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Langerak AJ, D'Olivo P, Thijm OSA, Regterschot GRH, Meskers CGM, Rozendaal MC, Visch VT, Bussmann JBJ. Stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools. Disabil Rehabil 2024:1-11. [PMID: 38339778 DOI: 10.1080/09638288.2024.2304091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE eHealth-based exercise therapies were developed to increase stroke patients' adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs. MATERIALS AND METHODS This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days. RESULTS We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: "Autonomy", "Competence", and "Relatedness". CONCLUSION Eight motivational themes related to the three Basic Psychological Needs describe stroke patients' motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient's needs and reduce motivational decreases in home-based rehabilitation.
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Affiliation(s)
- A J Langerak
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - P D'Olivo
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - O S A Thijm
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - G R H Regterschot
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - M C Rozendaal
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - V T Visch
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - J B J Bussmann
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Becker ML, Hurkmans HLP, Verhaar JAN, Bussmann JBJ. Validation of the Activ8 Activity Monitor for Monitoring Postures, Motions, Transfers, and Steps of Hospitalized Patients. Sensors (Basel) 2023; 24:180. [PMID: 38203041 PMCID: PMC10781347 DOI: 10.3390/s24010180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/13/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
Sedentary behaviors and low physical activity among hospitalized patients have detrimental effects on health and recovery. Wearable activity monitors are a promising tool to promote mobilization and physical activity. However, existing devices have limitations in terms of their outcomes and validity. The Activ8 device was optimized for the hospital setting. This study assessed the concurrent validity of the modified Activ8. Hospital patients performed an activity protocol that included basic (e.g., walking) and functional activities (e.g., room activities), with video recordings serving as the criterion method. The assessed outcomes were time spent walking, standing, upright, sedentary, and newly added elements of steps and transfers. Absolute and relative time differences were calculated, and Wilcoxon and Bland-Altman analyses were conducted. Overall, the observed relative time differences were lower than 2.9% for the basic protocol and 9.6% for the functional protocol. Statistically significant differences were detected in specific categories, including basic standing (p < 0.05), upright time (p < 0.01), and sedentary time (p < 0.01), but they did not exceed the predetermined 10% acceptable threshold. The modified Activ8 device is a valid tool for assessing body postures, motions, steps, and transfer counts in hospitalized patients. This study highlights the potential of wearable activity monitors to accurately monitor and promote PA among hospital patients.
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Affiliation(s)
- Marlissa L. Becker
- Physical Therapy, Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Henri L. P. Hurkmans
- Physical Therapy, Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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Roelofs JMB, Zandvliet SB, Schut IM, Huisinga ACM, Schouten AC, Hendricks HT, de Kam D, Aerden LAM, Bussmann JBJ, Geurts ACH, Weerdesteyn V. Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity. Neurorehabil Neural Repair 2023; 37:786-798. [PMID: 37877724 PMCID: PMC10685695 DOI: 10.1177/15459683231207360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. Objective. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls. METHODS An observational case-control study was performed. Main outcomes included the Mini-Balance Evaluation Systems Test (mini-BEST), Timed Up and Go (TUG), 10-m Walking Test (10-MWT), and 6-item version Activity-specific Balance Confidence (6-ABC) scale which were measured in 1 session. Objectively measured daily physical activity was measured for 7 consecutive days. Fall rate in daily life was recorded for 12 months. Individuals after a mild stroke were considered eligible when they: (1) sustained a transient ischemic attack or stroke longer than 6 months ago, resulting in motor and/or sensory loss in the contralesional leg at the time of stroke, (2) showed (near-) complete motor function, that is, ≥24 points on the Fugl-Meyer Assessment-Lower Extremity (range: 0-28). RESULTS Forty-seven healthy controls and 70 participants after mild stroke were included. Participants with stroke fell more than twice as often as healthy controls, had a 2 point lower median score on the mini-BEST, were 1.7 second slower on TUG, 0.6 km/h slower on the 10-MWT, and had a 12% lower 6-ABC score. Intensity for both total activity (8%) as well as walking activity (6%) was lower in the participants with stroke, while no differences were found in terms of duration. CONCLUSIONS Individuals in the chronic phase after a mild stroke demonstrate persistent balance limitations and have an increased fall risk. Our results point at an unmet clinical need in this population.
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Affiliation(s)
- Jolanda M. B. Roelofs
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sarah B. Zandvliet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid M. Schut
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Alfred C. Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Henk T. Hendricks
- Department of Rehabilitation Medicine, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Digna de Kam
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo A. M. Aerden
- Department of Neurology, Reinier de Graafgasthuis, Delft, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research, Nijmegen, The Netherlands
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De Vries EA, Heijenbrok-Kal MH, Van Kooten F, Giurgiu M, Ebner-Priemer UW, Ribbers GM, Van den Berg-Emons RJG, Bussmann JBJ. Daily patterns of fatigue after subarachnoid haemorrhage: an ecological momentary assessment study. J Rehabil Med 2023; 55:jrm6486. [PMID: 37853923 PMCID: PMC10599157 DOI: 10.2340/jrm.v55.6486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/24/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE To examine the daily course of, and factors associated with, momentary fatigue after subarachnoid haemorrhage, and to explore subgroups of patients with distinct diurnal patterns of fatigue. DESIGN Observational study using ecological momentary assessment. SUBJECTS A total of 41 participants with subarachnoid haemorrhage. METHODS Patients with fatigue were included within one year post-onset. Momentary fatigue (scale 1-7) was assessed with repeated measurements (10-11 times/day) during 7 consecutive days. Multilevel-mixed-model analyses and latent-class trajectory modelling were conducted. RESULTS Mean (standard deviation; SD) age of the group was 53.9 (13.0) years, 56% female, and mean (SD) time post-subarachnoid haemorrhage onset was 9.3 (3.2) months. Mean (SD) momentary fatigue over all days was 3.22 (1.47). Fatigue increased significantly (p < 0.001) over the day, and experiencing more burden of fatigue and day type (working day vs weekend day) were significantly (p < 0.05) associated with higher momentary fatigue. Three subgroups could be distinguished based on diurnal patterns of fatigue. The largest group (n = 17, 41.5%) showed an increasing daily pattern of fatigue. CONCLUSION Momentary fatigue in patients with subarachnoid haemorrhage increases over the day, and diurnal patterns of fatigue differ between participants. In addition to conventional measures, momentary measures of fatigue might provide valuable information for physicians to optimize personalized management of fatigue after subarachnoid haemorrhage.
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Affiliation(s)
- Elisabeth A De Vries
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Rijndam Rehabilitation, Rotterdam, The Netherlands.
| | - Majanka H Heijenbrok-Kal
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Fop Van Kooten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Giurgiu
- Mental mHealth lab, Karlsruhe Institute of Technology, Germany
| | - Ulrich W Ebner-Priemer
- Mental mHealth lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe; mHealth Methods in Psychiatry, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Rita J G Van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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de Vries EA, Heijenbrok-Kal MH, van Kooten F, Giurgiu M, Ribbers GM, van den Berg-Emons RJG, Bussmann JBJ. Unraveling the interplay between daily life fatigue and physical activity after subarachnoid hemorrhage: an ecological momentary assessment and accelerometry study. J Neuroeng Rehabil 2023; 20:127. [PMID: 37752550 PMCID: PMC10521384 DOI: 10.1186/s12984-023-01241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Fatigue is one of the most commonly reported symptoms after subarachnoid hemorrhage (SAH) and is indirectly associated with physical activity (PA). Associations between fatigue and PA are primarily examined based on conventional measures (i.e. a single fatigue score or average PA levels), thereby assuming that fatigue and PA do not fluctuate over time. However, levels of fatigue and PA may not be stable and may interrelate dynamically in daily life. Insight in direct relationships between fatigue and PA in daily life, could add to the development of personalized rehabilitation strategies. Therefore we aimed to examine bidirectional relationships between momentary fatigue and PA in people with SAH. METHODS People (n = 38) with SAH who suffer from chronic fatigue were included in an observational study using Ecological Momentary Assessment (EMA) and accelerometry. Momentary fatigue was assessed on a scale from 1 to 7 (no to extreme fatigue), assessed with 10-11 prompts per day for 7 consecutive days using EMA with a mobile phone. PA was continuously measured during this 7-day period with a thigh-worn Activ8 accelerometer and expressed as total minutes of standing, walking, running and cycling in a period of 45 min before and after a momentary fatigue prompt. Multilevel mixed model analyses including random effects were conducted. RESULTS Mean age was 53.2 years (SD = 13.4), 58% female, and mean time post SAH onset was 9.5 months (SD = 2.1). Multilevel analyses with only time effects to predict fatigue and PA revealed that fatigue significantly (p < 0.001) increased over the day and PA significantly (p < 0.001) decreased. In addition, more PA was significantly associated with higher subsequent fatigue (β = 0.004, p < 0.05) and higher fatigue was significantly associated with less subsequent PA (β=-0.736, p < 0.05). Moreover, these associations significantly differed between participants (p < 0.001). CONCLUSIONS By combining EMA measures of fatigue with accelerometer-based PA we found that fatigue and PA are bidirectionally associated. In addition, these associations differ among participants. Given these different bidirectional associations, rehabilitation aimed at reducing fatigue should comprise personalized strategies to improve both fatigue and PA simultaneously, for example by combining exercise therapy with cognitive behavioral and/or energy management therapy.
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Affiliation(s)
- Elisabeth A de Vries
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands.
- Rijndam Rehabilitation, Rotterdam, the Netherlands.
| | - Majanka H Heijenbrok-Kal
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Fop van Kooten
- Erasmus MC, Department of Neurology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Giurgiu
- Institute for Sports and Sports Science, Mental mHealth lab, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Gerard M Ribbers
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Rita J G van den Berg-Emons
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes B J Bussmann
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Langerak AJ, Regterschot GRH, Evers M, van Beijnum BJF, Meskers CGM, Selles RW, Ribbers GM, Bussmann JBJ. A Sensor-Based Feedback Device Stimulating Daily Life Upper Extremity Activity in Stroke Patients: A Feasibility Study. Sensors (Basel) 2023; 23:5868. [PMID: 37447718 DOI: 10.3390/s23135868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
This study aims to evaluate the feasibility and explore the efficacy of the Arm Activity Tracker (AAT). The AAT is a device based on wrist-worn accelerometers that provides visual and tactile feedback to stimulate daily life upper extremity (UE) activity in stroke patients. METHODS A randomised, crossover within-subject study was conducted in sub-acute stroke patients admitted to a rehabilitation centre. Feasibility encompassed (1) adherence: the dropout rate and the number of participants with insufficient AAT data collection; (2) acceptance: the technology acceptance model (range: 7-112) and (3) usability: the system usability scale (range: 0-100). A two-way ANOVA was used to estimate the difference between the baseline, intervention and control conditions for (1) paretic UE activity and (2) UE activity ratio. RESULTS Seventeen stroke patients were included. A 29% dropout rate was observed, and two participants had insufficient data collection. Participants who adhered to the study reported good acceptance (median (IQR): 94 (77-111)) and usability (median (IQR): 77.5 (75-78.5)-). We found small to medium effect sizes favouring the intervention condition for paretic UE activity (η2G = 0.07, p = 0.04) and ratio (η2G = 0.11, p = 0.22). CONCLUSION Participants who adhered to the study showed good acceptance and usability of the AAT and increased paretic UE activity. Dropouts should be further evaluated, and a sufficiently powered trial should be performed to analyse efficacy.
