Hamana
- School of Healthcare Sciences, Cardiff University, UK
| | | | - Mark Kelson
- Department of Mathematics, Exeter University, Exeter, UK
| | - Robin Schubert
- George-Huntington-Institute and Institute for Clinical Radiology, University of Münster, Münster, Germany
| | - Ciaran Friel
- Feinstein Institutes for Medical Research, Northwell Health, NY, NY, UK
| | - Philippa Morgan-Jones
- Centre for Trials Research, Cardiff University, UK; School of Engineering, Cardiff University, Cardiff, UK
| | - Anne Rosser
- Schools of Medicine and Biosciences, Cardiff University, Cardiff, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, UK.
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11
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Shokouhi N, Khodakarami H, Fernando C, Osborn S, Horne M. Accuracy of Step Count Estimations in Parkinson’s Disease Can Be Predicted Using Ambulatory Monitoring. Front Aging Neurosci 2022; 14:904895. [PMID: 35783129 PMCID: PMC9244695 DOI: 10.3389/fnagi.2022.904895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives There are concerns regarding the accuracy of step count in Parkinson’s disease (PD) when wearable sensors are used. In this study, it was predicted that providing the normal rhythmicity of walking was maintained, the autocorrelation function used to measure step count would provide relatively low errors in step count. Materials and Methods A total of 21 normal walkers (10 without PD) and 27 abnormal walkers were videoed while wearing a sensor [Parkinson’s KinetiGraph (PKG)]. Median step count error rates were observed to be <3% in normal walkers but ≥3% in abnormal walkers. The simultaneous accelerometry data and data from a 6-day PKG were examined and revealed that the 5th percentile of the spectral entropy distribution, among 10-s walking epochs (obtained separately), predicted whether subjects had low error rate on step count with reference to the manual step count from the video recording. Subjects with low error rates had lower Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS III) scores and UPDRS III Q10–14 scores than the high error rate counterparts who also had high freezing of gait scores (i.e., freezing of gait questionnaire). Results Periods when walking occurred were identified in a 6-day PKG from 190 non-PD subjects aged over 60, and 155 people with PD were examined and the 5th percentile of the spectral entropy distribution, among 10-s walking epochs, was extracted. A total of 84% of controls and 72% of people with PD had low predicted error rates. People with PD with low bradykinesia scores (measured by the PKG) had step counts similar to controls, whereas those with high bradykinesia scores had step counts similar to those with high error rates. On subsequent PKGs, step counts increased when bradykinesia was reduced by treatment and decreased when bradykinesia increased. Among both control and people with PD, low error rates were associated with those who spent considerable time making walks of more than 1-min duration. Conclusion Using a measure of the loss of rhythmicity in walking appears to be a useful method for detecting the likelihood of error in step count. Bradykinesia in subjects with low predicted error in their step count is related to overall step count but when the predicted error is high, the step count should be assessed with caution.
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Affiliation(s)
| | | | - Chathurini Fernando
- Parkinson’s Laboratory, Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
- Department of Clinical Neurosciences, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Sarah Osborn
- Parkinson’s Laboratory, Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
- Department of Clinical Neurosciences, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Malcolm Horne
- Parkinson’s Laboratory, Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
- Department of Clinical Neurosciences, St Vincent’s Hospital, Fitzroy, VIC, Australia
- *Correspondence: Malcolm Horne,
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12
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Correno MB, Hansen C, Carlin T, Vuillerme N. Objective Measurement of Walking Activity Using Wearable Technologies in People with Parkinson Disease: A Systematic Review. SENSORS 2022; 22:s22124551. [PMID: 35746329 PMCID: PMC9229799 DOI: 10.3390/s22124551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 12/10/2022]
Abstract
Parkinson’s disease (PD) is a complex neurodegenerative disease with a multitude of disease variations including motor and non-motor symptoms. Quality of life and symptom management may be improved with physical activity. Due to technological advancement, development of small new wearable devices recently emerged and allowed objective measurement of walking activity in daily life. This review was specifically designed to synthesize literature on objective walking activity measurements using wearable devices of patients with PD. Inclusion criteria included patients with a diagnosis of PD and exclusion criteria included studies using animal models or mixed syndromes. Participants were not required to undergo any type of intervention and the studies must have reported at least one output that quantifies daily walking activity. Three databases were systematically searched with no limitation on publication date. Twenty-six studies were eligible and included in the systematic review. The most frequently used device was the ActiGraph GT3X which was used in 10 studies. Duration of monitoring presented a range from 8 h to one year. Nevertheless, 11 studies measured walking activity during a 7-day period. On-body sensor wearing location differed throughout the included studies showing eight positions, with the waist, ankle, and wrist being the most frequently used locations. The main procedures consisted of measurement of walking hours during a 2-day period or more, equipped with a triaxial accelerometer at the dominant hip or ankle. It is also important for further research to take care of different factors such as the population, their pathology, the period, and the environment.
