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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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Anthony EC, Kam OK, Klisch SM, Hazelwood SJ, Berg-Johansen B. Balance Assessment Using a Handheld Smartphone with Principal Component Analysis for Anatomical Calibration. SENSORS (BASEL, SWITZERLAND) 2024; 24:5467. [PMID: 39275378 PMCID: PMC11397924 DOI: 10.3390/s24175467] [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: 07/01/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/16/2024]
Abstract
Most balance assessment studies using inertial measurement units (IMUs) in smartphones use a body strap and assume the alignment of the smartphone with the anatomical axes. To replace the need for a body strap, we have used an anatomical alignment method that employs a calibration maneuver and Principal Component Analysis (PCA) so that the smartphone can be held by the user in a comfortable position. The objectives of this study were to determine if correlations existed between angular velocity scores derived from a handheld smartphone with PCA functional alignment vs. a smartphone placed in a strap with assumed alignment, and to analyze acceleration score differences across balance poses of increasing difficulty. The handheld and body strap smartphones exhibited moderately to strongly correlated angular velocity scores in the calibration maneuver (r = 0.487-0.983, p < 0.001). Additionally, the handheld smartphone with PCA functional calibration successfully detected significant variance between pose type scores for anteroposterior, mediolateral, and superoinferior acceleration data (p < 0.001).
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Affiliation(s)
- Evan C Anthony
- Mechanical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - Olivia K Kam
- Biomedical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - Stephen M Klisch
- Mechanical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
- Biomedical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - Scott J Hazelwood
- Mechanical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
- Biomedical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - Britta Berg-Johansen
- Biomedical Engineering Department, College of Engineering, California Polytechnic State University, San Luis Obispo, CA 93407, USA
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Cabo CA, Hernández-Beltrán V, Gamonales JM, Fernandes O, Espada MC, Parraca JA. Evolution of documents related to the influence of physical activity and functional capacity throughout the aging process: a bibliometric review. Front Physiol 2024; 15:1427038. [PMID: 39156828 PMCID: PMC11327041 DOI: 10.3389/fphys.2024.1427038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Physical inactivity can lead to frailty and negative health outcomes in middle-aged to older adults. Sedentary individuals have double the risk of death compared to those who engage in high levels of physical activity (PA). The advantages of practicing PA in older age are significant, with regular, moderate-intensity activity (150 min per week)being consistently linked with a decreased risk of chronic disease, cognitive decline, and mortality. Therefore, the study aimed to carry out a bibliometric review related to the terms "Physical activity," "Functional capacity" and "Aging" including all the documents published in the Web of Science Core Collection until 31st December 2023. The sample was made up of 231 studies related to the topic. The results reported that the first document was published in 1994. However, there was no continuity in the publication of the documents till 1998, which was the first year with at least one document published. Considering 1998 as the first year, it is observed an exponential growth of 77.4%, between the oldest (1997-2008) and contemporaneous studies (2008-2023), in which "Geriatric Gerontology" was the Web of Science category with the highest number of documents (n = 59). The journal "Experimental Gerontology" was associated with the largest number of published documents (n = 7), being indexed in Quartil 2. The years 2009 had the highest number of citations (n = 1811), with a total of 7 documents published and 2018 with the higher number of documents (n = 25). These results reported the importance of PA in elderly people, and how it influences the risk of falls, improving the balance and the functional capacity. Thus, it is important to carry out programmes to promote physical activity to this population and reduce the risk of falls and the presence of diseases.