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Affiliation(s)
- Anthonia J Langerak
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | | | - Marc Evers
- Rijndam Rehabilitation, 3015 LJ Rotterdam, The Netherlands
| | - Bert-Jan F van Beijnum
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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Giurgiu M, Ketelhut S, Kubica C, Nissen R, Doster AK, Thron M, Timm I, Giurgiu V, Nigg CR, Woll A, Ebner-Priemer UW, Bussmann JBJ. Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions. Int J Behav Nutr Phys Act 2023; 20:68. [PMID: 37291598 DOI: 10.1186/s12966-023-01473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Wearable technology is used by consumers and researchers worldwide for continuous activity monitoring in daily life. Results of high-quality laboratory-based validation studies enable us to make a guided decision on which study to rely on and which device to use. However, reviews in adults that focus on the quality of existing laboratory studies are missing. METHODS We conducted a systematic review of wearable validation studies with adults. Eligibility criteria were: (i) study under laboratory conditions with humans (age ≥ 18 years); (ii) validated device outcome must belong to one dimension of the 24-hour physical behavior construct (i.e., intensity, posture/activity type, and biological state); (iii) study protocol must include a criterion measure; (iv) study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in five electronic databases as well as back- and forward citation searches. The risk of bias was assessed based on the QUADAS-2 tool with eight signaling questions. RESULTS Out of 13,285 unique search results, 545 published articles between 1994 and 2022 were included. Most studies (73.8% (N = 420)) validated an intensity measure outcome such as energy expenditure; only 14% (N = 80) and 12.2% (N = 70) of studies validated biological state or posture/activity type outcomes, respectively. Most protocols validated wearables in healthy adults between 18 and 65 years. Most wearables were only validated once. Further, we identified six wearables (i.e., ActiGraph GT3X+, ActiGraph GT9X, Apple Watch 2, Axivity AX3, Fitbit Charge 2, Fitbit, and GENEActiv) that had been used to validate outcomes from all three dimensions, but none of them were consistently ranked with moderate to high validity. Risk of bias assessment resulted in 4.4% (N = 24) of all studies being classified as "low risk", while 16.5% (N = 90) were classified as "some concerns" and 79.1% (N = 431) as "high risk". CONCLUSION Laboratory validation studies of wearables assessing physical behaviour in adults are characterized by low methodological quality, large variability in design, and a focus on intensity. Future research should more strongly aim at all components of the 24-hour physical behaviour construct, and strive for standardized protocols embedded in a validation framework.
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Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
| | - Sascha Ketelhut
- Health Science Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Claudia Kubica
- Health Science Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Rebecca Nissen
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Ann-Kathrin Doster
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Maximiliane Thron
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Valeria Giurgiu
- Baden-Wuerttemberg Cooperative State University (DHBW), Karlsruhe, Germany
| | - Claudio R Nigg
- Sport Pedagogy Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
| | - Ulrich W Ebner-Priemer
- Department of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Hertzstr. 16, 76187, Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Johannes B J Bussmann
- Erasmus MC, Department of Rehabilitation medicine, University Medical Center Rotterdam, Rotterdam, Netherlands
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Langerak AJ, Regterschot GRH, Selles RW, Meskers CGM, Evers M, Ribbers GM, van Beijnum BJF, Bussmann JBJ. Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients: a user-centred approach. Disabil Rehabil Assist Technol 2023:1-13. [PMID: 36905631 DOI: 10.1080/17483107.2023.2183993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
PURPOSE Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients. METHODS We performed a requirement analysis consisting of the following steps: 1) context & groundwork; 2) eliciting requirements; 3) modelling & analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into "must-haves", "should-haves", and "could-haves". RESULTS We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined. CONCLUSION This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context.
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Affiliation(s)
- A J Langerak
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G R H Regterschot
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - R W Selles
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M Evers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - G M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B J F van Beijnum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Mohseni M, Kuckuck S, Meeusen REH, Jiskoot G, Lengton R, Savas M, Berk KAC, Van der Valk ES, Van der Voorn B, Van den Berg SAA, Iyer AM, Bussmann JBJ, Leenen PJM, Dik WA, de Groot CJ, Van den Akker ELT, Van Rossum EFC. Improved Physical and Mental Health After a Combined Lifestyle Intervention with Cognitive Behavioural Therapy for Obesity. Int J Endocrinol Metab 2023; 21:e129906. [PMID: 37038540 PMCID: PMC10082324 DOI: 10.5812/ijem-129906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Obesity is a multifactorial, chronic, progressive disease associated with decreased health-related quality of life, comorbidities, and increased mortality risk. Lifestyle interventions, focusing on dietetics, physical exercise, and behavioral therapy, are a cornerstone of therapy. Despite this very multidisciplinary treatment approach, the definition of treatment success is often based only on a weight loss of ≥ 5%. However, the heterogeneous nature of obesity may necessitate a more comprehensive approach to assessing treatment effects. OBJECTIVES Here, we describe changes in physiological, psychological, and behavioral health after a multidisciplinary combined lifestyle intervention (CLI). Additionally, we investigated whether these changes were related to weight loss. METHODS This prospective observational longitudinal study comprised 96 adults with obesity (73 women, 81 Caucasian) participating in a CLI at the Obesity Center CGG, Erasmus University Medical Center, Rotterdam, the Netherlands. The 1.5-year intervention comprised multidisciplinary professional guidance towards a healthy diet, increased physical activity, and included cognitive behavioral therapy. Physiological health outcomes, psychological well-being, eating behavior, and physical activity were assessed after ten weeks and 1.5 years and compared to baseline. RESULTS An average of 5.2% weight loss (-6.0 kg) was accompanied by a mean 9.8% decrease in fat mass (-5.9 kg; both P < 0.001) and significant improvements in metabolism, hormonal status, and immune parameters (all P < 0.05). Moreover, we observed decreased psychopathology, increased quality of life, and decreased disordered eating (all P < 0.05). Weight loss correlated with most metabolic changes (all P < 0.05) but not with most psychological/behavioral changes. CONCLUSIONS Combined lifestyle intervention in patients with obesity was accompanied by significant improvements in body weight and body composition along with cardiometabolic, endocrine, immunological, psychological, and behavioral improvements. Interestingly, most changes in psychological and behavioral health occurred independently of weight loss. Obesity treatment success should be evaluated based on a combination of physical and patient-reported outcomes rather than weight loss alone.
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Affiliation(s)
- Mostafa Mohseni
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Susanne Kuckuck
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Renate E. H. Meeusen
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Geranne Jiskoot
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robin Lengton
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mesut Savas
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kirsten A. C. Berk
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eline S. Van der Valk
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bibian Van der Voorn
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoerd A. A. Van den Berg
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anand M. Iyer
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter J. M. Leenen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Willem A. Dik
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Cornelis J. de Groot
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erica L. T. Van den Akker
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elisabeth F. C. Van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Corresponding Author: Internist-Endocrinologist/Professor of Medicine, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, P.O. Box: 2400, Room Rg-5., Rotterdam, the Netherlands.
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10
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Giurgiu M, Timm I, Becker M, Schmidt S, Wunsch K, Nissen R, Davidovski D, Bussmann JBJ, Nigg CR, Reichert M, Ebner-Priemer UW, Woll A, von Haaren-Mack B. Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e36377. [PMID: 35679106 PMCID: PMC9227659 DOI: 10.2196/36377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/13/2022] Open
Abstract
Background Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking. Objective This study aimed to raise researchers’ and consumers’ attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies. Methods Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time). Results Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk. Conclusions Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity.
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Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marlissa Becker
- Unit Physiotherapy, Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Steffen Schmidt
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Kathrin Wunsch
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Rebecca Nissen
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Denis Davidovski
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Claudio R Nigg
- Health Science Department, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Markus Reichert
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of eHealth and Sports Analytics, Faculty of Sport Science, Ruhr-University Bochum, Bochum, Germany
| | - Ulrich W Ebner-Priemer
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Birte von Haaren-Mack
- Department of Health and Social Psychology, Institute of Psychology, German Sport University, Cologne, Germany
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11
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Giurgiu M, Kolb S, Nigg C, Burchartz A, Timm I, Becker M, Rulf E, Doster AK, Koch E, Bussmann JBJ, Nigg C, Ebner-Priemer UW, Woll A. Assessment of 24-hour physical behaviour in children and adolescents via wearables: a systematic review of free-living validation studies. BMJ Open Sport Exerc Med 2022; 8:e001267. [PMID: 35646389 PMCID: PMC9109110 DOI: 10.1136/bmjsem-2021-001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Studies that assess all three dimensions of the integrative 24-hour physical behaviour (PB) construct, namely, intensity, posture/activity type and biological state, are on the rise. However, reviews on validation studies that cover intensity, posture/activity type and biological state assessed via wearables are missing. Design Systematic review. The risk of bias was evaluated by using the QUADAS-2 tool with nine signalling questions separated into four domains (ie, patient selection/study design, index measure, criterion measure, flow and time). Data sources Peer-reviewed validation studies from electronic databases as well as backward and forward citation searches (1970–July 2021). Eligibility criteria for selecting studies Wearable validation studies with children and adolescents (age <18 years). Required indicators: (1) study protocol must include real-life conditions; (2) validated device outcome must belong to one dimension of the 24-hour PB construct; (3) the study protocol must include a criterion measure; (4) study results must be published in peer-reviewed English language journals. Results Out of 13 285 unique search results, 76 articles with 51 different wearables were included and reviewed. Most studies (68.4%) validated an intensity measure outcome such as energy expenditure, but only 15.9% of studies validated biological state outcomes, while 15.8% of studies validated posture/activity type outcomes. We identified six wearables that had been used to validate outcomes from two different dimensions and only two wearables (ie, ActiGraph GT1M and ActiGraph GT3X+) that validated outcomes from all three dimensions. The percentage of studies meeting a given quality criterion ranged from 44.7% to 92.1%. Only 18 studies were classified as ‘low risk’ or ‘some concerns’. Summary Validation studies on biological state and posture/activity outcomes are rare in children and adolescents. Most studies did not meet published quality principles. Standardised protocols embedded in a validation framework are needed. PROSPERO registration number CRD42021230894.