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Affiliation(s)
- Mathias Baptiste Correno
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany
- Correspondence:
| | - Thomas Carlin
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
| | - Nicolas Vuillerme
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75231 Paris, France
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13
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Kenny L, Moore K, O' Riordan C, Fox S, Barton J, Tedesco S, Sica M, Crowe C, Alamäki A, Condell J, Nordström A, Timmons S. The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration. JMIR Form Res 2022; 6:e27418. [PMID: 34989693 PMCID: PMC8778562 DOI: 10.2196/27418] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/23/2021] [Accepted: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. OBJECTIVE This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. METHODS This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. RESULTS Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. CONCLUSIONS Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease-related health barriers and the users' confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management.
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Affiliation(s)
- Lorna Kenny
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Kevin Moore
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Clíona O' Riordan
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - John Barton
- Tyndall National Institute, University College Cork, Cork, Ireland
| | | | - Marco Sica
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Colum Crowe
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Antti Alamäki
- Research, Development and Innovation Activities & Physiotherapy Education, Karelia University of Applied Sciences, Joensuu, Finland
| | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, Faculty of Computing, Engineering and the Built Environment, Ulster University, Magee, United Kingdom
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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14
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Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice. J Neurol Phys Ther 2021; 46:103-117. [PMID: 34507339 DOI: 10.1097/npt.0000000000000376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. SUMMARY OF KEY POINTS Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. RECOMMENDATIONS FOR CLINICAL PRACTICE Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).
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15
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Manta C, Mahadevan N, Bakker J, Ozen Irmak S, Izmailova E, Park S, Poon JL, Shevade S, Valentine S, Vandendriessche B, Webster C, Goldsack JC. EVIDENCE Publication Checklist for Studies Evaluating Connected Sensor Technologies: Explanation and Elaboration. Digit Biomark 2021; 5:127-147. [PMID: 34179682 DOI: 10.1159/000515835] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/10/2021] [Indexed: 12/21/2022] Open
Abstract
The EVIDENCE (EValuatIng connecteD sENsor teChnologiEs) checklist was developed by a multidisciplinary group of content experts convened by the Digital Medicine Society, representing the clinical sciences, data management, technology development, and biostatistics. The aim of EVIDENCE is to promote high quality reporting in studies where the primary objective is an evaluation of a digital measurement product or its constituent parts. Here we use the terms digital measurement product and connected sensor technology interchangeably to refer to tools that process data captured by mobile sensors using algorithms to generate measures of behavioral and/or physiological function. EVIDENCE is applicable to 5 types of evaluations: (1) proof of concept; (2) verification, (3) analytical validation, and (4) clinical validation as defined by the V3 framework; and (5) utility and usability assessments. Using EVIDENCE, those preparing, reading, or reviewing studies evaluating digital measurement products will be better equipped to distinguish necessary reporting requirements to drive high-quality research. With broad adoption, the EVIDENCE checklist will serve as a much-needed guide to raise the bar for quality reporting in published literature evaluating digital measurements products.