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Affiliation(s)
- Carolina A. Cabo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
- Instituto Politécnico de Setúbal, Escola Superior de Educação, Setúbal, Portugal
- Sport Physical Activity and Health Research and Innovation Center (SPRINT), Rio Maior, Portugal
| | - Víctor Hernández-Beltrán
- Training Optimization and Sports Performance Research Group (GOERD), Faculty of Sport Science, University of Extremadura, Cáceres, Spain
| | - José M. Gamonales
- Training Optimization and Sports Performance Research Group (GOERD), Faculty of Sport Science, University of Extremadura, Cáceres, Spain
- Faculty of Education and Psychology, University of Extremadura, Badajoz, Spain
- Programa de Doctorado en Educación y Tecnología, Universidad a Distancia de Madrid, Madrid, Spain
| | - Orlando Fernandes
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
| | - Mário C. Espada
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
- Instituto Politécnico de Setúbal, Escola Superior de Educação, Setúbal, Portugal
- Sport Physical Activity and Health Research and Innovation Center (SPRINT), Rio Maior, Portugal
- Life Quality Research Centre (CIEQV), Setúbal, Portugal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - José A. Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Brognara L. Gait Assessment Using Smartphone Applications in Older Adults: A Scoping Review. Geriatrics (Basel) 2024; 9:95. [PMID: 39051259 PMCID: PMC11270307 DOI: 10.3390/geriatrics9040095] [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: 06/27/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
Spatiotemporal parameters such as gait velocity and stride length are simple indicators of functional status and can be used to predict major adverse outcomes in older adults. A smartphone can be used for gait analysis by providing spatiotemporal parameters useful for improving the diagnosis and rehabilitation processes in frail people. The aim of this study was to review articles published in the last 20 years (from 2004 to 2024) concerning the application of smartphones to assess the spatiotemporal parameters of gait in older adults. This systematic review was performed in line with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), and original articles were identified by searching seven electronic databases: SciVerse (ScienceDirect), Excerpta Medica Database (EMBASE), Medline, Scopus, PubMed, Web of Science and the Cochrane Library. Studies were rigorously screened using the inclusion criteria of smartphones and mobile apps, older adults and spatiotemporal gait parameters, and results were narratively synthesized. Seventy-three articles were initially identified while searching the scientific literature regarding this topic. Eleven articles were selected and included in this review. Analysis of these studies covered information about gait assessment using mobile apps recorded in 723 older adults and 164 control cases. Analysis of data related to the application of smartphones to assess spatiotemporal parameters of gait in older adults showed moderate-to-excellent test-retest reliability and validity (ICCs around 0.9) of gait speed, the most common parameter reported. Additionally, gait speeds recorded with mobile apps showed excellent agreement when compared to gold standard systems. Smartphones and mobile apps are useful, non-invasive, low-cost and objective tools that are being extensively used to perform gait analysis in older adults. Smartphones and mobile apps can reliably identify spatiotemporal parameters related to adverse outcomes, such as a slow gait speed, as predictors and outcomes in clinical practice and research involving older adults.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40123 Bologna, Italy
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Thomas J, Hall JB, Schauffler R, Guess TM. Objective Clinical Measurement Tools for Functional Evaluation of the Surgical Patient. J Knee Surg 2024; 37:577-585. [PMID: 37562433 DOI: 10.1055/s-0043-1772222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Following knee surgery, clinicians have traditionally used visually rated or time-based assessments of lower extremity movement quality to measure surgical outcomes, plan rehabilitation interventions, and measure success. These methods of assessment are prone to error and do not fully capture a patient's inefficient movement patterns post surgery. Further, currently available systems which objectively measure kinematics during these tasks are expensive and unidimensional. For these reasons, recent research has called for the development of objective and low-cost precision rehabilitation tools to improve clinical measurement of movement tasks. The purpose of this article is to highlight two such tools and their applications to knee surgery. The systems highlighted within this article are the Mizzou Point-of-Care Assessment System (MPASS) and the Mizzou Knee Arthrometer Testing System (MKATS). MPASS has demonstrated high levels of agreement with the gold-standard Vicon system in measuring kinematics during sit-to-stand (R > 0.71), lateral step-down (intraclass correlation coefficient [ICC] > 0.55, apart from ankle flexion), and drop vertical jump tasks (ICC > 0.62), as well as gait (R > 0.87). MKATS has been used to quantify differences in tibiofemoral motion between groups during lateral step-down, step-up-and-over, and step-up/step-down tasks. Objective measurement of clinical tasks using portable and inexpensive instruments, such as the MPASS and MKATS, can help clinicians identify inefficient movement patterns and asymmetries which may damage and wear down supporting structures within the knee and throughout the kinetic chain causing pain and discomfort. Identifying these issues can help clinicians to plan interventions and measure their progress at a lower cost than currently available systems. The MPASS and MKATS are useful tools which have many applications to knee surgery.
