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Contreras C, Stanley EC, Deschamps-Prescott C, Burnap S, Hopkins M, Browning B, Christensen JC. Evaluation of Smartphone Technology on Spatiotemporal Gait in Older and Diseased Adult Populations. SENSORS (BASEL, SWITZERLAND) 2024; 24:5839. [PMID: 39275750 PMCID: PMC11397937 DOI: 10.3390/s24175839] [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: 07/12/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024]
Abstract
Objective: Advancements in smartphone technology provide availability to evaluate movement in a more practical and feasible manner, improving clinicians' ability to diagnose and treat adults at risk for mobility loss. The purpose of this study was to evaluate the validity and reliability of a smartphone application to measure spatiotemporal outcomes during level (primary) and uphill/downhill (secondary) walking with and without an assistive device for older adults (OAs), Parkinson's Disease (PD) and cerebrovascular accident (CVA) populations. Methods: A total of 50 adults (OA = 20; PD = 15; CVA = 15) underwent gait analysis at self-selected gait speeds under 0-degree, 5-degree uphill and 5-degree downhill environments. The validity and reliability of the smartphone outcomes were compared to a motion-capture laboratory. Bland-Altman analysis was used to evaluate limits of agreement between the two systems. Intraclass correlation coefficients (ICCs) were used to determine absolute agreement, and Pearson correlation coefficients (r) were used to assess the strength of the association between the two systems. Results: For level walking, Bland-Altman analysis revealed relatively equal estimations of spatiotemporal outcomes between systems for OAs without an assistive device and slight to mild under- and overestimations of outcomes between systems for PD and CVA with and without an assistive device. Moderate to very high correlations between systems (without an assistive device: OA r-range, 0.72-0.99; PD r-range, 0.87-0.97; CVA r-range, 0.56-0.99; with an assistive device: PD r-range, 0.35-0.98; CVA r-range, 0.50-0.99) were also observed. Poor to excellent ICCs for reliability between systems (without an assistive device: OA ICC range, 0.71-0.99; PD ICC range, 0.73-0.97; CVA ICC range, 0.56-0.99; with an assistive device: PD ICC range, 0.22-0.98; CVA ICC range, 0.44-0.99) were observed across all outcomes. Conclusions: This smartphone application can be clinically useful in detecting most spatiotemporal outcomes in various walking environments for older and diseased adults at risk for mobility loss.
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Affiliation(s)
- Coby Contreras
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Ethan C Stanley
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Chanc Deschamps-Prescott
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Susan Burnap
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Madison Hopkins
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Bennett Browning
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Jesse C Christensen
- Veterans Affairs Salt Lake City Health Care System, Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
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Rentz C, Kaiser V, Jung N, Turlach BA, Sahandi Far M, Peterburs J, Boltes M, Schnitzler A, Amunts K, Dukart J, Minnerop M. Sensor-Based Gait and Balance Assessment in Healthy Adults: Analysis of Short-Term Training and Sensor Placement Effects. SENSORS (BASEL, SWITZERLAND) 2024; 24:5598. [PMID: 39275509 PMCID: PMC11397791 DOI: 10.3390/s24175598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024]
Abstract
While the analysis of gait and balance can be an important indicator of age- or disease-related changes, it remains unclear if repeated performance of gait and balance tests in healthy adults leads to habituation effects, if short-term gait and balance training can improve gait and balance performance, and whether the placement of wearable sensors influences the measurement accuracy. Healthy adults were assessed before and after performing weekly gait and balance tests over three weeks by using a force plate, motion capturing system and smartphone. The intervention group (n = 25) additionally received a home-based gait and balance training plan. Another sample of healthy adults (n = 32) was assessed once to analyze the impact of sensor placement (lower back vs. lower abdomen) on gait and balance analysis. Both the control and intervention group exhibited improvements in gait/stance. However, the trends over time were similar for both groups, suggesting that targeted training and repeated task performance equally contributed to the improvement of the measured variables. Since no significant differences were found in sensor placement, we suggest that a smartphone used as a wearable sensor could be worn both on the lower abdomen and the lower back in gait and balance analyses.
