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Berger M, Bertrand AM, Robert T, Chèze L. Measuring objective physical activity in people with chronic low back pain using accelerometers: a scoping review. Front Sports Act Living 2023; 5:1236143. [PMID: 38022769 PMCID: PMC10646390 DOI: 10.3389/fspor.2023.1236143] [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: 06/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Accelerometers can be used to objectively measure physical activity. They could be offered to people with chronic low back pain (CLBP) who are encouraged to maintain an active lifestyle. The aim of this study was to examine the use of accelerometers in studies of people with CLBP and to synthesize the main results regarding the measurement of objective physical activity. Methods A scoping review was conducted following Arksey and O'Malley's framework. Relevant studies were collected from 4 electronic databases (PubMed, Embase, CINHAL, Web of Science) between January 2000 and July 2023. Two reviewers independently screened all studies and extracted data. Results 40 publications out of 810 citations were included for analysis. The use of accelerometers in people with CLBP differed across studies; the duration of measurement, physical activity outcomes and models varied, and several limitations of accelerometry were reported. The main results of objective physical activity measures varied and were sometimes contradictory. Thus, they question the validity of measurement methods and provide the opportunity to discuss the objective physical activity of people with CLBP. Conclusions Accelerometers have the potential to monitor physical performance in people with CLBP; however, important technical limitations must be overcome.
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Affiliation(s)
- Mathilde Berger
- Occupational Therapy Department (HETSL | HES-SO), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Anne Martine Bertrand
- Occupational Therapy Department (HETSL | HES-SO), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Thomas Robert
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Laurence Chèze
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
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Patterson DG, Wilson D, Fishman MA, Moore G, Skaribas I, Heros R, Dehghan S, Ross E, Kyani A. Objective wearable measures correlate with self-reported chronic pain levels in people with spinal cord stimulation systems. NPJ Digit Med 2023; 6:146. [PMID: 37582839 PMCID: PMC10427619 DOI: 10.1038/s41746-023-00892-x] [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: 01/27/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
Spinal Cord Stimulation (SCS) is a well-established therapy for treating chronic pain. However, perceived treatment response to SCS therapy may vary among people with chronic pain due to diverse needs and backgrounds. Patient Reported Outcomes (PROs) from standard survey questions do not provide the full picture of what has happened to a patient since their last visit, and digital PROs require patients to visit an app or otherwise regularly engage with software. This study aims to assess the feasibility of using digital biomarkers collected from wearables during SCS treatment to predict pain and PRO outcomes. Twenty participants with chronic pain were recruited and implanted with SCS. During the six months of the study, activity and physiological metrics were collected and data from 15 participants was used to develop a machine learning pipeline to objectively predict pain levels and categories of PRO measures. The model reached an accuracy of 0.768 ± 0.012 in predicting the pain intensity of mild, moderate, and severe. Feature importance analysis showed that digital biomarkers from the smartwatch such as heart rate, heart rate variability, step count, and stand time can contribute to modeling different aspects of pain. The results of the study suggest that wearable biomarkers can be used to predict therapy outcomes in people with chronic pain, enabling continuous, real-time monitoring of patients during the use of implanted therapies.
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Quirk DA, Johnson ME, Anderson DE, Smuck M, Sun R, Matthew R, Bailey J, Marras WS, Bell KM, Darwin J, Bowden AE. Biomechanical Phenotyping of Chronic Low Back Pain: Protocol for BACPAC. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S48-S60. [PMID: 36315101 PMCID: PMC10403313 DOI: 10.1093/pm/pnac163] [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: 07/26/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Biomechanics represents the common final output through which all biopsychosocial constructs of back pain must pass, making it a rich target for phenotyping. To exploit this feature, several sites within the NIH Back Pain Consortium (BACPAC) have developed biomechanics measurement and phenotyping tools. The overall aims of this article were to: 1) provide a narrative review of biomechanics as a phenotyping tool; 2) describe the diverse array of tools and outcome measures that exist within BACPAC; and 3) highlight how leveraging these technologies with the other data collected within BACPAC could elucidate the relationship between biomechanics and other metrics used to characterize low back pain (LBP). METHODS The narrative review highlights how biomechanical outcomes can discriminate between those with and without LBP, as well as among levels of severity of LBP. It also addresses how biomechanical outcomes track with functional improvements in LBP. Additionally, we present the clinical use case for biomechanical outcome measures that can be met via emerging technologies. RESULTS To answer the need for measuring biomechanical performance, our "Results" section describes the spectrum of technologies that have been developed and are being used within BACPAC. CONCLUSION AND FUTURE DIRECTIONS The outcome measures collected by these technologies will be an integral part of longitudinal and cross-sectional studies conducted in BACPAC. Linking these measures with other biopsychosocial data collected within BACPAC increases our potential to use biomechanics as a tool for understanding the mechanisms of LBP, phenotyping unique LBP subgroups, and matching these individuals with an appropriate treatment paradigm.
