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Babaei N, Hannani N, Dabanloo NJ, Bahadori S. A Systematic Review of the Use of Commercial Wearable Activity Trackers for Monitoring Recovery in Individuals Undergoing Total Hip Replacement Surgery. CYBORG AND BIONIC SYSTEMS (WASHINGTON, D.C.) 2022; 2022:9794641. [PMID: 36751476 PMCID: PMC9636847 DOI: 10.34133/2022/9794641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
The innovation of wearable devices is advancing rapidly. Activity monitors can be used to improve the total hip replacement (THR) patients' recovery process and reduce costs. This systematic review assessed the body-worn accelerometers used in studies to enhance the rehabilitation process and monitor THR patients. Electronic databases such as Cochrane Database of Systematic Reviews library, CINAHL CompleteVR, Science Citation Index, and MedlineVR from January 2000 to January 2022 were searched. Due to inclusion criteria, fourteen eligible studies that utilised commercial wearable technology to monitor physical activity both before and after THR were identified. Their evidence quality was assessed with RoB 2.0 and ROBINS-I. This study demonstrates that wearable device technology might be feasible to predict, monitor, and detect physical activity following THR. They could be used as a motivational tool to increase patients' mobility and enhance the recovery process. Also, wearable activity monitors could provide a better insight into the individual's activity level in contrast to subjective self-reported questionnaires. However, they have some limitations, and further evidence is needed to establish this technology as the primary device in THR rehabilitation.
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Affiliation(s)
- Nasibeh Babaei
- Department of Biomedical Engineering, Science And Research Branch, Islamic Azad University, Tehran, Iran
| | - Negin Hannani
- Department of Biomedical Engineering, Science And Research Branch, Islamic Azad University, Tehran, Iran
| | - Nader Jafarnia Dabanloo
- Department of Biomedical Engineering, Science And Research Branch, Islamic Azad University, Tehran, Iran
| | - Shayan Bahadori
- Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK
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2
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Giurgiu M, Timm I, Becker M, Schmidt S, Wunsch K, Nissen R, Davidovski D, Bussmann JBJ, Nigg CR, Reichert M, Ebner-Priemer UW, Woll A, von Haaren-Mack B. Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e36377. [PMID: 35679106 PMCID: PMC9227659 DOI: 10.2196/36377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/13/2022] Open
Abstract
Background Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking. Objective This study aimed to raise researchers’ and consumers’ attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies. Methods Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time). Results Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk. Conclusions Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity.
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Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marlissa Becker
- Unit Physiotherapy, Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Steffen Schmidt
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Kathrin Wunsch
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Rebecca Nissen
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Denis Davidovski
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Claudio R Nigg
- Health Science Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Markus Reichert
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of eHealth and Sports Analytics, Faculty of Sport Science, Ruhr-University Bochum, Bochum, Germany
| | - Ulrich W Ebner-Priemer
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Birte von Haaren-Mack
- Department of Health and Social Psychology, Institute of Psychology, German Sport University, Cologne, Germany
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Use of Wearable Technology to Measure Activity in Orthopaedic Trauma Patients: A Systematic Review. Indian J Orthop 2022; 56:1112-1122. [PMID: 35813536 PMCID: PMC9232686 DOI: 10.1007/s43465-022-00629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROMs) are widely used for measurement of functional outcomes after orthopaedic trauma. However, PROMs rely on patient collaboration and suffer from various types of bias. Wearable Activity Monitors (WAMs) are increasingly used to objectify functional assessment. The objectives of this systematic review were to identify and characterise the WAMs technology and metrics currently used for orthopaedic trauma research. METHODS PubMed and Embase biomedical literature search engines were queried. Eligibility criteria included: Human clinical studies published in the English language between 2010 and 2019 involving fracture management and WAMs. Variables collected from each article included: Technology used, vendor/product, WAM body location, metrics measured, measurement time period, year of publication, study geographic location, phase of treatment studied, fractures studied, number of patients studied, sex and age of the study subjects, and study level of evidence. Six investigators reviewed the resulting papers. Descriptive statistics of variables of interest were used to analyse the data. RESULTS One hundred and thirty-six papers were available for analysis, showing an increasing trend of publications per year. Accelerometry followed by plantar pressure insoles were the most commonly employed technologies. The most common location for WAM placement was insoles, followed by the waist. The most commonly studied fracture type was hip fractures followed by fragility fractures in general, ankle, "lower extremity", and tibial fractures. The rehabilitation phase following surgery was the most commonly studied period. Sleep duration, activity time or step counts were the most commonly reported WAM metrics. A preferred, clinically validated WAM metric was not identified. CONCLUSIONS WAMs have an increasing presence in the orthopaedic trauma literature. The optimal implementation of this technology and its use to understand patients' pre-injury and post-injury functions is currently insufficiently explored and represents an area that will benefit from future study. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO ID:210344. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00629-0.