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Affiliation(s)
- Clara Rentz
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, 52425 Jülich, Germany
| | - Vera Kaiser
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, 52425 Jülich, Germany
- Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Naomi Jung
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, 52425 Jülich, Germany
| | - Berwin A Turlach
- Centre for Applied Statistics, The University of Western Australia, Perth, WA 6000, Australia
| | - Mehran Sahandi Far
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52425 Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Jutta Peterburs
- Faculty of Mathematics and Natural Sciences, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Institute of Systems Medicine and Department of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Maik Boltes
- Institute for Advanced Simulation (IAS-7), Research Centre Jülich, 52425 Jülich, Germany
| | - Alfons Schnitzler
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, 52425 Jülich, Germany
- C. and O. Vogt Institute for Brain Research, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Juergen Dukart
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52425 Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, 52425 Jülich, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
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Gonçalves HIT, Ferreira MC, Campos MJ, Fernandes CS. Using Digital Technology to Promote Patient Participation in the Rehabilitation Process in Hip Replacement: A Scoping Review. Comput Inform Nurs 2024:00024665-990000000-00224. [PMID: 39159144 DOI: 10.1097/cin.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
The purpose of this scoping review was to identify and summarize how technology can promote patient participation in the rehabilitation process in hip replacement. We conducted a scoping review following the steps outlined by the Joanna Briggs Institute. The PRISMA Checklist (Preferred Reporting Items for Systematic reviews and Meta-Analyses) was utilized to systematically organize the gathered information. A thorough search of articles was performed on PubMed, Scopus, and CINAHL databases for all publications up to December 2022. Twenty articles were included in this study. Various technologies, such as mobile applications, Web sites, and platforms, offer interactive approaches to facilitate total hip replacement rehabilitation. The analyzed studies were based on the rehabilitation of total hip arthroplasty, which in most of them was developed in mobile applications and Web sites. The studies identified reflect trends in the application of digital health technologies to promote patient engagement in the rehabilitation process and provide risk monitoring and patient education.
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Affiliation(s)
- Helena Isabel Teixeira Gonçalves
- Author Affiliations: Faculty of Engineering, University of Porto (Dr Gonçalves); INESC TEC center; Faculty of Engineering, University of Porto (Prof Ferreira); Porto Higher School of Nursing (Dr Campos); and Research Center for Health Technologies and Services (CINTESIS@RISE), Porto Higher School of Nursing, Portugal; Association ADITGames, Portugal (Dr Fernandes)
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Hameed D, Sodhi N, Dubin J, Schneider A, Barrack RL, Mont MA. Integrating Smartphone Applications and Wearable Devices for Postoperative Rehabilitation in Total Knee Arthroplasty: A Critical Review. J Arthroplasty 2024; 39:2028-2039.e1. [PMID: 38403080 DOI: 10.1016/j.arth.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination. METHODS A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on applications, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by adherence and patient satisfaction, functional outcomes and pain scores, gait analyses and ranges of motion, and measurement and comparison tools. RESULTS A review of 24 of 25 publications related to smartphone applications used for postoperative recovery in TKA showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies used in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months. CONCLUSIONS Smartphone applications and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of TKA patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings.
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Affiliation(s)
- Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, North Shore University Hospital, Northwell Health, New York, New York
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Andrew Schneider
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Marom P, Brik M, Agay N, Dankner R, Katzir Z, Keshet N, Doron D. The Reliability and Validity of the OneStep Smartphone Application for Gait Analysis among Patients Undergoing Rehabilitation for Unilateral Lower Limb Disability. SENSORS (BASEL, SWITZERLAND) 2024; 24:3594. [PMID: 38894386 PMCID: PMC11175355 DOI: 10.3390/s24113594] [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: 04/04/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
An easy-to-use and reliable tool is essential for gait assessment of people with gait pathologies. This study aimed to assess the reliability and validity of the OneStep smartphone application compared to the C-Mill-VR+ treadmill (Motek, Nederlands), among patients undergoing rehabilitation for unilateral lower extremity disability. Spatiotemporal gait parameters were extracted from the treadmill and from two smartphones, one on each leg. Inter-device reliability was evaluated using Pearson correlation, intra-cluster correlation coefficient (ICC), and Cohen's d, comparing the application's readings from the two phones. Validity was assessed by comparing readings from each phone to the treadmill. Twenty-eight patients completed the study; the median age was 45.5 years, and 61% were males. The ICC between the phones showed a high correlation (r = 0.89-1) and good-to-excellent reliability (ICC range, 0.77-1) for all the gait parameters examined. The correlations between the phones and the treadmill were mostly above 0.8. The ICC between each phone and the treadmill demonstrated moderate-to-excellent validity for all the gait parameters (range, 0.58-1). Only 'step length of the impaired leg' showed poor-to-good validity (range, 0.37-0.84). Cohen's d effect size was small (d < 0.5) for all the parameters. The studied application demonstrated good reliability and validity for spatiotemporal gait assessment in patients with unilateral lower limb disability.