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Affiliation(s)
- Christine Manta
- Digital Medicine Society, Boston, Massachusetts, USA.,Elektra Labs, Boston, Massachusetts, USA
| | - Nikhil Mahadevan
- Digital Medicine Society, Boston, Massachusetts, USA.,Pfizer Inc., Cambridge, Massachusetts, USA
| | - Jessie Bakker
- Digital Medicine Society, Boston, Massachusetts, USA.,Philips, Monroeville, Pennsylvania, USA
| | | | - Elena Izmailova
- Digital Medicine Society, Boston, Massachusetts, USA.,Koneksa Health Inc., New York, New York, USA
| | - Siyeon Park
- Geisinger Health System, Danville, Pennsylvania, USA
| | | | | | | | - Benjamin Vandendriessche
- Byteflies, Antwerp, Belgium.,Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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16
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Jeng B, Cederberg KLJ, Lai B, Sasaki JE, Bamman MM, Motl RW. Accelerometer output and its association with energy expenditure in persons with mild-to-moderate Parkinson's disease. PLoS One 2020; 15:e0242136. [PMID: 33175904 PMCID: PMC7657517 DOI: 10.1371/journal.pone.0242136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/28/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study examined the association between ActiGraph accelerometer output and energy expenditure across different speeds of walking in persons with Parkinson's disease (PD), and further generated cut-points that represent a metric for quantifying time spent in moderate-to-vigorous physical activity (MVPA) among persons with PD. METHODS The sample included 30 persons with mild-to-moderate PD (Hoehn and Yahr stages 2-3) and 30 adults without PD matched by sex and age. All participants completed 5 minutes of quiet, seated rest and then underwent three, 6-minute bouts of walking on a treadmill at three different speeds relative to the individual's self-selected pace. Activity counts were measured using an ActiGraph accelerometer worn at the waist level on the least affected side for persons with PD and the dominant side for controls. The rate of oxygen consumption, or energy expenditure, was measured using a portable, open-circuit spirometry system. RESULTS Our results indicated a strong association between activity counts and energy expenditure for persons with PD (R2 = 0.87) and controls (R2 = 0.89). However, the significant difference in slopes resulted in a lower cut-point of 1,354 counts·min-1 for persons with PD than the cut-point of 2,010 counts·min-1 for controls. CONCLUSION Our results support the application of the disease-specific cut-point for quantifying the amount of time spent in MVPA using ActiGraph accelerometers among persons with mild-to-moderate PD. Such an application may provide accurate estimates of MVPA in this population, and better inform future research examining the possible determinants and consequences of physical activity as well as testing of interventions for changing MVPA in PD.
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Affiliation(s)
- Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Katie L. J. Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Byron Lai
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jeffer E. Sasaki
- Graduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Marcas M. Bamman
- University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, United States of America
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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17
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Lang CE, Barth J, Holleran CL, Konrad JD, Bland MD. Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field. SENSORS 2020; 20:s20205744. [PMID: 33050368 PMCID: PMC7601835 DOI: 10.3390/s20205744] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
- Correspondence:
| | - Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jeff D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
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18
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Fuller D, Colwell E, Low J, Orychock K, Tobin MA, Simango B, Buote R, Van Heerden D, Luan H, Cullen K, Slade L, Taylor NGA. Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e18694. [PMID: 32897239 PMCID: PMC7509623 DOI: 10.2196/18694] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022] Open
Abstract
Background Consumer-wearable activity trackers are small electronic devices that record fitness and health-related measures. Objective The purpose of this systematic review was to examine the validity and reliability of commercial wearables in measuring step count, heart rate, and energy expenditure. Methods We identified devices to be included in the review. Database searches were conducted in PubMed, Embase, and SPORTDiscus, and only articles published in the English language up to May 2019 were considered. Studies were excluded if they did not identify the device used and if they did not examine the validity or reliability of the device. Studies involving the general population and all special populations were included. We operationalized validity as criterion validity (as compared with other measures) and construct validity (degree to which the device is measuring what it claims). Reliability measures focused on intradevice and interdevice reliability. Results We included 158 publications examining nine different commercial wearable device brands. Fitbit was by far the most studied brand. In laboratory-based settings, Fitbit, Apple Watch, and Samsung appeared to measure steps accurately. Heart rate measurement was more variable, with Apple Watch and Garmin being the most accurate and Fitbit tending toward underestimation. For energy expenditure, no brand was accurate. We also examined validity between devices within a specific brand. Conclusions Commercial wearable devices are accurate for measuring steps and heart rate in laboratory-based settings, but this varies by the manufacturer and device type. Devices are constantly being upgraded and redesigned to new models, suggesting the need for more current reviews and research.