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Affiliation(s)
- Jacob Thomas
- College of Health Sciences, University of Missouri, Columbia, Missouri
| | - Jamie B Hall
- Department of Physical Therapy, University of Missouri, Columbia, Missouri
| | - Rose Schauffler
- Department of Mechanical Engineering, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Department of Physical Therapy, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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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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Ni Y, Li S, Lv X, Wang Y, Xu L, Xi Y, Sun Y, Bao J, Liao S, Li Y. Efficacy of sensory-based static balance training on the balance ability, aging attitude, and perceived stress of older adults in the community: a randomized controlled trial. BMC Geriatr 2024; 24:49. [PMID: 38212725 PMCID: PMC10782606 DOI: 10.1186/s12877-023-04596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study explores the effect of sensory-based static balance training on the balance ability, aging attitude, and perceived stress of older adults in the community. It provides a practical basis for the in-depth implementation and revision of the community health management model. METHODS A randomized controlled intervention study was conducted from 2022 to 2023. A total of 72 older adults were recruited and randomly divided into an intervention group (36 individuals) and a control group (36 individuals). Balance ability (measured by the Short Physical Performance Battery and One Leg Stand Test), aging attitudes, and perceived stress were assessed at baseline and at the 12-week and 24-week follow-ups. Repeated-measures ANOVA and generalized estimating equations were used to compare outcome measures. RESULTS Sensory-based static balance training was beneficial for balance ability and aging attitude among participants in the intervention group. At the end of the intervention, participants in the intervention group showed significant improvements in SPPB scores and OLST scores compared with the control group (FSPPB = 12.347, P = 0.001, Waldχ2OLST = 45.530, P < 0.001), as well as significant differences in aging attitudes (FAAQ = 18.549, P < 0.001). Multiple comparisons at different time points in the intervention group reveal a significant intervention effect (FSPPB = 29.211, Waldχ2OLST = 80.428, FAAQ = 45.981, all P < 0.05). However, the difference in perceived stress before and after the intervention was not significant (FCPSS = 2.876, P = 0.095). CONCLUSIONS Sensory-based static balance training significantly improved balance ability and aging attitudes among older adults in the community. The effect on perceived stress among older adults in the community was not significant. TRIAL REGISTRATION Registered in the Chinese Clinic on 04/06/2022. The registration number is ChiCTR2200060541.
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Affiliation(s)
- Yingyuan Ni
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
| | - Shasha Li
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China.
| | - Xiaoying Lv
- Department of Nursing, Huzhou Central Hospital, No. 1558 Sanhuan North Road, Wuxing District, Huzhou, Zhejiang, 313000, China
| | - Yuecong Wang
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
| | - Lijun Xu
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
| | - Yingxue Xi
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
| | - Yanhua Sun
- Department of Nursing, Huzhou Central Hospital, No. 1558 Sanhuan North Road, Wuxing District, Huzhou, Zhejiang, 313000, China
- Department of Orthopedics, Huzhou Central Hospital, Huzhou, No. 1558 Sanhuan North Road, Wuxing District, Zhejiang, 313000, China
| | - Jianyi Bao
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
| | - Shufang Liao
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
| | - Yue Li
- Department of Nursing, College of Medical Science, Huzhou University, No. 759 Second Ring Road, Huzhou City, Zhejiang Province, 313000, China
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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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Corrêa BDC, Santos EGR, Belgamo A, Pinto GHL, Xavier SS, Silva CC, Dias ÁRN, Paranhos ACM, Cabral ADS, Callegari B, Costa e Silva ADA, Quaresma JAS, Falcão LFM, Souza GS. Smartphone-based evaluation of static balance and mobility in long-lasting COVID-19 patients. Front Neurol 2023; 14:1277408. [PMID: 38148981 PMCID: PMC10750373 DOI: 10.3389/fneur.2023.1277408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Background SARS-CoV-2 infection can lead to a variety of persistent sequelae, collectively known as long COVID-19. Deficits in postural balance have been reported in patients several months after COVID-19 infection. The purpose of this study was to evaluate the static balance and balance of individuals with long COVID-19 using inertial sensors in smartphones. Methods A total of 73 participants were included in this study, of which 41 had long COVID-19 and 32 served as controls. All participants in the long COVID-19 group reported physical complaints for at least 7 months after SARS-CoV-2 infection. Participants were evaluated using a built-in inertial sensor of a smartphone attached to the low back, which recorded inertial signals during a static balance and mobility task (timed up and go test). The parameters of static balance and mobility obtained from both groups were compared. Results The groups were matched for age and BMI. Of the 41 participants in the long COVID-19 group, 22 reported balance impairment and 33 had impaired balance in the Sharpened Romberg test. Static balance assessment revealed that the long COVID-19 group had greater postural instability with both eyes open and closed than the control group. In the TUG test, the long COVID-19 group showed greater acceleration during the sit-to-stand transition compared to the control group. Conclusion The smartphone was feasible to identify losses in the balance motor control and mobility of patients with long-lasting symptomatic COVID-19 even after several months or years. Attention to the balance impairment experienced by these patients could help prevent falls and improve their quality of life, and the use of the smartphone can expand this monitoring for a broader population.