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Affiliation(s)
- Pnina Marom
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel Aviv 6772830, Israel; (M.B.); (R.D.); (Z.K.)
- Department of Health Promotion, School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michael Brik
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel Aviv 6772830, Israel; (M.B.); (R.D.); (Z.K.)
| | - Nirit Agay
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel;
| | - Rachel Dankner
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel Aviv 6772830, Israel; (M.B.); (R.D.); (Z.K.)
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel;
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zoya Katzir
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel Aviv 6772830, Israel; (M.B.); (R.D.); (Z.K.)
- Department of General Medicine, School of Medicine, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Naama Keshet
- Department of Physical Therapy, Reuth Rehabilitation Hospital, Tel Aviv 6772830, Israel;
| | - Dana Doron
- Ambulatory Day Care, Reuth Rehabilitation Hospital, Tel Aviv 6772830, Israel
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Yanez Touzet A, Houhou T, Rahic Z, Kolias A, Yordanov S, Anderson DB, Laufer I, Li M, Grahovac G, Kotter MR, Davies BM. Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study. JMIR Form Res 2024; 8:e56889. [PMID: 38787602 PMCID: PMC11161705 DOI: 10.2196/56889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. OBJECTIVE The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. METHODS A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points. RESULTS In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. CONCLUSIONS The criteria from COSMIN provide "very good" quality evidence of the reliability of the MoveMed tests in an adult population living with DCM.
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Affiliation(s)
- Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- MoveMed Ltd., Cambridge, United Kingdom
| | - Tatiana Houhou
- Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Zerina Rahic
- Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- ANAPLASI Rehabilitation Centre, Athens, Greece
- 1st Neurosurgery Department, Henry Dunant Hospital Center, Athens, Greece
| | - Stefan Yordanov
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - David B Anderson
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ilya Laufer
- New York University Langone Health, New York, NY, United States
| | - Maggie Li
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Gordan Grahovac
- King's College Hospital, Kings NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Mark Rn Kotter
- MoveMed Ltd., Cambridge, United Kingdom
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Neurosciences, Ann McLaron Laboratory of Regenerative Medicine, Cambridge, United Kingdom
| | - Benjamin M Davies
- MoveMed Ltd., Cambridge, United Kingdom
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Elshorbagy R, Alkhaldi H, Alshammari N, El Semary M. Influence of Sex on Cognitive and Motor Dual-Task Performance Among Young Adults: A Cross-Sectional Study. Ann Rehabil Med 2024; 48:163-170. [PMID: 38575372 PMCID: PMC11058369 DOI: 10.5535/arm.23150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/17/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE To investigate the sex-related differences in single-task performance through motor torque, cognitive tasks and walking speed, and the combined dual-task costs (DTCs) considering both motor and cognitive performance in young adults. METHODS Sixty-seven non-athletic subjects 37 females and 30 males were enrolled. The study measured their knee extension muscle torque using an isokinetic strength dynamometer and their walking speed using the one step app. these assessments were performed both with and without a cognitive task, and the DTCs were calculated. RESULTS The females exhibited significantly larger motor performance dual task effect through (torque-DTC, speed-DTC) compared with males while exhibiting smaller cognitive dual task effect with muscle torque and speed. CONCLUSION Deterioration in motor performance during muscle force production and speed during dual tasks was large in females compared to males, whereas males experience a decline in cognitive ability when performing dual tasks compared with females.