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Affiliation(s)
- D Adam Quirk
- Harvard School of Engineering and Applied Science, Harvard University, Cambridge, Massachusetts
| | - Marit E Johnson
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis E Anderson
- Center for Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Robert Matthew
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, California
| | - Jeannie Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - William S Marras
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio
| | - Kevin M Bell
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessa Darwin
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, USA
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Heros R, Patterson D, Huygen F, Skaribas I, Schultz D, Wilson D, Fishman M, Falowski S, Moore G, Kallewaard JW, Dehghan S, Kyani A, Mansouri M. Objective wearable measures and subjective questionnaires for predicting response to neurostimulation in people with chronic pain. Bioelectron Med 2023; 9:13. [PMID: 37340467 PMCID: PMC10283222 DOI: 10.1186/s42234-023-00115-4] [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: 05/08/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Neurostimulation is an effective therapy for treating and management of refractory chronic pain. However, the complex nature of pain and infrequent in-clinic visits, determining subject's long-term response to the therapy remains difficult. Frequent measurement of pain in this population can help with early diagnosis, disease progression monitoring, and evaluating long-term therapeutic efficacy. This paper compares the utilization of the common subjective patient-reported outcomes with objective measures captured through a wearable device for predicting the response to neurostimulation therapy. METHOD Data is from the ongoing international prospective post-market REALITY clinical study, which collects long-term patient-reported outcomes from 557 subjects implanted by Spinal Cord Stimulator (SCS) or Dorsal Root Ganglia (DRG) neurostimulators. The REALITY sub-study was designed for collecting additional wearables data on a subset of 20 participants implanted with SCS devices for up to six months post implantation. We first implemented a combination of dimensionality reduction algorithms and correlation analyses to explore the mathematical relationships between objective wearable data and subjective patient-reported outcomes. We then developed machine learning models to predict therapy outcome based on the subject's response to the numerical rating scale (NRS) or patient global impression of change (PGIC). RESULTS Principal component analysis showed that psychological aspects of pain were associated with heart rate variability, while movement-related measures were strongly associated with patient-reported outcomes related to physical function and social role participation. Our machine learning models using objective wearable data predicted PGIC and NRS outcomes with high accuracy without subjective data. The prediction accuracy was higher for PGIC compared with the NRS using subjective-only measures primarily driven by the patient satisfaction feature. Similarly, the PGIC questions reflect an overall change since the study onset and could be a better predictor of long-term neurostimulation therapy outcome. CONCLUSIONS The significance of this study is to introduce a novel use of wearable data collected from a subset of patients to capture multi-dimensional aspects of pain and compare the prediction power with the subjective data from a larger data set. The discovery of pain digital biomarkers could result in a better understanding of the patient's response to therapy and their general well-being.
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Affiliation(s)
| | | | - Frank Huygen
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | - Michael Fishman
- Center for Interventional Pain and Spine, Lancaster, PA, USA
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Hung JD, Brugaletta S, Spratt JC. The future of individualized cardiovascular care: how wearables could be integrated to improve outcomes. Eur Heart J Suppl 2022; 24:H43-H47. [DOI: 10.1093/eurheartjsupp/suac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Personalized medicine is a concept all clinicians must strive to deliver. Recent advances in technology increasingly offer new opportunities to personalize care, not least in cardiovascular medicine. Health trackers and wearables are technologies in an explosive phase of development. They allow accurate and continuous measurement of bio-data, recorded and analysed using apps and mobile devices. However, although there is huge potential, most physicians and healthcare organizations are yet to realize the value of integrating wearables into routine clinical practice. We discuss how this state-of-the-art technology can support patients in making meaningful lifestyle changes and revolutionize the future of cardiovascular medicine.
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Affiliation(s)
- John D Hung
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust , London , UK
| | - Salvatore Brugaletta
- Hospital Clinic, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - James C Spratt
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust , London , UK
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Nam HS, Lee WH, Seo HG, Smuck MW, Kim S. Evaluation of Motion Segment Size as a New Sensor-based Functional Outcome Measure in Stroke Rehabilitation. J Int Med Res 2022; 50:3000605221122750. [PMID: 36129970 PMCID: PMC9511330 DOI: 10.1177/03000605221122750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate a novel parameter, motion segment size (MSS), in stroke patients with upper limb impairment and validate its clinical applicability by correlating results with a standard clinical task-based functional evaluation tool. Methods In this cross-sectional study, patients with hemiplegia and healthy controls equipped with multiple inertial measurement unit (IMU) sensors performed Action Research Arm Test (ARAT) and activities of daily living (ADL) tasks. Acceleration of the wrist and Euler angles of each upper limb segment were measured. The average and maximum MSS, accumulated motion, total performance time, and average motion speed (AMS) were extracted for analysis. Results Data from nine patients and 10 controls showed that the average MSS of forearm supination/pronation and elbow flexion/extension during full ARAT tasks showed a significant difference between patients and controls and a significant correlation with ARAT scores. Conclusions We suggest that MSS may provide clinically relevant information regarding upper limb functional status in stroke patients.