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Affiliation(s)
| | | | | | | | - Stanley Soares Xavier
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
| | - Camilla Costa Silva
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
| | | | - Alna Carolina Mendes Paranhos
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
| | | | - Bianca Callegari
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Brazil
| | | | - Juarez Antônio Simões Quaresma
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
- School of Medicine, São Paulo University, São Paulo, São Paulo, Brazil
| | | | - Givago Silva Souza
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
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10
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Shafi H, Awan WA, Olsen S, Siddiqi FA, Tassadaq N, Rashid U, Niazi IK. Assessing Gait & Balance in Adults with Mild Balance Impairment: G&B App Reliability and Validity. SENSORS (BASEL, SWITZERLAND) 2023; 23:9718. [PMID: 38139564 PMCID: PMC10747653 DOI: 10.3390/s23249718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&Balance smartphone application (G&B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50-75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant's lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&B App outcomes against both the force plate data and the clinical measures using Pearson's product-moment correlation coefficients. To assess the G&B App's sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r -0.70 and 0.67), step length (r -0.56 and -0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&B App measures of steadiness. Notably, G&B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&B App's potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app's accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.
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Affiliation(s)
- Hina Shafi
- Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Waqar Ahmed Awan
- Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Sharon Olsen
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
| | - Furqan Ahmed Siddiqi
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Naureen Tassadaq
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Usman Rashid
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Imran Khan Niazi
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
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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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Pooranawatthanakul K, Siriphorn A. Testing the validity and reliability of a new android application-based accelerometer balance assessment tool for community-dwelling older adults. Gait Posture 2023; 104:103-108. [PMID: 37379735 DOI: 10.1016/j.gaitpost.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/22/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Postural instability is a risk factor for falls in older adults. It is possible to detect postural stability using an integrated accelerometer (ACC) sensor in a smartphone. Therefore, a novel ACC-based smartphone application running on the Android operating system called BalanceLab was created and tested. PURPOSE This study aimed to determine the validity and reliability of a novel ACC-based Android smartphone application for assessing balance in older adults. METHODS Using BalanceLab, 20 older adults completed three balance assessments: the Modified Clinical Test of Sensory Interaction in Balance (MCTSIB), a single-leg stance test (SLST), and a limit of stability test (LOS). The validity of this mobile application was investigated using a three-dimensional (3D) motion analysis system and the Fullerton Advanced Balance (FAB) scale. The test-retest reliability of this mobile application was determined on two separate occasions within one day, at least two hours apart. RESULTS The two static balance assessments (the MCTSIB and SLST) demonstrated moderate to excellent correlation with the 3D motion analysis system (r = 0.70-0.91) and the FAB scale (r = 0.67-0.80). However, the majority of the dynamic balance tests (the LOS tests) did not demonstrate any correlation with the 3D motion analysis system or the FAB scale. This novel ACC-based application demonstrated good to excellent test-retest reliability (ICC = 0.76-0.91). CONCLUSION A static, but not dynamic, balance assessment tool that uses a novel ACC-based application for Android can be used to measure balance in older adults. This application has moderate to excellent validity and test-retest reliability.
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Affiliation(s)
- Kanokporn Pooranawatthanakul
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences Chulalongkorn University, Thailand
| | - Akkradate Siriphorn
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences Chulalongkorn University, Thailand.