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Fan X, Lind CM, Rhen IM, Forsman M. Effects of Sensor Types and Angular Velocity Computational Methods in Field Measurements of Occupational Upper Arm and Trunk Postures and Movements. SENSORS 2021; 21:s21165527. [PMID: 34450967 PMCID: PMC8401405 DOI: 10.3390/s21165527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022]
Abstract
Accelerometer-based inclinometers have dominated kinematic measurements in previous field studies, while the use of inertial measurement units that additionally include gyroscopes is rapidly increasing. Recent laboratory studies suggest that these two sensor types and the two commonly used angular velocity computational methods may produce substantially different results. The aim of this study was, therefore, to evaluate the effects of sensor types and angular velocity computational methods on the measures of work postures and movements in a real occupational setting. Half-workday recordings of arm and trunk postures, and movements from 38 warehouse workers were compared using two sensor types: accelerometers versus accelerometers with gyroscopes-and using two angular velocity computational methods, i.e., inclination velocity versus generalized velocity. The results showed an overall small difference (<2° and value independent) for posture percentiles between the two sensor types, but substantial differences in movement percentiles both between the sensor types and between the angular computational methods. For example, the group mean of the 50th percentiles were for accelerometers: 71°/s (generalized velocity) and 33°/s (inclination velocity)-and for accelerometers with gyroscopes: 31°/s (generalized velocity) and 16°/s (inclination velocity). The significant effects of sensor types and angular computational methods on angular velocity measures in field work are important in inter-study comparisons and in comparisons to recommended threshold limit values.
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Affiliation(s)
- Xuelong Fan
- IMM Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (X.F.); (I.-M.R.); (M.F.)
| | - Carl Mikael Lind
- IMM Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (X.F.); (I.-M.R.); (M.F.)
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, SE-141 57 Huddinge, Sweden
- Correspondence:
| | - Ida-Märta Rhen
- IMM Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (X.F.); (I.-M.R.); (M.F.)
- Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65 Stockholm, Sweden
- Department of Industrial and Materials Science, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Mikael Forsman
- IMM Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (X.F.); (I.-M.R.); (M.F.)
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, SE-141 57 Huddinge, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65 Stockholm, Sweden
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Katzan I, Schuster A, Kinzy T. Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e14494. [PMID: 33464213 PMCID: PMC7854036 DOI: 10.2196/14494] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Continuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. Objective The primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. Methods A total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. Results Participants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was –4.8 steps (–1.8%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95% CI –0.14 to 0.75), –0.12 (95% CI –0.67 to 0.64), and 0.17 (95% CI –0.46 to 0.66), respectively. Values were similarly poor at 30 days. Conclusions The use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function.
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Affiliation(s)
- Irene Katzan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States.,Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Andrew Schuster
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
| | - Tyler Kinzy
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
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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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7
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Armitage LC, Chi Y, Santos M, Lawson BK, Areia C, Velardo C, Watkinson PJ, Tarassenko L, Costa ML, Farmer AJ. Monitoring activity of hip injury patients (MoHIP): a sub-study of the World Hip Trauma Evaluation observational cohort study. Pilot Feasibility Stud 2020; 6:70. [PMID: 32477588 PMCID: PMC7243330 DOI: 10.1186/s40814-020-00612-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background Hip fracture is common, affecting 20% of women and 10% of men during their lifetime. The trajectory of patients’ recovery as they transition from the acute hospital setting to their usual residence is poorly understood. Recently, the use of activity trackers to monitor physical activity during recovery has been investigated as a way to explore this trajectory. Methods This prospective observational cohort study followed patients from hospital to home as they recovered from a hip fracture. Participants were recruited from a single centre and provided with a 3-axis logging accelerometer worn as a pendant, for 16 weeks from recruitment. Participants received monthly follow-up visits which included questions about wearing the monitor. Monthly activity monitor data were also downloaded. Participant activity was estimated from the monitor data using the calibrated “Euclidean Norm Minus One” (ENMO) metric. Polynomial mixed-effects modelling was used to evaluate the difference between the weekly activity trends of 2 groups of participants: those with and without independent mobility at 16 weeks (defined by whether aids or personal assistance were required to mobilise). Results Twenty-nine participants from 125 eligible patients were recruited. Of these, 19 (66%) reported being aware of wearing the monitor at least some of the time. Fourteen (48%) participants withdrew before study completion. Data for thirteen (45%) participants were of sufficient quantity to be included in the activity modelling procedure. Of these, 8 reported independent mobility at 16 weeks post-surgery, and 5 did not. By week 7, the weekly predicted mean ENMO (\documentclass[12pt]{minimal}
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\begin{document}$$ {\overline{ENMO}}_W $$\end{document}ENMO¯W) values were significantly different between the two participant groups, demonstrating feasibility of the model’s ability to predict which patients will report independent mobility at 16 weeks. Conclusions This is the first study to our knowledge to investigate acceptability and feasibility of a pendant-worn activity monitor in this patient cohort. Acceptability of wearing the monitor and feasibility of recruitment and retention of participants were limited. Future research into the use of activity monitors in this population should use minimally intrusive devices which are acceptable to this population. Study registration MoHIP is a sub-study of the World Hip Trauma Evaluation (WHiTE) Study (ISRCTN 63982700).