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Affiliation(s)
- Daniel Fuller
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada.,Department of Computer Science, Memorial University, St. John's, NL, Canada.,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Emily Colwell
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Jonathan Low
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Kassia Orychock
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | | | - Bo Simango
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Richard Buote
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | | | - Hui Luan
- Department of Geography, University of Oregon, Eugene, OR, United States
| | - Kimberley Cullen
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada.,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Logan Slade
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Nathan G A Taylor
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
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19
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Lai B, Sasaki JE, Jeng B, Cederberg KL, Bamman MM, Motl RW. Accuracy and Precision of Three Consumer-Grade Motion Sensors During Overground and Treadmill Walking in People With Parkinson Disease: Cross-Sectional Comparative Study. JMIR Rehabil Assist Technol 2020; 7:e14059. [PMID: 31944182 PMCID: PMC6996761 DOI: 10.2196/14059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/07/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Wearable motion sensors are gaining popularity for monitoring free-living physical activity among people with Parkinson disease (PD), but more evidence supporting the accuracy and precision of motion sensors for capturing step counts is required in people with PD. OBJECTIVE This study aimed to examine the accuracy and precision of 3 common consumer-grade motion sensors for measuring actual steps taken during prolonged periods of overground and treadmill walking in people with PD. METHODS A total of 31 ambulatory participants with PD underwent 6-min bouts of overground and treadmill walking at a comfortable speed. Participants wore 3 devices (Garmin Vivosmart 3, Fitbit One, and Fitbit Charge 2 HR), and a single researcher manually counted the actual steps taken. Accuracy and precision were based on absolute and relative metrics, including intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS Participants walked 628 steps over ground based on manual counting, and Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR devices had absolute (relative) error values of 6 (6/628, 1.0%), 8 (8/628, 1.3%), and 30 (30/628, 4.8%) steps, respectively. ICC values demonstrated excellent agreement between manually counted steps and steps counted by both Garmin Vivosmart (0.97) and Fitbit One (0.98) but poor agreement for Fitbit Charge 2 HR (0.47). The absolute (relative) precision values for Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR were 11.1 (11.1/625, 1.8%), 14.7 (14.7/620, 2.4%), and 74.4 (74.4/598, 12.4%) steps, respectively. ICC confidence intervals demonstrated low variability for Garmin Vivosmart (0.96 to 0.99) and Fitbit One (0.93 to 0.99) but high variability for Fitbit Charge 2 HR (-0.57 to 0.74). The Fitbit One device maintained high accuracy and precision values for treadmill walking, but both Garmin Vivosmart and Fitbit Charge 2 HR (the wrist-worn devices) had worse accuracy and precision for treadmill walking. CONCLUSIONS The waist-worn sensor (Fitbit One) was accurate and precise in measuring steps with overground and treadmill walking. The wrist-worn sensors were accurate and precise only during overground walking. Similar research should inform the application of these devices in clinical research and practice involving patients with PD.