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Affiliation(s)
- Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Wearable Health Lab, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA.,Department of Rehabilitation Medicine, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE
| | - Woo Hyung Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Matthew W Smuck
- Wearable Health Lab, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Institute of Bioengineering, Seoul National University, Seoul, Korea
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Objective features of sedentary time and light activity differentiate people with low back pain from healthy controls: a pilot study. Spine J 2022; 22:629-634. [PMID: 34798245 DOI: 10.1016/j.spinee.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Physical inactivity has been described as both a cause and a consequence of low back pain (LBP) largely based on self-reported measures of daily activity. A better understanding of the connections between routine physical activity and LBP may improve LBP interventions. PURPOSE In this study, we aim to objectively characterize the free-living physical activity of people with low back pain in comparison to healthy controls using accelerometers, and we aim to derive a set of LBP-specific physical activity minutes thresholds that may be used as targets for future physical activity interventions. STUDY DESIGN Cross-sectional. PATIENT SAMPLE A total of 22 low back pain patients and 155 controls. OUTCOME MEASURES Accelerometry derived physical activity measures. METHODS Twenty-two people with LBP were compared to 155 age and gender-matched healthy controls. All subjects wore an ActiGraph accelerometer on the right hip for 7 consecutive days. Accelerometry-based physical activity features (count-per-minute CPM) were derived using Freedson's intervals and physical performance intervals. A random forest machine learning classifier was trained to classify LBP status using a leave-one-out cross-validation procedure. An interpretation algorithm, the SHapley Additive exPlanations (SHAP) algorithm was subsequently applied to assess the feature importance and to establish LBP-specific physical activity thresholds. RESULTS The LBP group reported mild to moderate disability (average ODI=18.5). The random forest classifier identified a set of 8 features (digital biomarkers) that achieved 88.1% accuracy for distinguishing LBP from controls. All of the top distinguishing features were related to differences in the sedentary and light activity ranges (<800 CPM), whereas moderate to vigorous physical activity was not discriminative. In addition, we identified and ranked physical activity thresholds that are associated with LBP prediction that can be used in future studies of physical activity interventions for LBP. CONCLUSIONS We describe a set of physical activity features from accelerometry data associated with LBP. All of the discriminating features were derived from the sedentary and light activity range. We also identified specific activity intensity minutes thresholds that distinguished LBP subjects from healthy controls. Future examination on the digital markers and thresholds identified through this work can be used to improve physical activity interventions for LBP treatment and prevention by allowing the development of LBP-specific physical activity guidelines.
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Duong TTH, Uher D, Montes J, Zanotto D. Ecological Validation of Machine Learning Models for Spatiotemporal Gait Analysis in Free-Living Environments Using Instrumented Insoles. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3188895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ton T. H. Duong
- Dept. of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - David Uher
- Dept. of Rehabilitation & Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jacqueline Montes
- Dept. of Rehabilitation & Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Damiano Zanotto
- Dept. of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
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Odonkor CA, Taraben S, Tomkins-Lane C, Zhang W, Muaremi A, Leutheuser H, Sun R, Smuck M. Examining the Association Between Self-Reported Estimates of Function and Objective Measures of Gait and Physical Capacity in Lumbar Stenosis. Arch Rehabil Res Clin Transl 2021; 3:100147. [PMID: 34589697 PMCID: PMC8463455 DOI: 10.1016/j.arrct.2021.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: To evaluate the association of self-reported physical function with subjective and objective measures as well as temporospatial gait features in lumbar spinal stenosis (LSS). Design: Cross-sectional pilot study. Setting: Outpatient multispecialty clinic. Participants: Participants with LSS and matched controls without LSS (n=10 per group; N=20). Interventions: Not applicable. Main Outcome Measures: Self-reported physical function (36-Item Short Form Health Survey [SF-36] physical functioning domain), Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, the Neurogenic Claudication Outcome Score, and inertia measurement unit (IMU)-derived temporospatial gait features Results: Higher self-reported physical function scores (SF-36 physical functioning) correlated with lower disability ratings, neurogenic claudication, and symptom severity ratings in patients with LSS (P<.05). Compared with controls without LSS, patients with LSS have lower scores on physical capacity measures (median total distance traveled on 6-minute walk test: controls 505 m vs LSS 316 m; median total distance traveled on self-paced walking test: controls 718 m vs LSS 174 m). Observed differences in IMU-derived gait features, physical capacity measures, disability ratings, and neurogenic claudication scores between populations with and without LSS were statistically significant. Conclusions: Further evaluation of the association of IMU-derived temporospatial gait with self-reported physical function, pain related-disability, neurogenic claudication, and spinal stenosis symptom severity score in LSS would help clarify their role in tracking LSS outcomes.
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Affiliation(s)
- Charles A Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT.,Orthopedics and Rehabilitation, Interventional Pain Medicine and Physiatry, Yale New Haven Hospital, New Haven, CT
| | - Salam Taraben
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Wei Zhang
- Department of Essential Medicine and Health Product, World Health Organization, Geneva, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Heike Leutheuser
- Central Institute for Medical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ruopeng Sun
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
| | - Matthew Smuck
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
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Stanton TR, Braithwaite FA, Butler D, Moseley GL, Hill C, Milte R, Ratcliffe J, Maher C, Tomkins-Lane C, Pulling BW, MacIntyre E, Esterman A, Stanford T, Lee H, Fraysse F, Metcalf B, Mouatt B, Bennell K. The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis - a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis. BMC Musculoskelet Disord 2021; 22:738. [PMID: 34454458 PMCID: PMC8401372 DOI: 10.1186/s12891-021-04561-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program. Methods Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. Discussion We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04561-6.