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Sato EH, Stevenson KL, Blackburn BE, Peters C, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00358-3. [PMID: 37068568 DOI: 10.1016/j.arth.2023.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA. METHODS Prospective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement (HOOS-JR) and EuroQol-5 dimension (EQ5D). Physical activity was recorded on a wearable technology. Data was collected pre-operatively and at one, three, six, and twelve months post-operatively. Generalized estimating equations were used to evaluate outcomes over time. RESULTS Significant improvement occurred between pre- and post-operative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month post-operatively, each improving by at least one minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least one MCID (three months and one year, respectively). Gait speed and walking asymmetry returned to baseline by three months, but did not reach a MCID of improvement by one-year. CONCLUSION Patients can be counseled that the greatest proportional improvement in PROMs is within one month after THA, while function surpasses pre-operative baselines by three-months, and gait quality may not improve until after one-year. This can help set realistic expectations and target interventions toward patients deviating from the norm.
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Affiliation(s)
- Eleanor H Sato
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Brenna E Blackburn
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher Peters
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Michael J Archibeck
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher E Pelt
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lucas A Anderson
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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15
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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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Olsen S, Rashid U, Allerby C, Brown E, Leyser M, McDonnell G, Alder G, Barbado D, Shaikh N, Lord S, Niazi IK, Taylor D. Smartphone-based gait and balance accelerometry is sensitive to age and correlates with clinical and kinematic data. Gait Posture 2023; 100:57-64. [PMID: 36481647 DOI: 10.1016/j.gaitpost.2022.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Gait&Balance (G&B) App has produced valid and reliable measures of gait and balance in young healthy adults but has not been tested in older adults. RESEARCH QUESTION In healthy middle-to-older aged adults, are G&B App measurements sensitive to age, valid against clinical and kinematic measures, and reliable? METHOD Healthy participants (n = 34, 14 male, 42-94 years) completed the G&B App protocol three times within a single session. 3D kinematics were collected concurrently. Clinical balance measures were collected (Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), Mini Balance Evaluation Systems Test (MBT), and Functional Gait Assessment (FGA)). Sensitivity to age was assessed with Pearson's correlations. Validity tests included Pearson's correlations and Bland-Altman limits of agreement. Reliability tests included intra-class correlation coefficients and standard error of the measure. RESULTS During quiet stance on a compliant surface, the G&B App was sensitive to age-related differences not detectable with the mCTSIB. During walking tasks, there was adequate convergent validity between the MBT and G&B App measures of step length, and between the FGA and G&B App measures of walking speed, step length, and periodicity. The G&B App had moderate-to-excellent validity against 3D kinematics for postural stability during quiet stance (r 0.98 [0.98, 0.99]), step time (r 0.97 [0.96, 0.98]), walking speed (r 0.79 [0.7, 0.86]), and step length (r 0.73 [0.61, 0.81]). Test-retest reliability was moderate-to-excellent for G&B App measures of postural stability, walking speed, periodicity, step length, and step time. G&B App measures of step length asymmetry, step length variability, step time asymmetry, and step time variability had poor validity and reliability. SIGNIFICANCE The G&B App was sensitive to age-related differences in balance not detectable with clinical measurement. It provides valid and reliable measures of postural stability, step length, step time, and periodicity, which are not currently available in standard practice.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health & 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
| | - Celia Allerby
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Eliza Brown
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Michaela Leyser
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gabrielle McDonnell
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, 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
| | - Nusratnaaz Shaikh
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Sue Lord
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health & 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 & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Zhou Z, Huang Y, Wang J, Su H, Tang H, Wang Y. A novel digital biomarker of sarcopenia in frail elderly: New combination of gait parameters under dual-task walking. Front Aging Neurosci 2023; 15:1087318. [PMID: 36891555 PMCID: PMC9986265 DOI: 10.3389/fnagi.2023.1087318] [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: 11/12/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Background Frailty caused by deterioration in multiple physiological systems has led to a significant increase in adverse events such as falls, disability, and death in frail older people. Similar to frailty, sarcopenia, defined as loss of skeletal muscle mass and strength, is tightly related to mobility disorders, falls, and fractures. With population aging, co-occurrences of frailty and sarcopenia are increasingly common in the elderly, which are more deleterious for the health and independence of older adults. But the high similarity and overlap between the frailty and sarcopenia increase the difficulty of early recognition of frailty with sarcopenia. The purpose of this study is to use detailed gait assessment to determine the more convenient and sensitive digital biomarker of sarcopenia in the frail population. Methods