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Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Simon Kolb
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Carina Nigg
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Sport Pedagogy, University of Bern, Bern, Switzerland
| | - Alexander Burchartz
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marlissa Becker
- Department of Orthopedics, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen Rulf
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ann-Kathrin Doster
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Elena Koch
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claudio Nigg
- Department of Health Science, University of Bern, Bern, Switzerland
| | - Ulrich W Ebner-Priemer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Department of Sports and Sports Science, Institute of Sports and Sports Science, Karlsruhe, Germany
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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12
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Saes M, Mohamed Refai MI, van Beijnum BJF, Bussmann JBJ, Jansma EP, Veltink PH, Buurke JH, van Wegen EEH, Meskers CGM, Krakauer JW, Kwakkel G. Quantifying Quality of Reaching Movements Longitudinally Post-Stroke: A Systematic Review. Neurorehabil Neural Repair 2022; 36:183-207. [PMID: 35100897 PMCID: PMC8902693 DOI: 10.1177/15459683211062890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allows for this disambiguation. Objectives To identify longitudinal studies that used kinematic and/or kinetic metrics to investigate post-stroke recovery of reaching and assess whether these studies distinguish behavioral restitution from compensation. Methods A systematic literature search was conducted using the databases PubMed, Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies were identified if they performed longitudinal kinematic and/or kinetic measurements during reaching, starting within the first 6 months post-stroke. Results Thirty-two longitudinal studies were identified, which reported a total of forty-six different kinematic metrics. Although the majority investigated improvements in kinetics or kinematics to quantify recovery of QoM, none of these studies explicitly addressed the distinction between behavioral restitution and compensation. One study obtained kinematic metrics for both performance assays and a functional task. Conclusions Despite the growing number of kinematic and kinetic studies on post-stroke recovery, longitudinal studies that explicitly seek to delineate between behavioral restitution and compensation are still lacking in the literature. To rectify this situation, future studies should measure kinematics and/or kinetics during performance assays to isolate restitution and during a standardized functional task to determine the contributions of restitution and compensation.
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Affiliation(s)
- M Saes
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - M I Mohamed Refai
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - B J F van Beijnum
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - E P Jansma
- Medical Library, 1190Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmcAmsterdam, The Netherlands
| | - P H Veltink
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J H Buurke
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands.,Rehabilitation Technology, Roessingh Research and Development, Enschede, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - E E H van Wegen
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - J W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine and Rehabilitation, 1500Johns Hopkins University, Baltimore, MD, United States
| | - G Kwakkel
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA.,Department of Neurorehabilitation, 522567Amsterdam Rehabilitation Research Centre, Amsterdam, Netherlands
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13
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Braakhuis HEM, Berger MAM, Regterschot RGRH, van Wegen EEH, Selles RW, Ribbers GM, Bussmann JBJ. Physical activity dimensions after stroke: patterns and relation with lower limb motor function. J Neuroeng Rehabil 2021; 18:171. [PMID: 34895265 PMCID: PMC8666008 DOI: 10.1186/s12984-021-00960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Stroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity patterns may guide the development and timing of targeted rehabilitation interventions. This longitudinal cohort study explored how multidimensional physical activity outcomes develop during recovery in the subacute phase after stroke and if changes in physical activity were correlated to recovery of lower limb motor function. Methods Patients were recruited during inpatient rehabilitation. At 3, 12, and 26 weeks post-onset, motor function was measured by the Fugl-Meyer Lower Extremity Assessment (FMA-LE). Physical activity was measured with the Activ8 accelerometer in multiple outcomes: counts per minute during walking (CPMwalking; a measure of Intensity), number of active bouts (Frequency), mean length of active bouts (Distribution) and % of waking time in upright positions (Duration). Generalized estimating equations (GEE) were used to study changes in physical activity over time and the relation with the change in lower limb motor recovery. Results Thirty-nine patients (age 56 ± 9, 77% male, 89% ischemic stroke) were included. GEE models showed a significant main effect of time for PA Intensity (+ 13%, p = 0.007) and Duration (+ 64%, p = 0.012) between 3 and 12 weeks. Motor function did not show a significant effect in all PA models across the 3 timepoints (p > 0.020). A significant interaction effect of time × motor function was observed (p < 0.001). Conclusions Patterns of PA recovery depend on the PA dimensions: PA Intensity and Duration increased mostly between 3 and 12 weeks post-stroke, whereas Frequency and Distribution did not show substantial changes. Further, no strong associations with motor recovery and high inter-individual variability were documented, which underlies the need to consider factors specific to the disease, the individual patient and the context.
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Affiliation(s)
- Hanneke E M Braakhuis
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Rijndam Rehabilitation, Rotterdam, The Netherlands. .,Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands.
| | - Monique A M Berger
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Ruben G R H Regterschot
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
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14
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Saes M, Mohamed Refai MI, van Kordelaar J, Scheltinga BL, van Beijnum BJF, Bussmann JBJ, Buurke JH, Veltink PH, Meskers CGM, van Wegen EEH, Kwakkel G. Smoothness metric during reach-to-grasp after stroke: part 2. longitudinal association with motor impairment. J Neuroeng Rehabil 2021; 18:144. [PMID: 34560898 PMCID: PMC8461930 DOI: 10.1186/s12984-021-00937-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The cause of smoothness deficits as a proxy for quality of movement post stroke is currently unclear. Previous simulation analyses showed that spectral arc length (SPARC) is a valid metric for investigating smoothness during a multi-joint goal-directed reaching task. The goal of this observational study was to investigate how SPARC values change over time, and whether SPARC is longitudinally associated with the recovery from motor impairments reflected by the Fugl-Meyer motor assessment of the upper extremity (FM-UE) in the first 6 months after stroke. METHODS Forty patients who suffered a first-ever unilateral ischemic stroke (22 males, aged 58.6 ± 12.5 years) with upper extremity paresis underwent kinematic and clinical measurements in weeks 1, 2, 3, 4, 5, 8, 12, and 26 post stroke. Clinical measures included amongst others FM-UE. SPARC was obtained by three-dimensional kinematic measurements using an electromagnetic motion tracking system during a reach-to-grasp movement. Kinematic assessments of 12 healthy, age-matched individuals served as reference. Longitudinal linear mixed model analyses were performed to determine SPARC change over time, compare smoothness in patients with reference values of healthy individuals, and establish the longitudinal association between SPARC and FM-UE scores. RESULTS SPARC showed a significant positive longitudinal association with FM-UE (B: 31.73, 95%-CI: [27.27 36.20], P < 0.001), which encompassed significant within- and between-subject effects (B: 30.85, 95%-CI: [26.28 35.41], P < 0.001 and B: 50.59, 95%-CI: [29.97 71.21], P < 0.001, respectively). Until 5 weeks post stroke, progress of time contributed significantly to the increase in SPARC and FM-UE scores (P < 0.05), whereafter they levelled off. At group level, smoothness was lower in patients who suffered a stroke compared to healthy subjects at all time points (P < 0.05). CONCLUSIONS The present findings show that, after stroke, recovery of smoothness in a multi-joint reaching task and recovery from motor impairments are longitudinally associated and follow a similar time course. This suggests that the reduction of smoothness deficits quantified by SPARC is a proper objective reflection of recovery from motor impairment, as reflected by FM-UE, probably driven by a common underlying process of spontaneous neurological recovery early post stroke.
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Affiliation(s)
- Mique Saes
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Mohamed Irfan Mohamed Refai
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Joost van Kordelaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bouke L Scheltinga
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Bert-Jan F van Beijnum
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jaap H Buurke
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Il, USA
- Rehabilitation Technology, Roessingh Research and Development, Enschede, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Il, USA
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, de Boelelaan 1117, Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Il, USA.
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.
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Regterschot GRH, Ribbers GM, Bussmann JBJ. Wearable Movement Sensors for Rehabilitation: From Technology to Clinical Practice. Sensors (Basel) 2021; 21:s21144744. [PMID: 34300484 PMCID: PMC8309586 DOI: 10.3390/s21144744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Gerrit Ruben Hendrik Regterschot
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (G.M.R.); (J.B.J.B.)
- Correspondence:
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (G.M.R.); (J.B.J.B.)
- Rijndam Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (G.M.R.); (J.B.J.B.)
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Hendrickx W, Riveros C, Askim T, Bussmann JBJ, Callisaya ML, Chastin SFM, Dean C, Ezeugwu V, Jones TM, Kuys SS, Mahendran N, Manns PJ, Mead G, Moore SA, Paul L, Pisters MF, Saunders DH, Simpson DB, Tieges Z, Verschuren O, English C. An Exploration of Sedentary Behavior Patterns in Community-Dwelling People With Stroke: A Cluster-Based Analysis. J Neurol Phys Ther 2021; 45:221-227. [PMID: 33867457 DOI: 10.1097/npt.0000000000000357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Long periods of daily sedentary time, particularly accumulated in long uninterrupted bouts, are a risk factor for cardiovascular disease. People with stroke are at high risk of recurrent events and prolonged sedentary time may increase this risk. We aimed to explore how people with stroke distribute their periods of sedentary behavior, which factors influence this distribution, and whether sedentary behavior clusters can be distinguished? METHODS This was a secondary analysis of original accelerometry data from adults with stroke living in the community. We conducted data-driven clustering analyses to identify unique accumulation patterns of sedentary time across participants, followed by multinomial logistical regression to determine the association between the clusters, and the total amount of sedentary time, age, gender, body mass index (BMI), walking speed, and wake time. RESULTS Participants in the highest quartile of total sedentary time accumulated a significantly higher proportion of their sedentary time in prolonged bouts (P < 0.001). Six unique accumulation patterns were identified, all of which were characterized by high sedentary time. Total sedentary time, age, gender, BMI, and walking speed were significantly associated with the probability of a person being in a specific accumulation pattern cluster, P < 0.001 - P = 0.002. DISCUSSION AND CONCLUSIONS Although unique accumulation patterns were identified, there is not just one accumulation pattern for high sedentary time. This suggests that interventions to reduce sedentary time must be individually tailored.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A343).
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Affiliation(s)
- Wendy Hendrickx
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (W.H., M.F.P.); School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia (W.H., D.B.S., C.E.); Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands (W.H., M.F.P.); Bioinformatics, Hunter Medical Research Institute, and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia (C.R.); Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway (T.A.); Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands (J.B.J.B.); Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia (M.L.C.); School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom (S.F.M.C., L.P., Z.T.); Department of Movement and Sports Sciences, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium (S.F.M.C.); Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (C.D., T.M.J.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada (V.E., P.J.M.); National Head, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia (S.S.K.); Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia (N.M.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.M.); Stroke Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.); Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands (M.F.P.); Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (D.H.S.); Department of Geriatric Medicine, University of Edinburgh, United Kingdom (Z.T.); UMC Utrecht Brain Center, Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (O.V.); and Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Newcastle, Australia (C.E.)
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17
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Braakhuis HEM, Bussmann JBJ, Ribbers GM, Berger MAM. Wearable Activity Monitoring in Day-to-Day Stroke Care: A Promising Tool but Not Widely Used. Sensors (Basel) 2021; 21:s21124066. [PMID: 34204824 PMCID: PMC8231529 DOI: 10.3390/s21124066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Abstract
Physical activity monitoring with wearable technology has the potential to support stroke rehabilitation. Little is known about how physical therapists use and value the use of wearable activity monitors. This cross-sectional study explores the use, perspectives, and barriers to wearable activity monitoring in day-to-day stroke care routines amongst physical therapists. Over 300 physical therapists in primary and geriatric care and rehabilitation centers in the Netherlands were invited to fill in an online survey that was developed based on previous studies and interviews with experts. In total, 103 complete surveys were analyzed. Out of the 103 surveys, 27% of the respondents were already using activity monitoring. Of the suggested treatment purposes of activity monitoring, 86% were perceived as useful by more than 55% of the therapists. The most recognized barriers to clinical implementation were lack of skills and knowledge of patients (65%) and not knowing what brand and type of monitor to choose (54%). Of the non-users, 79% were willing to use it in the future. In conclusion, although the concept of remote activity monitoring was perceived as useful, it was not widely adopted by physical therapists involved in stroke care. To date, skills, beliefs, and attitudes of individual therapists determine the current use of wearable technology.