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Affiliation(s)
- Tasha R Stanton
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
| | - Felicity A Braithwaite
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - David Butler
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.,NOIgroup Pty Ltd, Adelaide, South Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Catherine Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Brian W Pulling
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Erin MacIntyre
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Ty Stanford
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Francois Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Brendan Mouatt
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
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Physical activity thresholds for predicting longitudinal gait decline in adults with knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:965-972. [PMID: 33865966 DOI: 10.1016/j.joca.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the longitudinal relationship between physical performance (via real-life accelerometry) and physical capacity (laboratory measurement of gait speed) in patients with knee osteoarthritis (KOA), and to derive accelerometry measured thresholds associated with gait speed decline in KOA that may provide targets for disease-specific physical activity guidelines. DESIGN Longitudinal data from the Osteoarthritis Initiative (OAI) accelerometer sub-study was extracted from 1,229 participants assessed 2 years apart. Extracted data include functional capacity, demographic and anthropometric characteristics, patient-reported outcome measures, and accelerometry-based physical activity measures. A "poor capacity" group was defined based on the gait speed quintile decline between baseline and the 2-yr follow-up. A Random Forest classifier was trained to classify individuals' capacity status, and the impact of each extracted factor on the prediction outcome was analyzed using a novel machine learning interpretation algorithm. RESULTS The most impactful predicting feature for gait decline is low minutes in the performance of moderate-vigorous activity (count per min 2,500+). Slower sit-to-stand performance, higher age and self-reported knee pain, and lower minutes in performance light activities (count per min 350-2499) also contributed to the model prediction. The overall classification accuracy is 76.3% (75.4% sensitivity, 76.5% specificity). CONCLUSIONS We investigated the impact magnitude and direction of each predicting feature on the longitudinal capacity status among KOA patients. Using novel data interpretation method, we established feature thresholds that may increase the probability of gait decline. These identified thresholds may provide meaningful information for establishing specific physical activity guidelines for KOA.
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Smuck M, Schneider BJ, Ehsanian R, Martin E, Kao MCJ. Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain. PAIN MEDICINE 2021; 21:1759-1768. [PMID: 31578562 DOI: 10.1093/pm/pnz224] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Examine the interrelationship between smoking and pain in the US population. DESIGN A cross-sectional population-based study. SETTING Nationwide survey. METHODS Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003-2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions. RESULTS Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21-3.77), followed by headache (OR = 2.47, 95% CI = 1.73-3.53), trunk pain (OR = 2.17, 95% CI = 1.45-2.74), and limb pain (OR = 1.99, 95% CI = 1.45-2.73). CONCLUSIONS Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.
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Affiliation(s)
- Matthew Smuck
- Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Medical Center, Center for Musculoskeletal Research
| | - Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Department of Neurosurgery, Stanford University, Palo Alto, California.,Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Elizabeth Martin
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Ming-Chih J Kao
- Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
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13
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The emerging clinical role of wearables: factors for successful implementation in healthcare. NPJ Digit Med 2021; 4:45. [PMID: 33692479 PMCID: PMC7946921 DOI: 10.1038/s41746-021-00418-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/16/2021] [Indexed: 01/06/2023] Open
Abstract
Wearable technologies promise to redefine assessment of health behaviors, yet their clinical implementation remains a challenge. To address this gap, two of the NIH’s Big Data to Knowledge Centers of Excellence organized a workshop on potential clinical applications of wearables. A workgroup comprised of 14 stakeholders from diverse backgrounds (hospital administration, clinical medicine, academia, insurance, and the commercial device industry) discussed two successful digital health interventions that involve wearables to identify common features responsible for their success. Seven features were identified including: a clearly defined problem, integration into a system of healthcare delivery, technology support, personalized experience, focus on end-user experience, alignment with reimbursement models, and inclusion of clinician champions. Health providers and systems keen to establish new models of care inclusive of wearables may consider these features during program design. A better understanding of these features is necessary to guide future clinical applications of wearable technology.
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14
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Greenberg J, Mace RA, Popok PJ, Kulich RJ, Patel KV, Burns JW, Somers TJ, Keefe FJ, Schatman ME, Vranceanu AM. Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain. J Pain Res 2020; 13:2255-2265. [PMID: 32982388 PMCID: PMC7498493 DOI: 10.2147/jpr.s266455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures. PURPOSE To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement. METHODS Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based 6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function. RESULTS Performance-based and objective physical function were significantly interrelated (r=0.48, p<0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p<0.001), adaptive coping (β=-0.65, p<0.001) and social-emotional dysfunction (β=0.65, p<0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps>0.1). CONCLUSION Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity. TRIAL REGISTRATION ClinicalTrials.gov NCT03412916.