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Affiliation(s)
- Radwa Elshorbagy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
- Department of Physical Therapy for Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hanin Alkhaldi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Njoud Alshammari
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Moataz El Semary
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Lee PA, DuMontier C, Yu W, Ask L, Zhou J, Testa MA, Kim D, Abel G, Travison T, Manor B, Lo OY. Validity and Reliability of a Smartphone Application for Home Measurement of Four-Meter Gait Speed in Older Adults. Bioengineering (Basel) 2024; 11:257. [PMID: 38534531 PMCID: PMC10968134 DOI: 10.3390/bioengineering11030257] [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: 01/18/2024] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024] Open
Abstract
The four-meter gait speed (4MGS) is a recommended physical performance test in older adults but is challenging to implement clinically. We developed a smartphone application (App) with a four-meter ribbon for remote 4MGS testing at home. This study aimed to assess the validity and reliability of this smartphone App-based assessment of the home 4MGS. We assessed the validity of the smartphone App by comparing it against a gold standard video assessment of the 4MGS conducted by study staff visiting community-dwelling older adults and against the stopwatch-based measurement. Moreover, we assessed the test-retest reliability in two supervised sessions and three additional sessions performed by the participants independently, without staff supervision. The 4MGS measured by the smartphone App was highly correlated with video-based 4MGS (r = 0.94), with minimal differences (mean = 0.07 m/s, ± 1.96 SD = 0.12) across a range of gait speeds. The test-retest reliability for the smartphone App 4MGS was high (ICC values: 0.75 to 0.93). The home 4MGS in older adults can be measured accurately and reliably using a smartphone in the pants pocket and a four-meter strip of ribbon. Leveraging existing technology carried by a significant portion of the older adult population could overcome barriers in busy clinical settings for this well-established objective mobility test.
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Affiliation(s)
- Pei-An Lee
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Clark DuMontier
- VA Boston Healthcare System, Harvard Medical School, Boston, MA 02130, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Wanting Yu
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
| | - Levi Ask
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
| | - Junhong Zhou
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Marcia A. Testa
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Dae Kim
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Gregory Abel
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Tom Travison
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Brad Manor
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - On-Yee Lo
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA (O.-Y.L.)
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Pritwani S, Shrivastava P, Pandey S, Kumar A, Malhotra R, Maddison R, Devasenapathy N. Mobile and Computer-Based Applications for Rehabilitation Monitoring and Self-Management After Knee Arthroplasty: Scoping Review. JMIR Mhealth Uhealth 2024; 12:e47843. [PMID: 38277195 PMCID: PMC10858429 DOI: 10.2196/47843] [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: 04/04/2023] [Revised: 10/10/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Successful post-knee replacement rehabilitation requires adequate access to health information, social support, and periodic monitoring by a health professional. Mobile health (mHealth) and computer-based technologies are used for rehabilitation and remote monitoring. The extent of technology use and its function in post-knee replacement rehabilitation care in low and middle-income settings are unknown. OBJECTIVE To inform future mHealth intervention development, we conducted a scoping review to map the features and functionality of existing technologies and determine users' perspectives on telerehabilitation and technology for self-management. METHODS We followed the Joanna Briggs Institute methodology for scoping reviews. We searched the Embase, Medline, PsycINFO via OVID, and Cochrane Central Register of Controlled Trials databases for manuscripts published from 2001 onward. We included original research articles reporting the use of mobile or computer-based technologies by patients, health care providers, researchers, or family members. Studies were divided into the following 3 categories based on the purpose: validation studies, clinical evaluation, and end user feedback. We extracted general information on study design, technology features, proposed function, and perspectives of health care providers and patients. The protocol for this review is accessible in the Open Science Framework. RESULTS Of the 5960 articles, 158 that reported from high-income settings contributed to the qualitative summary (64 studies on mHealth or telerehabilitation programs, 28 validation studies, 38 studies describing users' perceptions). The highest numbers of studies were from Europe or the United Kingdom and North America regarding the use of a mobile app with or without wearables and reported mainly in the last decade. No studies were from low and middle-income settings. The primary functions of technology for remote rehabilitation were education to aid recovery and enable regular, appropriate exercises; monitoring progress of pain (n=19), activity (n=20), and exercise adherence (n=30); 1 or 2-way communication with health care professionals to facilitate the continuum of care (n=51); and goal setting (n=23). Assessment of range of motion (n=16) and gait analysis (n=10) were the commonly validated technologies developed to incorporate into a future rehabilitation program. Few studies (n=14) reported end user involvement during the development stage. We summarized the reasons for satisfaction and dissatisfaction among users across various technologies. CONCLUSIONS Several existing mobile and computer-based technologies facilitate post-knee replacement rehabilitation care for patients and health care providers. However, they are limited to high-income settings and may not be extrapolated to low-income settings. A systematic needs assessment of patients undergoing knee replacement and health care providers involved in rehabilitation, involving end users at all stages of development and evaluation, with clear reporting of the development and clinical evaluation can make post-knee replacement rehabilitation care in resource-poor settings accessible and cost-effective.