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Affiliation(s)
- Hanneke E. M. Braakhuis
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (J.B.J.B.); (G.M.R.)
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, 2521 EN The Hague, The Netherlands;
- Rijndam Rehabilitation, 3015 LJ Rotterdam, The Netherlands
- Correspondence:
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (J.B.J.B.); (G.M.R.)
- Rijndam Rehabilitation, 3015 LJ Rotterdam, The Netherlands
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (J.B.J.B.); (G.M.R.)
- Rijndam Rehabilitation, 3015 LJ Rotterdam, The Netherlands
| | - Monique A. M. Berger
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, 2521 EN The Hague, The Netherlands;
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18
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Regterschot GRH, Bussmann JBJ, Fanchamps MHJ, Meskers CGM, Ribbers GM, Selles RW. Objectively measured arm use in daily life improves during the first 6 months poststroke: a longitudinal observational cohort study. J Neuroeng Rehabil 2021; 18:51. [PMID: 33741017 PMCID: PMC7980644 DOI: 10.1186/s12984-021-00847-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Background It is unclear how arm use in daily life changes after stroke since studies investigating the change in arm use poststroke are scarce. The aim of this study was to investigate the change in arm use during the first six months poststroke. Secondary aim was to compare arm use changes between arm recovery clusters. Methods Arm use was measured during week 3, 12, and 26 poststroke with accelerometers on the wrists and the nonaffected leg. Outcomes were the amount of affected and nonaffected arm use during sitting and standing per day and per sit/stand hour, and the daily ratio between arms. Arm function was measured with the Fugl-Meyer Upper Extremity Scale to identify recovery clusters (poor/moderate/excellent). Generalized estimating equations compared arm use outcomes between time points and between recovery clusters. Results Thirty-three stroke patients participated. Affected arm use per day increased between week 3 and 12 (30 %; p = 0.04) and it increased per sit/stand hour between week 3–12 (31 %; p < 0.001) and between week 3 and 26 (48 %; p = 0.02). Nonaffected arm use per day decreased between week 3 and 12 (13 %; p < 0.001) and between week 3 and 26 (22 %; p < 0.001) and it decreased per sit/stand hour between week 3 and 26 (18 %; p = 0.003). The daily ratio increased between week 3 and 12 (43 %; p < 0.001) and between week 3 and 26 (95 %; p < 0.001). Changes in arm use did not differ significantly between recovery clusters (p = 0.11–0.62). Affected arm use was higher in the excellent recovery cluster (p < 0.001). Conclusions Affected arm use and the ratio between arms increase during the first 26 weeks poststroke especially in patients with excellent arm recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00847-x.
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Affiliation(s)
- G R H Regterschot
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Malou H J Fanchamps
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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19
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Leichtenberg CS, van Tol FR, Gademan MGJ, Krom T, Tilbury C, Horemans HLD, Bussmann JBJ, Verdegaal SHM, Marijnissen WJCM, Nelissen RGHH, Vliet Vlieland TPM. Are pain, functional limitations and quality of life associated with objectively measured physical activity in patients with end-stage osteoarthritis of the hip or knee? Knee 2021; 29:78-85. [PMID: 33582594 DOI: 10.1016/j.knee.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/31/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Physical activity is promoted in patients with hip or knee osteoarthritis (OA), yet little is known about its relationship with symptoms, functional limitations and Quality of Life (QoL). We investigated if OA-associated pain, functional limitations and QoL are associated with objectively measured physical activity in patients with end-stage hip/knee OA. METHODS Cross-sectional study including patients scheduled for primary total hip/knee arthroplasty. Patients wore an accelerometer (Activ8) with physical activity assessed over waking hours, and expressed as number of activity daily counts (ADC) per hour, %time spent on physical activity i.e. walking, cycling or running (%PA), and %time spent sedentary (%SB). Pain, functional limitations and joint-specific and general QoL were assessed with the Hip disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) and the Short Form (SF)-12. Multivariate linear regression models with the three to Z-scores transformed parameters of physical activity as dependent variables and adjusted for confounding, were conducted. RESULTS 49 hip and 48 knee OA patients were included. In hip and knee OA patients the mean number of ADC, %PA and %SB were 18.79 ± 7.25 and 21.19 ± 6.16, 14 ± 6.4 and 15 ± 5.0, and 66 ± 10.5 and 68 ± 8.7, respectively. In hip OA, better joint-specific and general QoL were associated with more ADC, (β 0.028; 95%CI:0.007-0.048, β0.041; 95%CI:0.010-0.071). Also, better general QoL was associated with the %PA (β 0.040, 95%CI:0.007-0.073). No other associations were found. CONCLUSION Whereas QoL was associated with physical activity in hip OA, pain and functional limitations were not related to objectively measured physical activity in patients with end-stage hip or knee OA.
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Affiliation(s)
- C S Leichtenberg
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - F R van Tol
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - M G J Gademan
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands.
| | - T Krom
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - C Tilbury
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - H L D Horemans
- Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
| | - J B J Bussmann
- Erasmus MC University Medical Center, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
| | - S H M Verdegaal
- Alrijne Hospital, Department of Orthopaedics, Leiderdorp, the Netherlands
| | - W J C M Marijnissen
- Albert Schweitzer Hospital, Department of Orthopaedics, Dordrecht, the Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands
| | - T P M Vliet Vlieland
- Leiden University Medical Center, Department of Orthopaedics, Leiden, the Netherlands; Sophia Rehabilitation Center, The Hague, the Netherlands; Rijnlands Rehabilitation Center, Leiden, the Netherlands
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20
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Braakhuis HEM, Roelofs JMB, Berger MAM, Ribbers GM, Weerdesteyn V, Bussmann JBJ. Intensity of daily physical activity - a key component for improving physical capacity after minor stroke? Disabil Rehabil 2020; 44:3048-3053. [PMID: 33295227 DOI: 10.1080/09638288.2020.1851781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Elucidating the complex interactions between physical activity (PA), a multidimensional concept, and physical capacity (PC) may reveal ways to improve rehabilitation interventions. This cross-sectional study aimed to explore which PA dimensions are related to PC in people after minor stroke. MATERIALS AND METHODS Community dwelling individuals >6 months after minor stroke were evaluated with a 10-Meter-Walking-Test (10MWT), Timed-Up & Go, and the Mini Balance Evaluation System Test. The following PA outcomes were measured with an Activ8 accelerometer: counts per minute during walking (CPMwalking; a measure of intensity), number of active bouts (frequency), mean length of active bouts (distribution), and percentage of waking hours in upright positions (duration). Multivariable linear regression models, adjusted for age, sex and BMI, were used to assess the relationships between PC and PA outcomes. RESULTS Sixty-nine participants [62.2 ± 9.8 years, 61% male, 20 months post onset (IQR 13.0-53.5)] were included in the analysis. CPMwalking was significantly associated to PC in the 10MWT (std. ß = 0.409, p = 0.002), whereas other associations between PA and PC were not significant. CONCLUSIONS The PA dimension intensity of walking is significantly associated with PC, and appears to be an important tool for future interventions in rehabilitation after minor stroke.Implications for rehabilitationIt is recommended to express physical activity after minor stroke in multiple dimensions such as intensity, frequency, duration and distribution.In particular, intensity of physical activity measured with accelerometer counts is most closely related to physical capacity.The findings of this study underline the importance of being physically active beyond a certain intensity.In future development of interventions and guidelines that aim to promote daily physical activity, intensity should be taken into account.
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Affiliation(s)
- Hanneke E M Braakhuis
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands.,Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Jolanda M B Roelofs
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique A M Berger
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Sint Maartenskliniek, Nijmegen, The Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
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21
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Huijnen IPJ, Schasfoort FC, Smeets RJEM, Sneekes E, Verbunt JA, Bussmann JBJ. Subgrouping patients with chronic low back pain: What are the differences in actual daily life behavior between patients classified as avoider or persister? J Back Musculoskelet Rehabil 2020; 33:303-311. [PMID: 31450487 DOI: 10.3233/bmr-171048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to determine whether patients, classified by their treating consultant in rehabilitation medicine as avoider or persister, show differences in a large set of detailed outcomes of actual, objectively measured daily physical behaviour. METHODS In this explorative cross-sectional study, 16 patients were included; 9 patients were categorized as avoider and 7 patients as persister. Subjects wore the VitaMove activity monitor, a high-end accelerometry-based device that allowed automatic detection of a large set of body postures and motions. Physical behaviour was assessed in detail by total duration of body postures and motions as percentages of 24 hours, as well as by the number of sit-to-stand transfers, overall activity level, walking speed, and the distribution of bouts of physical activity and sedentary behaviour. Differences between groups were tested with the Mann Whitney U test. RESULTS There were no significant differences between groups in any of the physical behaviour outcomes. CONCLUSIONS Our study showed that activity-related behavioural style categorization by consultants in rehabilitation medicine is not expressed in objectively measured detailed outcomes of daily physical behaviour.
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Affiliation(s)
- Ivan P J Huijnen
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Fabienne C Schasfoort
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,CIR Revalidatie Location Eindhoven, Eindhoven, The Netherlands
| | - Emiel Sneekes
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Jeanine A Verbunt
- Department of Rehabilitation Medicine, Research Program Functioning and Rehabilitation, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Postma K, Bussmann JBJ, van Diemen T, Post MWM, Dekkers J, van Nes IJW, Osterthun R, van den Berg-Emons RJG. Physical Activity and Sedentary Behavior From Discharge to 1 Year After Inpatient Rehabilitation in Ambulatory People With Spinal Cord Injury: A Longitudinal Cohort Study. Arch Phys Med Rehabil 2020; 101:2061-2070. [PMID: 32750374 DOI: 10.1016/j.apmr.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate changes in duration of physical activity (PA) and sedentary behavior (SB) from discharge to 1 year after inpatient rehabilitation in ambulatory people with spinal cord injury (SCI). DESIGN Longitudinal cohort study with objective measurements of physical behavior at discharge and at 6 and 12 months post discharge. SETTING Three rehabilitation centers and the participant's home environment. PARTICIPANTS Participants (N=47) with ambulatory function were consecutively recruited from the self-management and self-efficacy in patients with SCI cohort (age 18 years or older, recent SCI, expected inpatient stay ≥4wk). Mean age was 54.5±12.9 years, all had incomplete lesions, 53% were men, 49% had tetraplegia, and 51% were community ambulators at discharge. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Duration (min) of PA (summed duration of walking, cycling, running, and wheeling) and SB (sitting/lying). RESULTS Mean duration of PA increased by 21 min/d (95% confidence interval, 7-35) and SB decreased by 64 min/d (95% confidence interval, -94 to -35) from discharge to 6 months after inpatient rehabilitation. No changes were found in the second half-year. One year after discharge mean PA was 116±59 min/d and mean SB was 665±121 min/d. The increase in PA was the result of an almost doubling of time spent walking. Variability in physical behavior and its change was large. Older age and lower ambulation level were associated with lower PA, lower ambulation level with higher SB, and tetraplegia was associated with a reduced increase in PA. CONCLUSIONS At group level, duration of PA and SB improved following inpatient rehabilitation in ambulatory people with SCI. However, there were large differences between individuals. Levels 1 year after discharge were still unfavorable, particularly regarding SB.