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Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - John W Burns
- Division of Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Tamara J Somers
- Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Francis J Keefe
- Department of Medicine, Duke University School of Medicine, Durham, NC, US
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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15
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Lawal TA, Todd JJ, Elliott JS, Linton MM, Andres M, Witherspoon JW, Collins JP, Chrismer IC, Tounkara F, Waite MR, Nichols C, Bönnemann CG, Vuillerot C, Bendixen R, Jain MS, Meilleur KG. Assessing Motor Function in Congenital Muscular Dystrophy Patients Using Accelerometry. J Neurosci Nurs 2020; 52:172-178. [PMID: 32511172 PMCID: PMC10449085 DOI: 10.1097/jnn.0000000000000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND When tested in a controlled clinic environment, individuals with neuromuscular-related symptoms may complete motor tasks within normal predicted ranges. However, measuring activity at home may better reflect typical motor performance. The accuracy of accelerometry measurements in individuals with congenital muscular dystrophy (CMD) is unknown. We aimed to compare accelerometry and manual step counts and assess free-living physical activity intensity in individuals with CMD using accelerometry. METHODS Ambulatory pediatric CMD participants (n = 9) performed the 6-minute walk test in clinic while wearing ActiGraph GT3X accelerometer devices. During the test, manual step counting was conducted to assess concurrent validity of the ActiGraph step count in this population using Bland-Altman analysis. In addition, activity intensity of 6 pediatric CMD participants was monitored at home with accelerometer devices for an average of 7 days. Cut-point values previously validated for neuromuscular disorders were used for data analysis. RESULTS Bland-Altman and intraclass correlation analyses showed no concurrent validity between manual and ActiGraph-recorded step counts. Fewer steps were recorded by ActiGraph step counts compared with manual step counts (411 ± 74 vs 699 ± 43, respectively; P = .004). Although improved, results were in the same direction with the application of low-frequency extension filters (587 ± 40 vs 699 ± 43, P = .03). ActiGraph step-count data did not correlate with manual step count (Spearman ρ = 0.32, P = .41; with low-frequency extension: Spearman ρ = 0.45, P = .22). Seven-day physical activity monitoring showed that participants spent more than 80% of their time in the sedentary activity level. CONCLUSIONS In a controlled clinic setting, step count was significantly lower by ActiGraph GT3X than by manual step counting, possibly because of the abnormal gait in this population. Additional studies using triaxial assessment are needed to validate accelerometry measurement of activity intensity in individuals with CMD. Accelerometry outcomes may provide valuable measures and complement the 6-minute walk test in the assessment of treatment efficacy in CMD.
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Chin SH, Huang WL, Akter S, Binks M. Obesity and pain: a systematic review. Int J Obes (Lond) 2019; 44:969-979. [PMID: 31848456 DOI: 10.1038/s41366-019-0505-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES The current systematic review considered research published within the 10 years preceding June 2019, dealing with the topic of obesity and pain. Within the context of the complex biological and behavioral interrelationships among these phenomena, we sought to identify gaps in the literature and to highlight key targets for future transdisciplinary research. The overarching inclusion criteria were that the included studies could directly contribute to our understanding of these complex phenomena. METHODS We searched PubMed/Medline/Cochrane databases dating back 10 years, using the primary search terms "obesity" and "pain," and for a secondary search we used the search terms "pain" and "diet quality." RESULTS Included studies (n = 70) are primarily human; however, some animal studies were included to enhance understanding of related basic biological phenomena and/or where human data were absent or significantly limited. CONCLUSIONS Our overall conclusions highlight (1) the mechanisms of obesity-related pain (i.e., mechanical, behavioral, and physiological) and potential biological and behavioral contributors (e.g., gender, distribution of body fat, and dietary factors), (2) the requirement for accurate and reliable objective measurement, (3) the need to integrate biological and behavioral contributors into comprehensive, well-controlled prospective study designs.
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Affiliation(s)
- Shao-Hua Chin
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Wei-Lin Huang
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Sharmin Akter
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Martin Binks
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA.
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17
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Subjective and Objective Measures of Daytime Activity and Sleep Disturbance in Retinitis Pigmentosa. Optom Vis Sci 2019; 95:837-843. [PMID: 30169358 DOI: 10.1097/opx.0000000000001265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
SIGNIFICANCE Objectively measured limitations in daytime activity levels appear to be inextricably linked with sleep disturbances in retinitis pigmentosa (RP) patients, as well as associated with unemployment status and central vision loss. Innovative interventional strategies should be developed to help improve these issues and overall quality of life for RP patients. PURPOSE Novel sensor devices are emerging as valuable tools to objectively assess behavior. We used validated measures of wrist accelerometry to determine relationships between sleep, vision, and physical activity in RP subjects. METHODS For one week, 33 RP adults wore a wrist Actiwatch to detect movement during the day (average total activity counts) and disturbed sleep at night. They completed Early Treatment Diabetic Retinopathy Study visual acuity testing, Pelli-Robson contrast sensitivity, Goldmann V4e visual fields, and sleep diaries and validated questionnaires to assess their sleep and general health. RESULTS Greater wake after sleep onset time measured with actigraphy (i.e., sleep disruption) (P = .01), loss of visual acuity (P = .009), and nonemployment/student status (P = .002) were all significant predictors of reduced daytime average total activity counts in a multiple linear regression model, after adjusting for contrast sensitivity as a cooperative suppressor variable (P = .01) (R = 0.54). Fragmentation measured with actigraphy (i.e., restlessness during sleep) (P = .07) and decreased sleep quality ratings reported upon awakening by the participants in a sleep diary (P = .06) were each marginally associated with reduced daytime average total activity counts, whereas nonemployment/student status, reduced visual acuity, and contrast sensitivity were still significant predictors. Objective and subjective measures of sleep or daytime activity were not statistically significantly correlated (P > .05). CONCLUSIONS We find nonemployment/student status and sleep disturbances appear to be related to reduced daytime activity levels in adults with central vision loss due to RP. These findings underscore the importance of developing and evaluating interventions to help RP patients maintain engagement in productive activities and improve their disturbed sleep.