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Affiliation(s)
- Byron Lai
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jeffer E Sasaki
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
- Federal University of Triangulo Mineiro, Uberaba, Brazil
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Katie L Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Marcas M Bamman
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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20
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Kim DW, Hassett LM, Nguy V, Allen NE. A Comparison of Activity Monitor Data from Devices Worn on the Wrist and the Waist in People with Parkinson's Disease. Mov Disord Clin Pract 2019; 6:693-699. [PMID: 31745480 DOI: 10.1002/mdc3.12850] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/22/2019] [Accepted: 09/15/2019] [Indexed: 01/15/2023] Open
Abstract
Background It is unclear if it is appropriate for people with Parkinson's disease (PD) to wear activity monitors on the wrist because of the potential influence of impairments on the data. Objective The objective of this study was to determine (1) whether activity monitor data collected from devices worn at the wrist and waist are comparable and (2) the contribution of PD impairments to any differences in step and activity counts at the wrist and waist. Methods A total of 46 community-dwelling people with PD wore an accelerometer at the wrist and waist simultaneously for 1 week. Motor impairments (rigidity, bradykinesia, tremor, dyskinesia) were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale part III (motor examination) and part IV (motor complications). Results Higher values were recorded by the wrist monitor for steps/day (wrist, 9236 [standard deviation (SD) 3812]; waist, 5324 [SD 2800]; difference 3912; P < 0.001) and activity counts/day (wrist, 872,590 [SD 349,148]; waist, 186,491 [SD 101,989]; difference 686,099; P < 0.001). However, the wrist and waist values were strongly correlated (steps, r = 0.89; counts, r = 0.74; P ≤ 0.001). Increased tremor and dyskinesia explained 19% of the variation in the difference in average steps/day, and these variables plus reduced bradykinesia explained 24% of the variation in the difference in average activity counts/day. Conclusion Wrist monitors are likely to overestimate activity, particularly in people with tremor and dyskinesia. Nonetheless, activity monitors can be worn on the wrist if the aim is to monitor change rather than accurately record activity.
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Affiliation(s)
- Dong Wook Kim
- Discipline of Physiotherapy, Faculty of Health Sciences The University of Sydney Sydney Australia
| | - Leanne M Hassett
- Discipline of Physiotherapy, Faculty of Health Sciences The University of Sydney Sydney Australia.,Institute for Musculoskeletal Health, Faculty of Medicine & Health The University of Sydney Sydney Australia
| | - Vanessa Nguy
- Discipline of Physiotherapy, Faculty of Health Sciences The University of Sydney Sydney Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences The University of Sydney Sydney Australia
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21
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Silveira SL, Motl RW. Activity monitor use among persons with multiple sclerosis: Report on rate, pattern, and association with physical activity levels. Mult Scler J Exp Transl Clin 2019; 5:2055217319887986. [PMID: 31741742 PMCID: PMC6843743 DOI: 10.1177/2055217319887986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Commercially available activity monitors are a promising approach for tracking and changing physical activity in multiple sclerosis. OBJECTIVE This study reports on the rate and pattern of activity monitor use in persons with multiple sclerosis, and compares self-reported physical activity levels between persons who do wear and those who do not wear activity monitors. METHODS Participants completed a cross-sectional survey that included a demographic and clinical characteristics scale, activity monitor use questionnaire, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) for measuring total and health-promoting physical activity. RESULTS Of the 629 participants who completed the full survey, 249 (40%) reported using an activity monitor. The most common activity monitors were Fitbit, Apple watch, iPhone, and Garmin. There was a significant (p < 0.05), moderate difference (d = 0.5) in GLTEQ total scores between activity monitor users (36.6 ± 23.9) and non-users (25.0 ± 22.2), and in GLTEQ Health Contribution Score between activity monitor users (25.6 ± 22.3) and non-users (14.6 ± 18.9) (p < 0.05, d = 0.5). Self-reported steps from the activity monitor were significantly correlated with GLTEQ total score (ρ = 0.45; r = 0.36) and GLTEQ Health Contribution Score (ρ = 0.41; r = 0.35). CONCLUSION Activity monitor use is common among persons with multiple sclerosis, and activity monitor users report more total and health-promoting physical activity; this warrants further research investigating how devices may be used as a behavioral intervention tool.