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Affiliation(s)
- Sabhya Pritwani
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
| | - Purnima Shrivastava
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
| | - Shruti Pandey
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
| | - Ajit Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India
| | - Ralph Maddison
- Department of School of Exercise & Nutrition, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Niveditha Devasenapathy
- Department of Research & Development, The George Institute for Global Health India, Delhi, India
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Olsen S, Rashid U, Barbado D, Suresh P, Alder G, Khan Niazi I, Taylor D. The validity of smartphone-based spatiotemporal gait measurements during walking with and without head turns: Comparison with the GAITRite® system. J Biomech 2024; 162:111899. [PMID: 38128468 DOI: 10.1016/j.jbiomech.2023.111899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Smartphone accelerometry has potential to provide clinicians with specialized gait analysis not available in most clinical settings. The Gait&Balance Application (G&B App) uses smartphone accelerometry to assess spatiotemporal gait parameters under two conditions: walking looking straight ahead and walking with horizontal head turns. This study investigated the validity of G&B App gait parameters compared with the GAITRite® pressure-sensitive walkway. Healthy young and older adults (age range 21-85 years) attended a single session where a smartphone was secured over the lumbosacral junction. Data were collected concurrently with the app and GAITRite® systems as participants completed the two walking conditions. Spatiotemporal gait parameters for 54 participants were determined from both systems and agreement evaluated with partial Pearson's correlation coefficients and limits of agreement. The results demonstrated moderate to excellent validity for G&B App measures of step time (rp 0.97, 95 % CI [0.96, 0.98]), walking speed (rp 0.83 [0.78, 0.87]), and step length (rp 0.74, [0.66, 0.80]) when walking looking straight ahead, and results were comparable with head turns. The validity of walking speed and step length measures was influenced by sex and height. G&B App measures of step length variability, step time variability, step length asymmetry, and step time asymmetry had poor validity. The G&B App has potential to provide valid measures of unilateral and bilateral step time, unilateral and bilateral step length, and walking speed, under two walking conditions in healthy young and older adults. Further research should validate this tool in clinical conditions and optimise the algorithm for demographic characteristics.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand
| | - David Barbado
- Department of Sport Science, Sports Research Centre, Miguel Hernandez University of Elche, Avda. de la Universidad s/n, Elche 03202, Spain; Institute for Health and Biomedical Research (ISABIAL Foundation), Avda. Pintor Baeza, 12 HGUA, Alicante 03550, Spain
| | - Priyadharshini Suresh
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand; Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Strongman C, Cavallerio F, Timmis MA, Morrison A. A Scoping Review of the Validity and Reliability of Smartphone Accelerometers When Collecting Kinematic Gait Data. SENSORS (BASEL, SWITZERLAND) 2023; 23:8615. [PMID: 37896708 PMCID: PMC10611257 DOI: 10.3390/s23208615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
The aim of this scoping review is to evaluate and summarize the existing literature that considers the validity and/or reliability of smartphone accelerometer applications when compared to 'gold standard' kinematic data collection (for example, motion capture). An electronic keyword search was performed on three databases to identify appropriate research. This research was then examined for details of measures and methodology and general study characteristics to identify related themes. No restrictions were placed on the date of publication, type of smartphone, or participant demographics. In total, 21 papers were reviewed to synthesize themes and approaches used and to identify future research priorities. The validity and reliability of smartphone-based accelerometry data have been assessed against motion capture, pressure walkways, and IMUs as 'gold standard' technology and they have been found to be accurate and reliable. This suggests that smartphone accelerometers can provide a cheap and accurate alternative to gather kinematic data, which can be used in ecologically valid environments to potentially increase diversity in research participation. However, some studies suggest that body placement may affect the accuracy of the result, and that position data correlate better than actual acceleration values, which should be considered in any future implementation of smartphone technology. Future research comparing different capture frequencies and resulting noise, and different walking surfaces, would be useful.