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Measurement properties of walking outcome measures for neurogenic claudication: a systematic review and meta analysis. Spine J 2019; 19:1378-1396. [PMID: 30986579 DOI: 10.1016/j.spinee.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Selecting a walking outcome measure for neurogenic claudication requires knowledge of its measurement properties. PURPOSE To systematically review and appraise the literature on the measurement properties of walking outcome measures for patients with neurogenic claudication. STUDY DESIGN A systematic review and meta-analysis. METHODS A systematic search was conducted on the following seven databases: PubMed, PsychINFO, Web of Science, Embase, CINAHL, MEDLINE, and Cochrane Central Register of Controlled Trials. Clinical studies that assessed a measurement property of a walking outcome measure for patients with neurogenic claudication were selected. The methodological quality of studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement property results were assessed using the adapted criteria from Terwee et al. (2007). RESULTS Twelve studies that evaluated 15 separate walking outcome measures were included. Out of the 12 studies included, half had poor methodological quality. Four measures had acceptable test-retest reliability: the self-paced walking test (intraclass correlation coefficient, or ICC was 0.98, 95% CI: 0.95-0.99), Physical Function Scale (PFS) (pooled analysis ICC = 0.79, 95% CI: 0.77-0.89), PFS walk item (ICC = 0.81, 95% CI: 0.68-0.89), and Oswestry Disability Index (ODI) walk item (ICC = 0.86, 95% CI: 0.76-0.92). Responsiveness was assessed on five walking outcome measures, and three had adequate responsiveness: the ODI walk item (Area under the Curve, or AUC, was 0.76, SD 0.15), Treadmill test (AUC = 0.70), and PFS (AUC = 0.77, SD 0.14). A meta-analysis demonstrated the PFS had adequate test retest reliability (pooled ICC = 0.79, 95% CI: 0.77-0.89) and internal consistency (pooled Cronbach's αlpha (α) = 0.84, 95% CI: 0.81-0.86), but not criterion validity (pooled correlation coefficient = -0.59, 95% CI: -0.71, -0.45). Measures that recorded adequate criterion validity were the ODI walk item (pooled correlation coefficient = -0.71, 95% CI: -0.80, -0.58), Treadmill test (pooled correlation coefficient = 0.86, 95% CI: 0.78-0.91), and self predicted walking item (pooled correlation coefficient = 0.74, 95% CI: 0.63-0.82). CONCLUSIONS The results of our systematic review demonstrated that high-quality studies that asses the measurement properties of walking outcome measures for patients with neurogenic claudication are lacking. There was only limited evidence available for each walking measure, which prevented any single outcome from being confirmed as the gold standard measure of neurogenic claudication. Clinicians and researchers are recommended to use the self-paced walking test and ODI walk item until further evidence is available. Future research should focus on producing high-quality studies with excellent methodology and larger sample sizes.
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Yoshida A, Kurimoto S, Iwatsuki K, Saeki M, Nishizuka T, Nakano T, Yoneda H, Onishi T, Yamamoto M, Tatebe M, Hirata H. Upper extremity disability is associated with pain intensity and grip strength in women with bilateral idiopathic carpal tunnel syndrome. NeuroRehabilitation 2019; 44:199-205. [PMID: 30856127 DOI: 10.3233/nre-182589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The upper extremity disability in patients with carpal tunnel syndrome (CTS) is related to dysfunction due to the median nerve damage. However, there is no report on which dysfunctions affect the upper extremity disability. PURPOSE This study aimed to investigate which clinical factors influence upper extremity disability in women with CTS. METHODS We analyzed 60 hands of women with bilateral idiopathic CTS. Upper extremity disability was assessed using Hand10, a validated and self-administered tool. Pain intensity was measured using the Japanese version of the Short-Form McGill Pain Questionnaire (SF-MPQ-J). We performed nerve conduction studies, assessed physical and psychological parameters, and collected demographic data. Physical parameters comprised grip strength, pinch strength, tactile threshold, static 2-point discrimination sensation, and severity of numbness. Psychological parameters include depression, pain anxiety, and distress. RESULTS The bivariate analysis revealed that Hand10 was significantly correlated with age, symptom duration, SF-MPQ-J, grip strength, pain anxiety, and distress. Multiple regression analysis demonstrated that SF-MPQ-J and grip strength were related to Hand10 score. CONCLUSIONS Pain intensity and grip strength were dysfunctions affecting the upper extremity disability in women with bilateral idiopathic CTS. Rehabilitation approaches for CTS should be considered based on the adaptive activities of the neural networks.