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Affiliation(s)
- Karin Postma
- Rijndam Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam.
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - Tijn van Diemen
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen; Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen
| | - Jos Dekkers
- Dutch Spinal Cord Injury Association, Nijkerk, The Netherlands
| | | | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
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23
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Bussmann JBJ, Pangalila RF, Stam HJ, Schasfoort F. The role of botulinum toxin in multimodal treatment of spasticity in ambulatory children with spastic Cerebral Palsy: extensive evaluation of a cost-effectiveness trial. J Rehabil Med 2020; 52:jrm00059. [PMID: 32301499 DOI: 10.2340/16501977-2680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A cost-effectiveness trial (the Space Bop study) on the added value of botulinum toxin injections (BoNT-A) in the leg muscles, as part of a multimodal intervention for ambulatory children with spastic cerebral palsy in the context of a single distinct cycle of care was performed recently by our group. For a broad set of effect outcomes, we found that BoNT-A had no added value if children received comprehensive rehabilitation. However, this counterintuitive finding was met with scepticism. OBJECTIVE Since several noteworthy facts and experiences were recorded during the course of the trial and the dissemination phase, the aim of this paper was to describe and discuss some crucial aspects of, and barriers to, the Space Bop study, related to context and perspective, design and results, as well as publication and implementation. METHODS This paper discusses 5 issues: (i) the design, interpretation and presentation of previous research; (ii) the role of one's own clinical experience and interpretation; (iii) the aims of (BoNT-A) treatment; (iv) conflict of interest, role of industry, and the role of history; (v) optimal treatment modalities and dose-response relationships. CONCLUSION Despite the unambiguous findings from the Space Bop study, several factors hindered acceptance of the results. Awareness of these factors is important when performing rehabilitation research and disseminating and implementing research findings.
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Affiliation(s)
- Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam P.O. BOX 2040, NL-3000 CA Rotterdam, The Netherlands
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24
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Hoorntje A, Witjes S, Kuijer PPFM, Bussmann JBJ, Horemans HLD, Kerkhoffs GMMJ, van Geenen RCI, Koenraadt KLM. Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial. J Arthroplasty 2020; 35:706-711. [PMID: 31740103 DOI: 10.1016/j.arth.2019.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Especially in younger knee osteoarthritis patients, the ability to perform physical activity (PA) after knee arthroplasty (KA) is of paramount importance, given many patients' wish to return to work and perform demanding leisure time activities. Goal Attainment Scaling (GAS) rehabilitation after KA may improve PA because it uses individualized activity goals. Therefore, our aim was to objectively quantify PA changes after KA and to compare GAS-based rehabilitation to standard rehabilitation. METHODS Data were obtained from the randomized controlled ACTION trial, which compares standard rehabilitation with GAS-based rehabilitation after total and unicompartmental KA in patients <65 years of age. At 2 time points, preoperatively and 6 months postoperatively, 120 KA patients wore a validated 3-dimensional accelerometer for 1 consecutive week. Data were classified as sedentary (lying, sitting), standing, and active (walking, cycling, running). Repeated measures analysis of variance was used to compare PA changes over time. RESULTS Complete data were obtained for 97 patients (58% female), with a mean age of 58 years (±4.8). For the total group, we observed a significant increase in PA of 9 minutes (±37) per day (P = .01) and significant decrease in sedentary time of 20 minutes (±79) per day (P = .02). There was no difference in standing time (P = .11). There was no difference between the control group and the intervention group regarding changes in PA, nor between the total KA group and the unicompartmental KA group. CONCLUSION We found a small but significant increase in overall PA after KA, but no difference between GAS-based rehabilitation and standard rehabilitation. Likely, enhanced multidisciplinary perioperative strategies are needed to further improve PA after KA.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Suzanne Witjes
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ICONE Orthopaedics and Sports Traumatology, Schijndel, the Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Herwin L D Horemans
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
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Krops LA, Geertzen JHB, Horemans HLD, Bussmann JBJ, Dijkstra PU, Dekker R. Feasibility and short-term effects of Activity Coach+: a physical activity intervention in hard-to-reach people with a physical disability. Disabil Rehabil 2020; 43:2769-2778. [PMID: 31999496 DOI: 10.1080/09638288.2020.1717650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Existing physical activity interventions do not reach a considerable proportion of physically disabled people. This study assessed feasibility and short-term effects of Activity Coach+, a community-based intervention especially targeting this hard-to-reach population. METHODS Feasibility was determined by reach, dropouts, and compliance with the protocol. Physical activity was measured with the Activ8 accelerometer and the adapted SQUASH questionnaire. Health outcomes were assessed by body composition, blood pressure, hand grip force, 10-metre walk test, 6-minute walk test, and the Berg Balance Scale. The RAND-36, Exercise Self-Efficacy Scale, Fatigue Severity Scale, and IMPACT-S were administered. Measurements were performed at baseline and after 2 and 4 months. Changes over time were analysed by Friedman tests. RESULTS Twenty-nine participants enrolled during the first 4 months, of whom two dropped out. Intervention components were employed in 86-100% of the participants. Physical activity did not change after the implementation of Activity Coach+. Body mass index (p = 0.006), diastolic blood pressure (p = 0.032), walking ability (p = 0.002), exercise capacity (p = 0.013), balance (p = 0.014), and vitality (p = 0.049) changed over time. CONCLUSIONS Activity Coach + is feasible in a community setting. Indications for effectivity of Activity Coach + in hard-to-reach people with a physical disability were found.Implications for rehabilitationActivity Coach + was able to reach physically disabled people living in community, a population that is assumed hard-to-reach.Activity Coach + was feasible in a population of persons with a physical disability that was heterogeneous with respect to age and (severity of) disability.The current study provides the first indications for the beneficial health effects of Activity Coach + in hard-to-reach people with a physical disability.
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Affiliation(s)
- L A Krops
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J H B Geertzen
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - H L D Horemans
- Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - J B J Bussmann
- Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - P U Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
| | - R Dekker
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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26
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Mohamed Refai MI, van Beijnum BJF, Buurke JH, Saes M, Bussmann JBJ, Meskers CG, Wegen EV, Kwakkel G, Veltink PH. Portable Gait Lab: Zero Moment Point for Minimal Sensing of Gait. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2077-2081. [PMID: 31946310 DOI: 10.1109/embc.2019.8857314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ambulatory sensing of gait kinematics using inertial measurement units (IMUs) usually uses sensor fusion filters. These algorithms require measurement updates to reduce drift between segments. A full body IMU suit can use biomechanical relations between body segments to solve this. However, when minimising the sensor set, we lose a lot of this information. In this study, we explore the assumptions of zero moment point (ZMP) as a possible source of measurement updates for the sensor fusion filters. ZMP is otherwise utilised for humanoid gait in robots. In this study, first, the relation between the ZMP and centre of pressure (CoP) is studied using a GRAIL system, consisting of opto-kinetic measurements. We find that the mean distance over the gait cycle between ZMP and CoP is 10.5±1.2% of the foot length. Following this, we show how these results could be used to improve measurements in a minimal IMU based sensing setup.
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Claridge EA, van den Berg-Emons RJG, Horemans HLD, van der Slot WMA, van der Stam N, Tang A, Timmons BW, Gorter JW, Bussmann JBJ. Detection of body postures and movements in ambulatory adults with cerebral palsy: a novel and valid measure of physical behaviour. J Neuroeng Rehabil 2019; 16:125. [PMID: 31665030 PMCID: PMC6821000 DOI: 10.1186/s12984-019-0594-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM's positioning affects validity. METHODS In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time-AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng's tests. RESULTS Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all). CONCLUSIONS The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.
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Affiliation(s)
- Everett A Claridge
- School of Rehabilitation Sciences, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Herwin L D Horemans
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Wilma M A van der Slot
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015, Rotterdam, LJ, Netherlands
| | - Nick van der Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada
| | - Brian W Timmons
- CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, 1280 Main St. W, Hamilton, Ontario, L8S 4L8, Canada
| | - Jan Willem Gorter
- School of Rehabilitation Sciences, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands.
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Braakhuis HEM, Berger MAM, van der Stok GA, van Meeteren J, de Groot V, Beckerman H, Bussmann JBJ. Three distinct physical behavior types in fatigued patients with multiple sclerosis. J Neuroeng Rehabil 2019; 16:105. [PMID: 31443714 PMCID: PMC6708224 DOI: 10.1186/s12984-019-0573-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation. Trial registration Clinical trial registration no ISRCTN 82353628, ISRCTN 69520623 and ISRCTN 58583714. Electronic supplementary material The online version of this article (10.1186/s12984-019-0573-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H E M Braakhuis
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Faculty of Health Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands.
| | - M A M Berger
- Faculty of Health Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - G A van der Stok
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J van Meeteren
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,MS Center Amsterdam, Amsterdam, The Netherlands
| | - H Beckerman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,MS Center Amsterdam, Amsterdam, The Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Blikman LJM, van Meeteren J, Twisk JWR, de Laat FAJ, de Groot V, Beckerman H, Stam HJ, Bussmann JBJ. Energy Conservation Management for People With Multiple Sclerosis-Related Fatigue: Who Benefits? Am J Occup Ther 2019; 73:7304205040p1-7304205040p9. [PMID: 31318668 DOI: 10.5014/ajot.2019.032474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated whether demographic, disease-related, or personal baseline determinants can predict a positive response to energy conservation management (ECM). METHOD We conducted a secondary analysis of a single-blind, two-parallel-arms randomized controlled trial that included ambulatory adults with severe MS-related fatigue. Therapy responders and nonresponders were categorized by Checklist Individual Strength fatigue change scores between baseline and end of treatment. Logistic regression analyses were used to assess the determinants of response. RESULTS Sixty-nine participants were included (ECM group, n = 34; control group, n = 35). In the ECM group, fatigue severity, perception of fatigue, illness cognitions about MS, and social support discrepancies were related to the probability of being a responder. CONCLUSION The results suggest that people with MS-related fatigue who had a less negative perception of fatigue and who perceived fewer disease benefits and a higher discrepancy in social support had the best response to ECM treatment.