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Affiliation(s)
- Laura C Armitage
- 1Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Yuan Chi
- 2Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Mauro Santos
- 2Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Beth K Lawson
- 1Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Carlos Areia
- 3Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Carmelo Velardo
- 2Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Peter J Watkinson
- 3Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- 2Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Matthew L Costa
- 4Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Farmer
- 1Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
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Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study. Rehabil Res Pract 2020; 2020:5907652. [PMID: 32411473 PMCID: PMC7204137 DOI: 10.1155/2020/5907652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023] Open
Abstract
Background Physical activity in elderly patients is crucial for recovery from proximal femoral fractures. Considering the limited possibilities for objective measurement, we aimed to evaluate the use of an accelerometer in this population to determine activity's association with functional independence, quality of life, and course of recovery. Methods 52 patients undergoing operative treatment for proximal femur fractures (81.3 ± 7.5 years) were included in a prospective cohort study. 12 patients with fall but without fracture of the lower extremities (80.8 ± 9.5 years) served as control. An Axivity AX3 tracker continuously recorded signal vector magnitudes during the hospital stay. Additionally, 2 ± 1 and 8 ± 3 days (time point 1 and 2) after operation EuroQol-5D and Barthel-20 indices were evaluated. Results Physical activity increased in all patients with time. Multiple regression analyses revealed that a high Barthel-20 before fracture, a low age, a high body mass index, high albumin, and low C-reactive protein levels were independent predictors for high physical activity at time point 1 (p < 0.05). Physical activity correlated significantly with EuroQol-5D and Barthel-20 at time point 1 and 2 (p < 0.02). Furthermore, physical activity at time point 1 predicted EuroQol-5D, physical activity, and Barthel-20 at time point 2 (p < 0.01). A multiple regression demonstrated equal physical activity in patients with or without a hip fracture. Conclusions Accelerometer signals correlate with postoperative physical activity, Barthel-20 and quality of life in elderly patients. Physical activity is thereby positively influenced by a high prefall functional independence and a good nutrition status. A timely and adequate operation provided, there is no difference between patients with or without a fracture. This trial is registered with DRKS 00011934 on 10th April 2017.
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Schmal H, Larsen AH, Froberg L, Erichsen JL, Madsen CF, Pedersen L. The effect of a heel-unloading orthosis in short-term treatment of calcaneus fractures on physical function, quality of life and return to work - study protocol for a randomized controlled trial. Trials 2019; 20:324. [PMID: 31164153 PMCID: PMC6549309 DOI: 10.1186/s13063-019-3447-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no standardized therapy guidelines for rehabilitation of calcaneus fractures. While there is consensus on non or partial weight-bearing, the use of supporting devices such as specific foot ankle orthosis is still a matter of debate. Recently, a heel-unloading orthosis ("Settner shoe") was introduced for aftercare of these fractures, allowing walking by shifting the load to the middle-foot and forefoot. This orthosis enables early mobilization of patients suffering from either one-sided or two-sided fractures. The Settner shoe can be applied in non-operative therapy and after surgery. Specifically in calcaneus fractures, early regain of physical activity has been highlighted as one of the key factors for quality of life and the ability to return to work. Thus, we hypothesize that mobilization with the Settner shoe results in improved quality of life and greater physical activity within the first 3 months. METHODS This is going to be analyzed by a randomized controlled study comparing treatment with and without this specific orthosis. The secondary outcome measure is the time point of return to work in patients aged between 18 and 60 years, with calcaneus fracture. Furthermore, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 3-dimensional gait analysis, and the Euroqol-5 dimension-3 level (EQ-5D-3 L) questionnaire for quality of life are assessed. DISCUSSION This is the first trial applying a standardized rehabilitation protocol in patients with calcaneus fractures, aiming to improve the non-operative part of treatment by use of an orthosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT03572816 . Registered on 27 July 2018.
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Affiliation(s)
- Hagen Schmal
- Department of Orthopedics and Traumatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Anders Holsgaard Larsen
- Department of Orthopedics and Traumatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonnie Froberg
- Department of Orthopedics and Traumatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Odense, Denmark
| | - Julie Ladeby Erichsen
- Department of Orthopedics and Traumatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Odense, Denmark
| | - Carsten Fladmose Madsen
- Department of Orthopedics and Traumatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Odense, Denmark
| | - Lasse Pedersen
- Department of Orthopedics and Traumatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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