Ninety-five frail elderly people (age = 86 ± 7 years old, BMI, and body mass index = 23.21 ± 3.40 kg/m2) were screened out by the evaluation of Fried criteria. Then, 41 participants (46%) were identified with sarcopenia, and 51 participants (54%) were identified without sarcopenia. Using a validated wearable platform, participants' gait performance was evaluated under single-task and dual-task (DT). Participants walked back and forth on the 7-m-long trail for 2 min at a habitual speed. Gait parameters of interest include cadence, gait cycle duration, step duration, gait speed, variability of gait speed, stride length, turn duration, and steps in turn. Results Our results showed that compared with the frail elderly without sarcopenia, the gait performance of the sarcopenic group in single-task and dual-task walking was worse. Overall, the parameters with high performance were the gait speed (DT) (OR 0.914; 95% CI 0.868-0.962) and turn duration (DT) (OR 7.907; 95% CI 2.401-26.039) under dual-task conditions, and the AUC in distinguishing between frail older adults with and without sarcopenia was 0.688 and 0.736, respectively. Turn duration in dual-task testing had larger observed effect than gait speed to identify sarcopenia in the frail population, this result remained significant even after controlling for potential confounds. When gait speed (DT) and turn duration (DT) were combined in the model, AUC increased from 0.688 to 0.763. Conclusion This study shows that gait speed and turn duration under dual-task are good predictors of sarcopenia in frail elderly, and turn duration (DT) has a better predictive ability. The gait speed (DT) combined with turn duration (DT) is a potential gait digital Biomarker of sarcopenia in the frail elderly. Dual-task gait assessment and detailed gait indexes provide important value for identification of sarcopenia in frail elderly people.
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Affiliation(s)
- Zheping Zhou
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yulun Huang
- Department of Neurosurgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Jing Wang
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huan Su
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Tang
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueju Wang
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Fukaya T, Mutsuzaki H, Mori K. Sway and Acceleration Changes of the Center of Mass during Walking Stance Phase before and after Total Knee Arthroplasty. Geriatrics (Basel) 2022; 8:geriatrics8010002. [PMID: 36648907 PMCID: PMC9844275 DOI: 10.3390/geriatrics8010002] [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: 10/18/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Elucidating the sway and changes in the acceleration of center of mass (COM) during walking is important for effective gait training and rehabilitation. The objective of this study was to verify the improvement in gait before and after total knee arthroplasty (TKA) from COM sway and the changes in the acceleration of COM during the stance phase of walking. This study included 13 patients (1 male and 12 females) with medial knee osteoarthritis who were hospitalized for TKA. The COM sway during the stance phase of walking was evaluated using root mean square (RMS) normalized by walking speed, and the changes in acceleration were further verified. Lateral and vertical RMS showed significant differences between preoperative and postoperative states and demonstrated low values after TKA. The lateral acceleration at the latter part of the early stance phase demonstrated a significant difference between preoperative and postoperative states. A significant difference was also observed in the lateral acceleration in the late stance phase between the two groups. Improvement in pain and alignment after TKA reduced the lateral sway of COM and the changes in acceleration during the gait stance phase, which is speculated to lead to improvement in gait and prevention of falls.
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Affiliation(s)
- Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura 300-0051, Japan
- Correspondence:
| | - Hirotaka Mutsuzaki
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Koichi Mori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
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Akgülle AH, Haidar M, Baştürk DK, Gündoğdu M, Coşkun ÖK. Hawthorne Effect in Gait Analysis of Children with In-Toeing Caused by Increased Femoral Anteversion. Indian J Orthop 2022; 56:1789-1794. [PMID: 36187586 PMCID: PMC9485350 DOI: 10.1007/s43465-022-00729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/20/2022] [Indexed: 02/04/2023]
Abstract
Background In-toeing is one of the main reasons children are applying to the orthopedics clinic. In the clinical settings, during in-toeing gait assessment parents often define that their child does not walk same at the clinic as at home, linked possibly to Hawthorne effect. Research Question How does the in-toeing angle differ when children are aware, versus when they are not aware of their gait inspection? Methods This single center, clinical, cross-sectional, observational study looked into the variation in gait pattern of twelve children with in-toeing, with and without their awareness. Two videos for each child was recorded with a smart phone, once at the clinic while aware and once by the family without awareness, and uploaded into Kinovea software for gait analysis. The angle of foot in-toeing was measured and analyzed using SPSS comparison of means and correlations. Results The gait pattern evaluated with the angle of in-toeing showed a significant difference between the two videos of the same child. The angle difference returned a p value of 0.000 using paired sample t test and a Cohen's d value of 1.4, representing the large significance between clinic and family recorded videos. The initial foot in-toeing angle showed a moderate positive Pearson's correlation of 0.031 when compared with the angle difference in both settings. Significance These results highlight the importance of including family recorded videos in gait pattern analysis without the patient's awareness. The study not only shows the significant difference found which can be explained by Hawthorne Effect but also suggests a clearer path of understanding the child's condition with the family.