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Affiliation(s)
- Lyan J M Blikman
- Lyan J. M. Blikman, PhD, is Job Coordinator, Research Support, Twente University, Enschede, the Netherlands. At the time of this study, she was PhD Student, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jetty van Meeteren
- Jetty van Meeteren, MD, PhD, is Physiatrist, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands, and Physiatrist, Rijndam Rehabilitation Center, Rotterdam, the Netherlands;
| | - Jos W R Twisk
- Jos W. R. Twisk, PhD, is Statistician and Epidemiologist, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Fred A J de Laat
- Fred A. J. de Laat, MD, PhD, is Physiatrist, Department of Rehabilitation, Libra Rehabilitation Medicine and Audiology, Tilburg, the Netherlands
| | - Vincent de Groot
- Vincent de Groot, MD, PhD, is Physiatrist, Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam Public Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Heleen Beckerman
- Heleen Beckerman, MD, PhD, is Assistant Professor, Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam Public Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Henk J Stam
- Henk J. Stam, MD, PhD, FRCP, is Physiatrist, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Johannes B J Bussmann
- Johannes B. J. Bussmann, PhD, is Associate Professor, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Braakhuis HEM, Berger MAM, Bussmann JBJ. Effectiveness of healthcare interventions using objective feedback on physical activity: A systematic review and meta-analysis. J Rehabil Med 2019; 51:151-159. [PMID: 30843082 DOI: 10.2340/16501977-2522] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of health-care interventions promoting physical activity, which use objective feedback on physical activity delivered using wearable activity monitors as part of the intervention. Intervention groups are compared with control groups receiving usual care or interventions without objective feedback. DATA SOURCES PubMed, EMBASE, MEDLINE and Cochrane Library were searched to identify randomized controlled trials. STUDY SELECTION Randomized controlled trials published after 2007 with (former) healthcare patients ≥ 21 years of age were included if physical activity was measured objectively using a wearable monitor for both feedback and outcome assessment. The main goal of included studies was promoting physical activity. Any concurrent strategies were related only to promoting physical activity. DATA EXTRACTION Effect sizes were calculated using a fixed-effects model with standardized mean difference. Information on study characteristics and interventions strategies were extracted from study descriptions. DATA SYNTHESIS Fourteen studies met the inclusion criteria (total n = 1,902), and 2 studies were excluded from meta-analysis. The overall effect size was in favour of the intervention groups (0.34, 95% CI 0.23-0.44, p < 0.01). Study characteristics and intervention strategies varied widely. CONCLUSION Healthcare interventions using feedback on objectively monitored physical activity have a moderately positive effect on levels of physical activity. Further research is needed to determine which strategies are most effective to promote physical activity in healthcare programmes.
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Hendrickx W, Riveros C, Askim T, Bussmann JBJ, Callisaya ML, Chastin SFM, Dean CM, Ezeugwu VE, Jones TM, Kuys SS, Mahendran N, Manns TJ, Mead G, Moore SA, Paul L, Pisters MF, Saunders DH, Simpson DB, Tieges Z, Verschuren O, English C. Identifying factors associated with sedentary time after stroke. Secondary analysis of pooled data from nine primary studies. Top Stroke Rehabil 2019; 26:327-334. [PMID: 31025908 DOI: 10.1080/10749357.2019.1601419] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11-19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke.
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Affiliation(s)
- Wendy Hendrickx
- a Department of Rehablilitation, Physiotherapy Science & Sport, Brain Center Rudolf Magnus , University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands.,b School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine , University of Newcastle , Newcastle , Australia.,c Center for Physical Therapy Research and Innovation in Primary Care , Julius Health Care Centers , Utrecht , The Netherlands
| | - Carlos Riveros
- d Bioinformatics , Hunter Medical Research Institute , Newcastle , Australia
| | - Torunn Askim
- e Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
| | - Johannes B J Bussmann
- f Department of Rehabilitation Medicine Erasmus , MC University Medical Center , Rotterdam , The Netherlands
| | - Michele L Callisaya
- g Menzies Institute for Medical Research , University of Tasmania , Hobart , Australia
| | - Sebastien F M Chastin
- h School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK.,i Department of Movement and Sports Sciences, Faculty of Medicine and Health Science , Ghent University , Ghent , Belgium
| | - Catherine M Dean
- j Department of Health Professions, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Victor E Ezeugwu
- k Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
| | - Taryn M Jones
- j Department of Health Professions, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Suzanne S Kuys
- l National Head, School of Physiotherapy , Faculty of Health Sciences Australian Catholic University , Brisbane , Australia
| | - Niruthikha Mahendran
- m Discipline of Physiotherapy, Faculty of Health , University of Canberra , Canberra , Australia
| | - Trish J Manns
- k Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
| | - Gillian Mead
- n Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK
| | - Sarah A Moore
- o Stroke Research Group , Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle University , UK
| | - Lorna Paul
- p School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Martijn F Pisters
- a Department of Rehablilitation, Physiotherapy Science & Sport, Brain Center Rudolf Magnus , University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands.,c Center for Physical Therapy Research and Innovation in Primary Care , Julius Health Care Centers , Utrecht , The Netherlands
| | - David H Saunders
- q Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences , University of Edinburgh , Edinburgh , UK
| | - Dawn B Simpson
- g Menzies Institute for Medical Research , University of Tasmania , Hobart , Australia
| | - Zoë Tieges
- r Department of Geriatric Medicine , University of Edinburgh , Edinburgh , UK
| | - Olaf Verschuren
- s Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation , University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Coralie English
- b School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine , University of Newcastle , Newcastle , Australia
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Lankhorst K, van den Berg-Emons RJ, Bussmann JBJ, Horemans HLD, de Groot JF. A Novel Tool for Quantifying and Promoting Physical Activity in Youths With Typical Development and Youths Who Are Ambulatory and Have Motor Disability. Phys Ther 2019; 99:354-363. [PMID: 30649497 DOI: 10.1093/ptj/pzy152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several device-based instruments have been validated in the pediatric population, but none of these are clinically applicable and provide real-time feedback on actual physical activity in terms of postures and movements. A new device (Activ8) is promising for that purpose. OBJECTIVE The objective was to investigate the criterion validity of the Activ8 for measuring static (sitting, standing) and dynamic (walking, bicycling, running) activities, and for separating postures and movements within basic and complex activities in children and adolescents (youths) with typical development (TD) and peers with motor disability (not typical development [NTD]). DESIGN This was a criterion validation study. METHODS Ten participants with TD (mean age [standard deviation] = 14 [2.5] years) and 10 participants with NTD (mean age = 12.9 [2.1] years) performed a standardized series of basic and daily life (complex) activities. The Activ8 measured postures and movements, while camera recording served as a reference. The outcome measures were the mean time differences between the Activ8 output and video data for the merged categories "static" and "dynamic" and for the separate postures and movements. RESULTS For the merged categories static and dynamic, the criterion validity was found to be excellent both in participants with TD and participants with NTD within basic activities, and was found to be good to excellent in participants with TD and moderate to good in participants with NTD within complex activities. The detection of separate postures and movements was found to be poor to excellent in both groups within complex activities. LIMITATIONS The sample of youths with NTD was small and limited to youths who could be considered to be at least ambulatory within a household. CONCLUSIONS Activ8 is a valid tool when the merged categories static and dynamic are used to interpret physical activity in daily life in both youths with TD and youths with NTD and mild motor impairment. To optimize the quantification of separate postures and movements, adjustment of the existing algorithm is required.
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Affiliation(s)
- Kristel Lankhorst
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands; and Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences, PO Box 85083, 3508 AB, Utrecht, the Netherlands
| | - Rita J van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Janke F de Groot
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab; Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences; and Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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Fanchamps MHJ, de Kam D, Sneekes EM, Stam HJ, Weerdesteyn V, Bussmann JBJ. Effect of different operationalizations of sedentary behavior in people with chronic stroke. Disabil Rehabil 2018; 42:999-1005. [PMID: 30475079 DOI: 10.1080/09638288.2018.1512164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Sedentary behavior is common in people with stroke and has devastating impact on their health. Quantifying it is important to provide people with stroke with adequate physical behavior recommendations. Sedentary behavior can be quantified in terms of posture (sitting) or intensity (low energy expenditure). We compared the effect of different operationalizations of sedentary behavior on sedentary behavior outcomes (total time; way of accumulation) in people with stroke.Methods: Sedentary behavior was analyzed in 44 people with chronic stroke with an activity monitor that measured both body postures and movement intensity. It was operationalized as: (1) combining postural and intensity data; (2) using only postural data; (3) using only intensity data. For each operationalization, we quantified a set of outcomes. Repeated measures ANOVA and Bland-Altman plots were used to compare the operationalizations.Results: All sedentary behavior outcomes differed significantly between all operationalizations (p < 0.01). Bland-Altman plots showed large limits of agreement for all outcomes, showing large individual differences between operationalizations.Conclusions: Although it was neither possible nor our aim to investigate the validity of the two-component definition of sedentary behavior, our study shows that the type of operationalization of sedentary behavior significantly influences sedentary behavior outcomes in people with stroke.Implications for RehabilitationReliable assessment of sedentary behavior after stroke is important in order to provide adequate physical behavior recommendations for people with stroke.Sedentary behavior can be operationalized in terms of body posture (sitting time) or in terms of movement intensity (time <1.5 MET) or as a combination of both criteria; this study reveals that the type of operationalization affects the different outcome measures used to quantify sedentary behavior.Comparing sedentary behavior outcomes requires caution and should only be done when sedentary behavior is operationalized in the same way.
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Affiliation(s)
- Malou H J Fanchamps
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Digna de Kam
- Department of Rehabilitation, Radboud University Medical Center Donders Center for Neuroscience, Nijmegen, The Netherlands
| | - Emiel M Sneekes
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Radboud University Medical Center Donders Center for Neuroscience, Nijmegen, The Netherlands.,Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Favejee MM, van der Meijden JC, Kruijshaar ME, Rizopoulos D, van der Ploeg AT, Bussmann JBJ. Association of Muscle Strength and Walking Performance in Adult Patients With Pompe Disease. Phys Ther 2018; 98:925-931. [PMID: 30265367 PMCID: PMC6328012 DOI: 10.1093/ptj/pzy090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/23/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The loss of the ability to walk is among the most prominent signs of Pompe disease. The associations with muscle strength have not been described. OBJECTIVE The objective of this study was to estimate the associations of walking performance with muscle strength in 4 specific lower extremity muscle groups along with other factors in adult patients with Pompe disease. DESIGN This was a single-center, cross-sectional study. METHODS Muscle strength (hand-held dynamometry of hip flexion and abduction and knee extension and flexion) and walking performance (unable to walk, able with aids, walking without aids but with a waddling gait, or walking without aids and with a normal gait) were assessed in 107 patients at their first visit. Relationships between walking performance and muscle strength were studied through multivariate analyses and regression modeling. Age, sex, body mass index (BMI), disease duration, and use of ventilator support were taken into account as potential confounders. The results were transformed into a nomogram to allow the probability of a patient having a certain level of walking performance to be calculated based on the values of the independent variables. RESULTS Walking performance declined significantly with decreasing muscle strength of hip flexion and abduction and knee extension and flexion. The final selected model, including strength of the hip abductor and knee extensor, BMI, age, sex, and use of ventilation, predicted 66% of the cases accurately. LIMITATIONS These results are based on cross-sectional data and do not predict future changes. CONCLUSIONS In adult people with Pompe disease, walking performance can be explained by muscle strength, BMI, age, sex, and ventilation use. The proposed model gives insight into how an individual is expected to walk based on his or her risk factors and serves as a starting point to unraveling factors associated with walking performance and ultimately to developing a prognostic model.