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Affiliation(s)
- Akihito Yoshida
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masaomi Saeki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takanobu Nishizuka
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Tomonori Nakano
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Tetsurou Onishi
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masahiro Tatebe
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Tomkins-Lane C, Norden J, Sinha A, Hu R, Smuck M. Digital biomarkers of spine and musculoskeletal disease from accelerometers: Defining phenotypes of free-living physical activity in knee osteoarthritis and lumbar spinal stenosis. Spine J 2019; 19:15-23. [PMID: 30025995 DOI: 10.1016/j.spinee.2018.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) and knee osteoarthritis (OA) are 2 of the leading causes of disability worldwide. In order to provide disease-specific prescriptions for physical activity, there is a clear need to better understand physical activity in daily life (performance) in these populations. PURPOSE To discover performance phenotypes for LSS and OA by applying novel analytical methods to accelerometry data. Specific objectives include the following: (1) to identify characteristic features (phenotypes) of free-living physical activity unique to individuals with LSS and OA, and (2) to determine which features can best differentiate between these conditions. STUDY DESIGN AND SETTING Leveraging data from 3 existing cross-sectional cohorts, accelerometry signal feature characterization and selection were performed in a computational laboratory. PATIENT SAMPLE Data from a total of 4,028 individuals were analyzed from the following 3 datasets: LSS Accelerometry Database (n=75); OA Initiative (n=1950); and the 2003 to 2004 National Health and Nutrition Examination Survey (pain-free controls, n=2003). METHODS In order to characterize the accelerometry signals, data were examined using (1) standard intervals for counts/minute from Freedson et al. and (2) the physical performance intervals for mobility-limited pain populations. From this, 42 novel accelerometry features were defined and evaluated for significance in discriminating between the groups (LSS, OA, and controls) in order to then determine which sparse set of features best differentiates between the groups. These sparse sets of features defined the performance phenotypes. OUTCOME MEASURES Accelerometry features and their ability to differentiate between individuals with LSS, OA, and controls. RESULTS Given age and gender, classification rates were at least 80% accurate (pairwise) between diseased and pain-free populations (LSS vs. controls and OA vs. controls). The most important features to distinguish between disease groups corresponded to measures in the light and sedentary activity intervals. The more subtle classification between diseased populations (LSS vs. OA) was 72% accurate, with light and moderate activity providing the prominent distinguishing features. CONCLUSIONS We describe the discovery of performance phenotypes of LSS and OA from accelerometry data, revealed through a novel set of features that characterize daily patterns of movement in people with LSS and OA. These performance phenotypes provide a new method for analyzing free-living physical activity (performance) in LSS and OA, and provide the groundwork for more personalized approaches to measuring and improving function.
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Affiliation(s)
- Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada.
| | - Justin Norden
- Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, USA
| | - Aman Sinha
- Department of Electrical Engineering, Stanford University, 350 Serra Mall, Stanford, CA 94305, USA
| | - Richard Hu
- Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA
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21
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Agarwal V, Smuck M, Tomkins-Lane C, Shah NH. Inferring Physical Function From Wearable Activity Monitors: Analysis of Free-Living Activity Data From Patients With Knee Osteoarthritis. JMIR Mhealth Uhealth 2018; 6:e11315. [PMID: 30394876 PMCID: PMC6315255 DOI: 10.2196/11315] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
Background Clinical assessments for physical function do not objectively quantify routine daily activities. Wearable activity monitors (WAMs) enable objective measurement of daily activities, but it remains unclear how these map to clinically measured physical function measures. Objective This study aims to derive a representation of physical function from daily measurements of free-living activity obtained through a WAM. In addition, we evaluate our derived measure against objectively measured function using an ordinal classification setup. Methods We defined function profiles representing average time spent in a set of pattern classes over consecutive days. We constructed a function profile using minute-level activity data from a WAM available from the Osteoarthritis Initiative. Using the function profile as input, we trained statistical models that classified subjects into quartiles of objective measurements of physical function as measured through the 400-m walk test, 20-m walk test, and 5 times sit-stand test. Furthermore, we evaluated model performance on held-out data. Results The function profile derived from minute-level activity data can accurately predict physical performance as measured through clinical assessments. Using held-out data, the Goodman-Kruskal Gamma statistic obtained in classifying performance values in the first quartile, interquartile range, and the fourth quartile was 0.62, 0.53, and 0.51 for the 400-m walk, 20-m walk, and 5 times sit-stand tests, respectively. Conclusions Function profiles accurately represent physical function, as demonstrated by the relationship between the profiles and clinically measured physical performance. The estimation of physical performance through function profiles derived from free-living activity data may enable remote functional monitoring of patients.
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Affiliation(s)
- Vibhu Agarwal
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, United States
| | - Matthew Smuck
- Stanford University Hospital and Clinics, Stanford, CA, United States
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, United States
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Dillon CF, Weisman MH. US National Health and Nutrition Examination Survey Arthritis Initiatives, Methodologies and Data. Rheum Dis Clin North Am 2018; 44:215-265. [PMID: 29622293 DOI: 10.1016/j.rdc.2018.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The US National Health and Nutrition Examination Survey (NHANES) has collected population-based, nationally representative examination, laboratory, and radiographic data for arthritis and musculoskeletal diseases for more than 50 years. The resulting body of data and publications are substantial, yet much data remain unpublished. This review provides a basic understanding of the design and capabilities of the NHANES survey, reviewing the major accomplishments in the area of arthritis and musculoskeletal diseases. Currently available US National Health and Nutrition Examination Survey arthritis-related datasets are identified. Guidelines for using these data, and opportunities for data analysis and designing future studies are presented.