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Affiliation(s)
- Clare Strongman
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK; (F.C.); (M.A.T.); (A.M.)
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12
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Rozanski G, Delgado A, Putrino D. Spatiotemporal parameters from remote smartphone-based gait analysis are associated with lower extremity functional scale categories. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1189376. [PMID: 37565184 PMCID: PMC10410151 DOI: 10.3389/fresc.2023.1189376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023]
Abstract
Objective Self-report tools are recommended in research and clinical practice to capture individual perceptions regarding health status; however, only modest correlations are found with performance-based results. The Lower Extremity Functional Scale (LEFS) is one well-validated measure of impairment affecting physical activities that has been compared with objective tests. More recently, mobile gait assessment software can provide comprehensive motion tracking output from ecologically valid environments, but how this data relates to subjective scales is unknown. Therefore, the association between the LEFS and walking variables remotely collected by a smartphone was explored. Methods Proprietary algorithms extracted spatiotemporal parameters detected by a standard integrated inertial measurement unit from 132 subjects enrolled in physical therapy for orthopedic or neurological rehabilitation. Users initiated ambulation recordings and completed questionnaires through the OneStep digital platform. Discrete categories were created based on LEFS score cut-offs and Analysis of Variance was applied to estimate the difference in gait metrics across functional groups (Low-Medium-High). Results The main finding of this cross-sectional retrospective study is that remotely-collected biomechanical walking data are significantly associated with individuals' self-evaluated function as defined by LEFS categorization (n = 132) and many variables differ between groups. Velocity was found to have the strongest effect size. Discussion When patients are classified according to subjective mobility level, there are significant differences in quantitative measures of ambulation analyzed with smartphone-based technology. Capturing real-time information about movement is important to obtain accurate impressions of how individuals perform in daily life while understanding the relationship between enacted activity and relevant clinical outcomes.
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Affiliation(s)
- Gabriela Rozanski
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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13
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Werner C, Hezel N, Dongus F, Spielmann J, Mayer J, Becker C, Bauer JM. Validity and reliability of the Apple Health app on iPhone for measuring gait parameters in children, adults, and seniors. Sci Rep 2023; 13:5350. [PMID: 37005465 PMCID: PMC10067003 DOI: 10.1038/s41598-023-32550-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/29/2023] [Indexed: 04/04/2023] Open
Abstract
This study assessed the concurrent validity and test-retest-reliability of the Apple Health app on iPhone for measuring gait parameters in different age groups. Twenty-seven children, 28 adults and 28 seniors equipped with an iPhone completed a 6-min walk test (6MWT). Gait speed (GS), step length (SL), and double support time (DST) were extracted from the gait recordings of the Health app. Gait parameters were simultaneously collected with an inertial sensors system (APDM Mobility Lab) to assess concurrent validity. Test-retest reliability was assessed via a second iPhone-instrumented 6MWT 1 week later. Agreement of the Health App with the APDM Mobility Lab was good for GS in all age groups and for SL in adults/seniors, but poor to moderate for DST in all age groups and for SL in children. Consistency between repeated measurements was good to excellent for all gait parameters in adults/seniors, and moderate to good for GS and DST but poor for SL in children. The Health app on iPhone is reliable and valid for measuring GS and SL in adults and seniors. Careful interpretation is required when using the Health app in children and when measuring DST in general, as both have shown limited validity and/or reliability.
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Affiliation(s)
- Christian Werner
- Geriatric Center, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University Hospital, 69126, Heidelberg, Germany.
| | - Natalie Hezel
- Geriatric Center, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University Hospital, 69126, Heidelberg, Germany
| | - Fabienne Dongus
- Institute of Sports and Sports Science, Heidelberg University, 69120, Heidelberg, Germany
| | | | - Jan Mayer
- TSG ResearchLab, 74939, Zuzenhausen, Germany
| | - Clemens Becker
- Unit of Digital Geriatric Medicine, Heidelberg University Hospital, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Geriatric Center, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University Hospital, 69126, Heidelberg, Germany
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