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Affiliation(s)
- Marein M Favejee
- Department of Paediatrics, Center for Lysosomal and Metabolic Diseases, and Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jan C van der Meijden
- Department of Paediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Michelle E Kruijshaar
- Department of Paediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands,Address all correspondence to Prof van der Ploeg at:
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine & Physical Therapy, Erasmus, MC University Medical Center
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Blikman LJM, van Meeteren J, Rizopoulos D, de Groot V, Beckerman H, Stam HJ, Bussmann JBJ. Physical behaviour is weakly associated with physical fatigue in persons with multiple sclerosis-related fatigue. J Rehabil Med 2018; 50:821-827. [PMID: 30183054 DOI: 10.2340/16501977-2375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fatigue affects 80% of persons with multiple sclerosis and is associated with daily physical functioning. Both fatigue and physical behaviour are multidimensional concepts. OBJECTIVE To study the association between the dimensions of physical behaviour and multiple sclerosis-related fatigue. METHODS Cross-sectional analysis of 212 persons with multiple sclerosis. Participants were severely fatigued, with a Fatigue Severity Scale median (interquartile range): 5.4 (4.8-5.9) and were minimally to moderately neurologically impaired, based on the Expanded Disability Status Scale: 2.5 (2.0-3.5), 73% had relapsing-remitting multiple sclerosis. Fatigue was measured by questionnaires (i.e. Checklist Individual Strength, Modified Fatigue Impact Scale), and the dimensions subjective, physical, cognitive and psychological fatigue were distinguished. Physical behaviour was measured using an Actigraph GT3X+, and outcomes were categorized into the dimensions of activity amount, activity intensity, day pattern, and distribution of activities. RESULTS The physical behaviour dimensions were significantly associated with only the physical fatigue dimension (omnibus F-test: 3.96; df1 = 4, df2 = 207; p = 0.004). Additional analysis showed that the amount of activity (unstandardized beta coefficient (β) = -0.16; 95% confidence interval (CI) -0.27 to -0.04; p = 0.007), activity intensity (β = -0.18; 95% CI -0.31 to -0.06; p = 0.004) and day pattern of activity (β = -0.17; 95% CI, -0.28 to -0.06; p = 0.002) were the physical behaviour dimensions that were significantly associated with physical fatigue. CONCLUSION Physical behaviour is weakly associated with physical fatigue and is not associated with other dimensions of fatigue.
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Affiliation(s)
- Lyan J M Blikman
- Rehabilitation Medicine, Erasmus MC, , 3000 CA Rotterdam, The Netherlands.
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Schasfoort F, Pangalila R, Sneekes EM, Catsman C, Becher J, Horemans H, Stam HJ, Dallmeijer AJ, Bussmann JBJ. Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy. J Rehabil Med 2018; 50:732-742. [PMID: 30080235 DOI: 10.2340/16501977-2369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Botulinum toxin (BoNT-A) is widely used in combined treatment for spastic cerebral palsy, but its added value preceding comprehensive rehabilitation for motor impairments, gait, and goal attainment has not been studied. DESIGN A comparative multi-centre trial, in which two groups underwent comprehensive rehabilitation (i.e. high-intensive functional physiotherapy, and indicated casting/orthoses). One group received intramuscular BoNT-A prior to rehabilitation, and the other group did not receive BoNT-A. SUBJECTS/PATIENTS Children with spastic cerebral palsy, Gross Motor Function Classification System (GMFCS) levels I-III, age range 4-12 years, indicated for BoNT-A treatment regarding mobility problems. METHODS Sixty-five children participated (37 boys), mean age 7.3 years (standard deviation (SD) 2.3, range 4-12 years), equally distributed across GMFCS levels. Forty-one children received BoNT-A+ comprehensive rehabilitation and 24 received comprehensive rehabilitation only. Functional leg muscle strength, passive range of motion, angle of catch, cerebral palsy-related pain, walking speed, kinematic gait parameters, goal attainment, and proxy-reported general functioning were assessed at baseline, primary end-point (12 weeks) and 24-week follow-up. Statistical analyses were performed with linear mixed models. RESULTS At the primary end-point there were no statistically significant differences in treatment effects between the groups, except for the angle-of-catch of the rectus femoris, which was in favour of comprehensive rehabilitation without BoNT-A (12° difference, 95% confidence interval (95% CI) 2:23, p = 0.025). Results at follow-up were similar. CONCLUSION At the group level, treating with BoNT-A prior to comprehensive rehabilitation did not add to the clinical effectiveness of rehabilitation. Thus, BoNT-A prescription and use should be critically reconsidered in this cerebral palsy age- and GMFCS-subgroup.
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Fanchamps MHJ, Selles RW, Stam HJ, Bussmann JBJ. Development and validation of a clinically applicable arm use monitor for people after stroke. J Rehabil Med 2018; 50:705-712. [PMID: 29944168 DOI: 10.2340/16501977-2358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To develop and validate a clinically applicable and easy-to-use accelerometry-based device to measure arm use in people after stroke; the Activ8 arm use monitor (Activ8-AUM). DESIGN Development and validation study. PATIENTS A total of 25 people at different stages of rehabilitation after stroke were included in this study. METHODS The Activ8-AUM consists of 3 single-sensor Activ8s: one on the unaffected thigh and one on each wrist. Arm use was calculated by combining movement intensity of the arms with data from body posture and movements on the leg sensor. Data were divided into 2 sets: one for determining situation-specific movement intensity thresholds for arm use, and the other to validate the Activ8-AUM using video recordings. RESULTS Overall agreement between the Activ8-AUM and video recordings was 75%, sensitivity was 73% and specificity was 77%. Agreement between the different categories of arm use ranged from 42% to 93% for the affected arm and from 24% to 82% for the unaffected arm. CONCLUSION By combining the movement intensity threshold with body posture and movements, good agreement was reached between the Activ8-AUM and video recordings. This result, together with the easy-to-use configuration, makes the Activ8-AUM a promising device to measure arm use in people after stroke.
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Kooijmans H, Post MWM, Stam HJ, van der Woude LHV, Spijkerman DCM, Snoek GJ, Bongers-Janssen HMH, van Koppenhagen CF, Twisk JW, Bussmann JBJ. Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial. Neurorehabil Neural Repair 2018; 31:991-1004. [PMID: 29256337 DOI: 10.1177/1545968317736819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. OBJECTIVE The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. METHODS This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. RESULTS Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes ( P ≥ .05). CONCLUSIONS A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude.
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Affiliation(s)
- Hedwig Kooijmans
- 1 Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marcel W M Post
- 2 University Medical Center Utrecht and De Hoogstraat, Utrecht, Netherlands.,3 University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Henk J Stam
- 1 Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Govert J Snoek
- 5 Roessingh Rehabilitation Center, Enschede, Netherlands
| | | | | | - Jos W Twisk
- 8 VU University Medical Center, Amsterdam, Netherlands
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Fanchamps MHJ, Horemans HLD, Ribbers GM, Stam HJ, Bussmann JBJ. The Accuracy of the Detection of Body Postures and Movements Using a Physical Activity Monitor in People after a Stroke. Sensors (Basel) 2018; 18:E2167. [PMID: 29976900 PMCID: PMC6069255 DOI: 10.3390/s18072167] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND In stroke rehabilitation not only are the levels of physical activity important, but body postures and movements performed during one’s daily-life are also important. This information is provided by a new one-sensor accelerometer that is commercially available, low-cost, and user-friendly. The present study examines the accuracy of this activity monitor (Activ8) in detecting several classes of body postures and movements in people after a stroke. METHODS Twenty-five people after a stroke participated in an activity protocol with either basic activities or daily-life activities performed in a laboratory and/or at home. Participants wore an Activ8 on their less-affected thigh. The primary outcome was the difference in registered time for the merged class “upright position” (standing/walking/running) between the Activ8 and the video recording (the reference method). Secondary analyses focused on classes other than “upright position”. RESULTS The Activ8 underestimated the merged class “upright position” by 3.8% (775 s). The secondary analyses showed an overestimation of “lying/sitting” (4.5% (569 s)) and of “cycling” (6.5% (206 s)). The differences were lowest for basic activities in the laboratory and highest for daily-life activities at home. CONCLUSIONS The Activ8 is sufficiently accurate in detecting different classes of body postures and movements of people after a stroke during basic activities and daily-life activities in a laboratory and/or at home.
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Affiliation(s)
- Malou H J Fanchamps
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
- Rijndam Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, The Netherlands.
| | - Herwin L D Horemans
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
- Rijndam Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, The Netherlands.
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Leving MT, Horemans HLD, Vegter RJK, de Groot S, Bussmann JBJ, van der Woude LHV. Validity of consumer-grade activity monitor to identify manual wheelchair propulsion in standardized activities of daily living. PLoS One 2018; 13:e0194864. [PMID: 29641582 PMCID: PMC5894999 DOI: 10.1371/journal.pone.0194864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Hypoactive lifestyle contributes to the development of secondary complications and lower quality of life in wheelchair users. There is a need for objective and user-friendly physical activity monitors for wheelchair-dependent individuals in order to increase physical activity through self-monitoring, goal setting, and feedback provision. Objective To determine the validity of Activ8 Activity Monitors to 1) distinguish two classes of activities: independent wheelchair propulsion from other non-propulsive wheelchair-related activities 2) distinguish five wheelchair-related classes of activities differing by the movement intensity level: sitting in a wheelchair (hands may be moving but wheelchair remains stationary), maneuvering, and normal, high speed or assisted wheelchair propulsion. Methods Sixteen able-bodied individuals performed sixteen various standardized 60s-activities of daily living. Each participant was equipped with a set of two Activ8 Professional Activity Monitors, one at the right forearm and one at the right wheel. Task classification by the Active8 Monitors was validated using video recordings. For the overall agreement, sensitivity and positive predictive value, outcomes above 90% are considered excellent, between 70 and 90% good, and below 70% unsatisfactory. Results Division in two classes resulted in overall agreement of 82.1%, sensitivity of 77.7% and positive predictive value of 78.2%. 84.5% of total duration of all tasks was classified identically by Activ8 and based on the video material. Division in five classes resulted in overall agreement of 56.6%, sensitivity of 52.8% and positive predictive value of 51.9%. 59.8% of total duration of all tasks was classified identically by Activ8 and based on the video material. Conclusions Activ8 system proved to be suitable for distinguishing between active wheelchair propulsion and other non-propulsive wheelchair-related activities. The ability of the current system and algorithms to distinguish five various wheelchair-related activities is unsatisfactory.