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Affiliation(s)
- Ahmet Hamdi Akgülle
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mariam Haidar
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Doruk Kaan Baştürk
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mert Gündoğdu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Özge Kenis Coşkun
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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McLaren R, Smith PF, Taylor RL, Ravindran S, Rashid U, Taylor D. Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis. Front Neurosci 2022; 16:1010239. [PMID: 36248647 PMCID: PMC9553993 DOI: 10.3389/fnins.2022.1010239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Noisy galvanic vestibular stimulation (nGVS) has been used to boost vestibular afferent information to the central nervous system. This has the potential to improve postural control for people for whom vestibular signals are weak, such as in bilateral vestibulopathy (BVP). The aim of this systematic review and meta-analysis is to investigate the evidence for nGVS as a modality to improve postural control in people with BVP. Methods A comprehensive systematic search was conducted of five databases up to July 2022 to find studies applying nGVS to people with BVP, with the aim of improving postural control. Two independent reviewers screened and identified eligible studies, completed a risk of bias evaluation (Cochrane) and extracted relevant data. The standardized mean difference (SMD) based on Hedges' g was calculated as a measure of effect size for the primary outcome measure that best identified postural control, and a forest plot generated. Results Seven studies met the eligibility criteria, with five being suitable for meta-analysis. Meta-analysis revealed a moderate effect in favor of nGVS improving postural control during standing and walking [pooled SMD = 0.47 95% CI (0.25, 0.7)]. nGVS-mediated improvements in postural control were most evident in observations of reduced sway velocity when standing on a firm surface with eyes closed, and in the reduced variability of gait parameters, particularly those measuring lateral stability. Conclusions Coincident nGVS in people with BVP improves postural control during standing and walking. This improvement appears to be context specific, in that vestibular augmentation is most effective in situations where visual inputs are limited, and where reliable context specific proprioceptive cues are available. Further research is warranted investigating additional circumstances in which nGVS improves postural control, including investigating the residual, and sustained effects of nGVS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342147, identifier: 342147.
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Affiliation(s)
- Ruth McLaren
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
- *Correspondence: Ruth McLaren
| | - Paul F. Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, The Brain Health Research Centre, University of Otago, Dunedin, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
| | - Rachael L. Taylor
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Shobika Ravindran
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, School of Clinical Science, Auckland University of Technology, Auckland, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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21
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O'Keeffe K, Argent R, Bourke A, Shabani S, Praestgaard J, Muaremi A, Goulding C, Brom M, Scotti C, Walsh LC, Caulfield B. Test-retest reliability of wireless inertial-sensor derived measurements of knee joint kinematics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4218-4221. [PMID: 36085698 DOI: 10.1109/embc48229.2022.9871584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Advances in sensor technology have provided an opportunity to measure gait characteristics using body-worn inertial measurement units (IMUs). Whilst research investigating the validity of IMUs in reporting gait characteristics is extensive, research investigating the reliability of IMUs is limited. This study aimed to investigate the inter-session reliability of wireless IMU derived measures of gait (i.e., knee angle, range of motion) taking multiple test administrators into account. Fifteen healthy volunteers (43 ± 15 years) completed two visits. Within each visit, participants were required to perform two sets of 6 gait trials (6-metre walk tests). IMUs were placed on the participant in 7 locations on the lower limbs and waist. A different test administrator (n = 3) applied the IMUs at each set. At visit 2, this procedure was repeated with the same test administrators as visit 1. Kinematic measures of maximum angle (Knee_Max), minimum angle (Knee_Min), and range of motion (RoM) are reported for the left and right knee. The intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) are reported to determine IMU reliability. The results confirmed moderate to good inter-session reliability across all features (0.73-0.87). SEM values ranged from 1.21-3.32° and MDC values ranged from 3.37 - 9.21°. Therefore, IMUs appear to be a reliable method to determine inter-session gait characteristics across multiple test administrators.
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