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Mizuno E, Ogasawara T, Mukaino M, Yamaguchi M, Tsukada S, Sonoda S, Otaka Y. Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study. JMIR Form Res 2024; 8:e51546. [PMID: 38809596 PMCID: PMC11170042 DOI: 10.2196/51546] [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: 08/08/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. OBJECTIVE This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. METHODS In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. RESULTS A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=-0.41, P=.21) or 4 weeks post admission (ρ=-0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=-0.82, P=.002) and 4 weeks post admission (ρ=-0.73, P=.01). CONCLUSIONS Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings.
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Affiliation(s)
- Emi Mizuno
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takayuki Ogasawara
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masumi Yamaguchi
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Shingo Tsukada
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Davoudi A, Urbanek JK, Etzkorn L, Parikh R, Soliman EZ, Wanigatunga AA, Gabriel KP, Coresh J, Schrack JA, Chen LY. Validation of a Zio XT Patch Accelerometer for the Objective Assessment of Physical Activity in the Atherosclerosis Risk in Communities (ARIC) Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:761. [PMID: 38339479 PMCID: PMC10857412 DOI: 10.3390/s24030761] [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: 12/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Combination devices to monitor heart rate/rhythms and physical activity are becoming increasingly popular in research and clinical settings. The Zio XT Patch (iRhythm Technologies, San Francisco, CA, USA) is US Food and Drug Administration (FDA)-approved for monitoring heart rhythms, but the validity of its accelerometer for assessing physical activity is unknown. OBJECTIVE To validate the accelerometer in the Zio XT Patch for measuring physical activity against the widely-used ActiGraph GT3X. METHODS The Zio XT and ActiGraph wGT3X-BT (Actigraph, Pensacola, FL, USA) were worn simultaneously in two separately-funded ancillary studies to Visit 6 of the Atherosclerosis Risk in Communities (ARIC) Study (2016-2017). Zio XT was worn on the chest and ActiGraph was worn on the hip. Raw accelerometer data were summarized using mean absolute deviation (MAD) for six different epoch lengths (1-min, 5-min, 10-min, 30-min, 1-h, and 2-h). Participants who had ≥3 days of at least 10 h of valid data between 7 a.m-11 p.m were included. Agreement of epoch-level MAD between the two devices was evaluated using correlation and mean squared error (MSE). RESULTS Among 257 participants (average age: 78.5 ± 4.7 years; 59.1% female), there were strong correlations between MAD values from Zio XT and ActiGraph (average r: 1-min: 0.66, 5-min: 0.90, 10-min: 0.93, 30-min: 0.93, 1-h: 0.89, 2-h: 0.82), with relatively low error values (Average MSE × 106: 1-min: 349.37 g, 5-min: 86.25 g, 10-min: 56.80 g, 30-min: 45.46 g, 1-h: 52.56 g, 2-h: 54.58 g). CONCLUSIONS These findings suggest that Zio XT accelerometry is valid for measuring duration, frequency, and intensity of physical activity within time epochs of 5-min to 2-h.
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Affiliation(s)
- Anis Davoudi
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.E.); (A.A.W.); (J.C.); (J.A.S.)
| | | | - Lacey Etzkorn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.E.); (A.A.W.); (J.C.); (J.A.S.)
| | - Romil Parikh
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Elsayed Z. Soliman
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Amal A. Wanigatunga
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.E.); (A.A.W.); (J.C.); (J.A.S.)
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Kelley Pettee Gabriel
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Josef Coresh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.E.); (A.A.W.); (J.C.); (J.A.S.)
| | - Jennifer A. Schrack
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.E.); (A.A.W.); (J.C.); (J.A.S.)