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Affiliation(s)
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, USA
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22
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Hermanns M, Haas BK, Lisk J. Engaging Older Adults With Parkinson's Disease in Physical Activity Using Technology: A Feasibility Study. Gerontol Geriatr Med 2019; 5:2333721419842671. [PMID: 31069250 PMCID: PMC6492351 DOI: 10.1177/2333721419842671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD), a progressive neurodegenerative disorder, presents unique and daily challenges. Living with PD may limit one's physical activity and negatively affect quality of life (QOL). No studies were identified that utilized online technology to promote health in this population. The purposes of this study were to (a) assess the feasibility of an intervention that requires wearing a physical activity tracker and participating in an online support group, and (b) examine the effect of this intervention on the self-efficacy for physical activity and QOL of older adults with PD. A 12-week longitudinal pretest/posttest design was used to assess physical activity, engagement in an online support group, self-efficacy, and QOL. A postintervention questionnaire was used to capture the participants' (n = 5) experience using the physical activity tracker and an electronic tablet to engage in an online support group. The sample size of this feasibility study precluded robust quantitative analysis of QOL or self-efficacy. Findings from the open-ended questionnaire suggest technology was challenging for most participants, yet it did provide social support. Teaching effective interventions to promote self-management for increasing physical activity, and consequently improving QOL, is recommended. While technology can assist, older persons with PD may experience technological challenges.
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Affiliation(s)
| | | | - Jerome Lisk
- CHRISTUS Trinity Mother Frances Neuroscience Institute, Tyler, TX, USA.,University of Texas Northeast, Tyler, USA
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23
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Ellis TD, Cavanaugh JT, DeAngelis T, Hendron K, Thomas CA, Saint-Hilaire M, Pencina K, Latham NK. Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study. Phys Ther 2019; 99:203-216. [PMID: 30715489 DOI: 10.1093/ptj/pzy131] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to reduced functional capacity and quality of life. OBJECTIVE The purpose of this study was to explore the preliminary effectiveness, safety, and acceptability of a mobile health (mHealth)-mediated exercise program designed to promote sustained physical activity in people with PD. DESIGN This was a 12-month single-blind (assessor), pilot, comparative-effectiveness, randomized controlled study. METHODS An mHealth-mediated exercise program (walking with a pedometer plus engagement in planned exercise supported by a mobile health application) was compared over 1 year with an active control condition (walking with a pedometer and exercise only). There were 51 participants in a community setting with mild-to-moderately severe (Hoehn and Yahr stages 1-3) idiopathic PD. Daily steps and moderate-intensity minutes were measured using a step activity monitor for 1 week at baseline and again at 12 months. Secondary outcomes included the 6-Minute Walk Test, Parkinson Disease Questionnaire 39 mobility domain, safety, acceptability, and adherence. RESULTS Both groups increased daily steps, moderate-intensity minutes, and 6-Minute Walk Test, with no statistically significant between-group differences observed. In the less active subgroup, changes in daily steps and moderate-intensity minutes were clinically meaningful. An improvement in the Parkinson Disease Questionnaire 39 mobility score favored mHealth in the overall comparison and was statistically and clinically meaningful in the less active subgroup. LIMITATIONS The limitation of the current study was the small sample size. CONCLUSIONS Both groups improved physical activity compared with expected activity decline over 1 year. The addition of the mHealth app to the exercise intervention appeared to differentially benefit the more sedentary participants. Further study in a larger group of people with low activity at baseline is needed.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215 (USA); and Center for Neurorehabilitation, Boston University
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Tamara DeAngelis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University
| | - Kathryn Hendron
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University
| | - Cathi A Thomas
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University
| | - Karol Pencina
- Research Program in Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy K Latham
- Research Program in Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School
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