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Affiliation(s)
| | - Michael H Weisman
- Division of Rheumatology, Cedars Sinai Medical Center, 1545 Calmar Court, Los Angeles, CA 90024, USA
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Sandell Jacobsen J, Thorborg K, Hölmich P, Bolvig L, Storgaard Jakobsen S, Søballe K, Mechlenburg I. Does the physical activity profile change in patients with hip dysplasia from before to 1 year after periacetabular osteotomy? Acta Orthop 2018; 89:622-627. [PMID: 30334645 PMCID: PMC6300733 DOI: 10.1080/17453674.2018.1531492] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Knowledge of physical activity profiles among patients with hip dysplasia is lacking. We investigated whether patients with hip dysplasia change physical activity profile from before to 1 year after periacetabular osteotomy. Furthermore, we investigated associations between change in accelerometer-based physical activity and change in self-reported participation in preferred physical activities (PA). Patients and methods - Physical activity was objectively measured at very low to high intensity levels with accelerometer-based sensors. Subjectively, PA was recorded with Copenhagen Hip and Groin Outcome Score (HAGOS) in 77 patients. Associations between the 2 were analyzed with simple linear regression analyses. Results - Changes in accelerometer-based physical activity ranged from -2.2 to 4.0% points at all intensity levels from baseline to 1-year follow-up. These changes represent very small effect sizes (-0.16 to 0.14). In contrast, self-reported PA showed a statistically and clinically relevant increase of 22 (CI 14-29) HAGOS PA points 1 year post-surgery. Associations between change in accelerometer-based physical activity and change in self-reported PA were, however, not statistically significant and correspond to a percentage change in physical activity of only -0.87% to 0.65% for a change of 10 HAGOS PA points. Interpretation - Patients with hip dysplasia do not seem to change physical activity profile 1 year post-surgery if measured with objective accelerometer-based sensors. This is interesting as self-reported PA indicates that patients' ability to participate in physical activity increases, suggesting that this increased self-reported participatory capacity is not manifested as increased objectively measured physical activity.
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Affiliation(s)
- Julie Sandell Jacobsen
- Department of Physiotherapy and Department of Research in Rehabilitation and Health Promotion, Faculty of Health Sciences, VIA University College, Aarhus;; ,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus;; ,*Correspondence:
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre;;
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre;;
| | - Lars Bolvig
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark;;
| | | | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark;; ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;;
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark;; ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;; ,Department of Public Health, Aarhus University, Aarhus, Denmark
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Kluge F, Hannink J, Pasluosta C, Klucken J, Gaßner H, Gelse K, Eskofier BM, Krinner S. Pre-operative sensor-based gait parameters predict functional outcome after total knee arthroplasty. Gait Posture 2018; 66:194-200. [PMID: 30199778 DOI: 10.1016/j.gaitpost.2018.08.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the general success of total knee arthroplasty (TKA) regarding patient-reported outcome measures, studies investigating gait function have shown diverse functional outcomes. Mobile sensor-based systems have recently been employed for accurate clinical gait assessments, as they allow a better integration of gait analysis into clinical routines as compared to laboratory based systems. RESEARCH QUESTION In this study, we sought to examine whether an accurate assessment of gait function of knee osteoarthritis patients with respect to surgery outcome evaluation after TKA using a mobile sensor-based gait analysis system is possible. METHODS A foot-worn sensor-based system was used to assess spatio-temporal gait parameters of 24 knee osteoarthritis patients one day before and one year after TKA, and in comparison to matched control participants. Patients were clustered into positive and negative responder groups using a heuristic approach regarding improvements in gait function. Machine learning was used to predict surgery outcome based on pre-operative gait parameters. RESULTS Gait function differed significantly between controls and patients. Patient-reported outcome measures improved significantly after surgery, but no significant global gait parameter difference was observed between pre- and post-operative status. However, the responder groups could be correctly predicted with an accuracy of up to 89% using pre-operative gait parameters. Patients exhibiting high pre-operative gait function were more likely to experience a functional decrease after surgery. Important gait parameters for the discrimination were stride time and stride length. SIGNIFICANCE The early identification of post-surgical functional outcomes of patients is of great importance to better inform patients pre-operatively regarding surgery success and to improve post-surgical management.
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Affiliation(s)
- Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Carl-Thiersch-Str. 2b, 91052 Erlangen, Germany.
| | - Julius Hannink
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Carl-Thiersch-Str. 2b, 91052 Erlangen, Germany.
| | - Cristian Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, 79110 Freiburg, Germany.
| | - Jochen Klucken
- Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Heiko Gaßner
- Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Kolja Gelse
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Carl-Thiersch-Str. 2b, 91052 Erlangen, Germany.
| | - Sebastian Krinner
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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