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Lin Yee Chen
- Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
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Ogasawara T, Mukaino M, Matsunaga K, Wada Y, Suzuki T, Aoshima Y, Furuzawa S, Kono Y, Saitoh E, Yamaguchi M, Otaka Y, Tsukada S. Prediction of stroke patients' bedroom-stay duration: machine-learning approach using wearable sensor data. Front Bioeng Biotechnol 2024; 11:1285945. [PMID: 38234303 PMCID: PMC10791943 DOI: 10.3389/fbioe.2023.1285945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024] Open
Abstract
Background: The importance of being physically active and avoiding staying in bed has been recognized in stroke rehabilitation. However, studies have pointed out that stroke patients admitted to rehabilitation units often spend most of their day immobile and inactive, with limited opportunities for activity outside their bedrooms. To address this issue, it is necessary to record the duration of stroke patients staying in their bedrooms, but it is impractical for medical providers to do this manually during their daily work of providing care. Although an automated approach using wearable devices and access points is more practical, implementing these access points into medical facilities is costly. However, when combined with machine learning, predicting the duration of stroke patients staying in their bedrooms is possible with reduced cost. We assessed using machine learning to estimate bedroom-stay duration using activity data recorded with wearable devices. Method: We recruited 99 stroke hemiparesis inpatients and conducted 343 measurements. Data on electrocardiograms and chest acceleration were measured using a wearable device, and the location name of the access point that detected the signal of the device was recorded. We first investigated the correlation between bedroom-stay duration measured from the access point as the objective variable and activity data measured with a wearable device and demographic information as explanatory variables. To evaluate the duration predictability, we then compared machine-learning models commonly used in medical studies. Results: We conducted 228 measurements that surpassed a 90% data-acquisition rate using Bluetooth Low Energy. Among the explanatory variables, the period spent reclining and sitting/standing were correlated with bedroom-stay duration (Spearman's rank correlation coefficient (R) of 0.56 and -0.52, p < 0.001). Interestingly, the sum of the motor and cognitive categories of the functional independence measure, clinical indicators of the abilities of stroke patients, lacked correlation. The correlation between the actual bedroom-stay duration and predicted one using machine-learning models resulted in an R of 0.72 and p < 0.001, suggesting the possibility of predicting bedroom-stay duration from activity data and demographics. Conclusion: Wearable devices, coupled with machine learning, can predict the duration of patients staying in their bedrooms. Once trained, the machine-learning model can predict without continuously tracking the actual location, enabling more cost-effective and privacy-centric future measurements.
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Affiliation(s)
- Takayuki Ogasawara
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Yoshitaka Wada
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takuya Suzuki
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Yasushi Aoshima
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Shotaro Furuzawa
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Yuji Kono
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masumi Yamaguchi
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shingo Tsukada
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
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Nakata R, Tanaka F, Sugawara N, Kojima Y, Takeuchi T, Shiba M, Higuchi K, Fujiwara Y. Analysis of autonomic function during natural defecation in patients with irritable bowel syndrome using real-time recording with a wearable device. PLoS One 2022; 17:e0278922. [PMID: 36490298 PMCID: PMC9733845 DOI: 10.1371/journal.pone.0278922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autonomic dysfunction is a factor in irritable bowel syndrome (IBS). However, there are no reports of autonomic nervous system (ANS) activity during natural defecation in patients with IBS. We aimed to clarify the relationship between ANS activity and life events, such as defecation and abdominal symptoms, using real-time recording. METHODS Six patients with IBS and 14 healthy controls were enrolled in this prospective multicenter study. ANS activity was recorded for 24 h using a T-shirt wearable device, and life events were recorded simultaneously in real time using a smartphone application software. Low frequency/high frequency (LF/HF) and HF calculated by power spectrum analysis were defined as activity indicators of the sympathetic and parasympathetic nerves, respectively. RESULTS The means of LF/HF and HF in the period with positive symptoms were comparable between the groups; however, the sum of LF/HF, sum of ΔLF/HF, and the maximum variation in ΔLF/HF were significantly higher in the IBS group. In the IBS group, the sum of ΔLF/HF and LF/HF increased significantly from 2 min before defecation, and the sum of LF/HF remained significantly higher until 9 min after defecation. The sum of ΔLF/HF at 2 min before defecation was significantly positively correlated with the intensity of abdominal pain and diarrhea and constipation scores. In contrast, it was significantly negatively correlated with defecation satisfaction and health-related quality of life. CONCLUSIONS In patients with IBS, sympathetic nerve activity was activated 2 min before defecation, which was correlated with abdominal symptoms and lower QOL.
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Affiliation(s)
- Rieko Nakata
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazuhide Higuchi
- Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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