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Affiliation(s)
- Marika T. Leving
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Henricus L. D. Horemans
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Riemer J. K. Vegter
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonja de Groot
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
PURPOSE Increasing physical activity level is a generally effective intervention goal for patients who suffer from chronic cancer-related fatigue (CCRF). However, patients are unlikely to benefit equally from these interventions, as their behavioral starting points might vary substantially. Therefore, we explored patterns of physical behavior of participants who suffer from CCRF. METHODS Baseline data of a randomized controlled trial were used for a latent profile analysis on nine accelerometer-derived physical behavior measures, describing levels and patterns of physical activity, moderate-to-vigorous intensity physical activity (MVPA), and sedentary behavior. The relation between participant characteristics and the latent profiles was analyzed. RESULTS Accelerometer data of 172 participants from the Netherlands was analyzed. Three latent profiles were distinguished that differed most on physical activity level and total time spent in MVPA. Eighty-eight percent of all participants were assigned to a profile with a probability higher than 8. Age and perceiving limitations by comorbid conditions and pain were significant covariates of profile membership. CONCLUSIONS We distinguished three physical behavior profiles. The differences between the patterns indicate that the heterogeneity of this sample requires patients to have substantially different treatment goals. Further research should test the applicability of these profiles in clinical practice.
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Affiliation(s)
- M D J Wolvers
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - F Z Bruggeman-Everts
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
- Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands
| | - S T Boerema
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - R van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - M M R Vollenbroek-Hutten
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
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Harmsen WJ, Ribbers GM, Heijenbrok-Kal MH, Bussmann JBJ, Sneekes EM, Khajeh L, van Kooten F, Neggers SJCMM, van den Berg-Emons RJ. Inactive lifestyles and sedentary behavior in persons with chronic aneurysmal subarachnoid hemorrhage: evidence from accelerometer-based activity monitoring. J Neuroeng Rehabil 2017; 14:120. [PMID: 29169368 PMCID: PMC5701368 DOI: 10.1186/s12984-017-0331-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/31/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (a-SAH) is a potential life-threatening stroke. Because survivors may be at increased risk for inactive and sedentary lifestyles, this study evaluates physical activity (PA) and sedentary behavior (SB) in the chronic phase after a-SAH. METHODS PA and SB were objectively measured at six months post a-SAH with an accelerometer-based activity monitor, with the aim to cover three consecutive weekdays. Total time spent in PA (comprising walking, cycling, running and non-cyclic movement) and SB (comprising sitting and lying) was determined. Also, in-depth analyses were performed to determine the accumulation and distribution of PA and SB throughout the day. Binary time series were created to determine the mean bout length and the fragmentation index. Measures of PA and SB in persons with a-SAH were compared to those in sex- and age-matched healthy controls. RESULTS The 51 participants comprised 33 persons with a-SAH and 18 controls. None of the participants had signs of paresis or spasticity. Persons with a-SAH spent 105 min/24 h being physically active, which was 35 min/24 h less than healthy controls (p = 0.005). For PA, compared with healthy controls, the mean bout length was shorter in those with a-SAH (12.0 vs. 13.5 s, p = 0.006) and the fragmentation index was higher (0.053 vs. 0.041, p < 0.001). Total sedentary time during waking hours showed no significant difference between groups (514 min vs. 474 min, p = 0.291). For SB, the mean bout length was longer in persons with a-SAH (122.3 vs. 80.5 s, p = 0.024), whereas there was no difference in fragmentation index between groups (0.0032 vs 0.0036, p = 0.396). CONCLUSIONS Persons with a-SAH are less physically active, they break PA time into shorter periods, and SB periods last longer compared to healthy controls. Since inactive lifestyles and prolonged uninterrupted periods of SB are independent risk factors for poor cardiovascular health, interventions seem necessary and should target both PA and SB. STUDY REGISTRATION Dutch registry number: NTR 2085.
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Affiliation(s)
- Wouter J Harmsen
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands. .,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Gerard M Ribbers
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Emiel M Sneekes
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sebastian J C M M Neggers
- Department of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rita J van den Berg-Emons
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Fanchamps MHJ, van den Berg-Emons HJG, Stam HJ, Bussmann JBJ. Sedentary behavior: Different types of operationalization influence outcome measures. Gait Posture 2017; 54:188-193. [PMID: 28324755 DOI: 10.1016/j.gaitpost.2017.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/23/2016] [Accepted: 02/23/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sedentary behavior (SB) influences health status independently of physical activity. The formal definition of SB is: "any waking behavior characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture". However, measuring SB mostly does not include both the intensity and postural component. The aim of this study was to quantify the effect of type of operationalization of SB on total sedentary time and the pattern of SB. METHODS 53 healthy subjects were measured 24h with a multi-sensor activity monitor that provides a valid one-second detection of body postures and movements and a calculated intensity measure. The SB outcome measures were: total sedentary time; number of sedentary bouts; mean bout length; fragmentation; and W-index. All outcomes were calculated for three types of operationalization of SB: 1) waking time in lying and sitting posture and below the sedentary intensity threshold (<0.016g comparable with Actigraph <150 counts, COMBI); 2) waking time in lying and sitting posture (POST); 3) waking time below the sedentary intensity threshold (<0.016g, INT). Outcome measures based on these three operationalizations were compared with repeated measures ANOVA. RESULTS Total sedentary time was significantly different (p<0.001) between all three conditions: 505.8 (113.85)min (COMBI), 593.2 (112.09)min (POST), and 565.5 (108.54)min (INT). Significant differences were also found for other outcome measures. CONCLUSION Our study shows that type of operationalization significantly affects SB outcome measures. Therefore, if SB is defined according to the formal definition, measurements must include both the intensity and postural component.
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Affiliation(s)
- Malou H J Fanchamps
- Dept. of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | | | - Henk J Stam
- Dept. of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Dept. of Rehabilitation Medicine, Erasmus MC University Medical Centre Rotterdam, The Netherlands.
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van den Berg LEM, Favejee MM, Wens SCA, Kruijshaar ME, Praet SFE, Reuser AJJ, Bussmann JBJ, van Doorn PA, van der Ploeg AT. Safety and efficacy of exercise training in adults with Pompe disease: evalution of endurance, muscle strength and core stability before and after a 12 week training program. Orphanet J Rare Dis 2015; 10:87. [PMID: 26187632 PMCID: PMC4506616 DOI: 10.1186/s13023-015-0303-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/07/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pompe disease is a proximal myopathy. We investigated whether exercise training is a safe and useful adjuvant therapy for adult Pompe patients, receiving enzyme replacement therapy. METHODS Training comprised 36 sessions of standardized aerobic, resistance and core stability exercises over 12 weeks. Before and after, the primary outcome measures safety, endurance (aerobic exercise capacity and distance walked on the 6 min walk test) and muscle strength, and secondary outcome measures core stability, muscle function and body composition, were evaluated. RESULTS Of 25 patients enrolled, 23 successfully completed the training. Improvements in endurance were shown by increases in maximum workload capacity (110 W before to 122 W after training, [95 % CI of the difference 6 · 0 to 19 · 7]), maximal oxygen uptake capacity (69 · 4 % and 75 · 9 % of normal, [2 · 5 to 10 · 4]), and maximum walking distance (6 min walk test: 492 meters and 508, [-4 · 4 to 27 · 7] ). There were increases in muscle strength of the hip flexors (156 · 4 N to 180 · 7 N [1 · 6 to 13 · 6) and shoulder abductors (143 · 1 N to 150 · 7 N [13 · 2 to 35 · 2]). As an important finding in secondary outcome measures the number of patients who were able to perform the core stability exercises rose, as did the core stability balancing time (p < 0.05, for all four exercises). Functional tests showed small reductions in the time needed to climb four steps (2 · 4 sec to 2 · 1, [- 0 · 54 to -0 · 04 ]) and rise to standing position (5 · 8 sec to 4 · 8, [-2 · 0 to 0 · 0]), while time to run, the quick motor function test results and body composition remained unchanged. CONCLUSIONS Our study shows that a combination of aerobic, strength and core stability exercises is feasible, safe and beneficial to adults with Pompe disease.
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Affiliation(s)
- Linda E M van den Berg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center - Sophia Children's Hospital, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Marein M Favejee
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center - Sophia Children's Hospital, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Stephan C A Wens
- Center for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Michelle E Kruijshaar
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center - Sophia Children's Hospital, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Stephan F E Praet
- Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Arnold J J Reuser
- Center for Lysosomal and Metabolic Diseases, Department of Clinical Genetics, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine & Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Center for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center - Sophia Children's Hospital, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Rozenberg R, Bussmann JBJ, Lesaffre E, Stam HJ, Praet SFE. A steep ramp test is valid for estimating maximal power and oxygen uptake during a standard ramp test in type 2 diabetes. Scand J Med Sci Sports 2014; 25:595-602. [PMID: 25439985 DOI: 10.1111/sms.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 01/26/2023]
Abstract
A short maximal steep ramp test (SRT, 25 W/10 s) has been proposed to guide exercise interventions in type 2 diabetes, but requires validation. This study aims to (a) determine the relationship between Wmax and V˙O2peak reached during SRT and the standard ramp test (RT); (b) obtain test-retest reliability; and (c) document electrocardiogram (ECG) abnormalities during SRT. Type 2 diabetes patients (35 men, 26 women) performed a cycle ergometer-based RT (women 1.2; men 1.8 W/6 s) and SRT on separate days. A random subgroup (n = 42) repeated the SRT. ECG, heart rate, and V˙O2 were monitored. Wmax during RT: 193 ± 63 (men) and 106 ± 33 W (women). Wmax during SRT: 193 ± 63 (men) and 188 ± 55 W (women). The relationship between RT and SRT was described by men RT V˙O2peak (mL/min) = 152 + 7.67 × Wmax SRT1 (r: 0.859); women RT V ˙ O 2 p e a k (mL/min) = 603 + 4.75 × Wmax SRT1 (r: 0.771); intraclass correlation coefficients between first (SRT1) and second SRT Wmax (SRT2) were men 0.951 [95% confidence interval (CI) 0.899-0.977] and women 0.908 (95% CI 0.727-0.971). No adverse events were noted during any of the exercise tests. This validation study indicates that the SRT is a low-risk, accurate, and reliable test to estimate maximal aerobic capacity during the RT to design exercise interventions in type 2 diabetes patients.
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Affiliation(s)
- R Rozenberg
- Subdivision MoveFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J B J Bussmann
- Subdivision MoveFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E Lesaffre
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,L-Biostat, Catholic University of Leuven, Leuven, Belgium
| | - H J Stam
- Subdivision MoveFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S F E Praet
- Subdivision MoveFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Harmsen WJ, Bussmann JBJ, Selles RW, Hurkmans HLP, Ribbers GM. A Mirror Therapy–Based Action Observation Protocol to Improve Motor Learning After Stroke. Neurorehabil Neural Repair 2014; 29:509-16. [DOI: 10.1177/1545968314558598] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Mirror therapy is a priming technique to improve motor function of the affected arm after stroke. Objective. To investigate whether a mirror therapy–based action observation (AO) protocol contributes to motor learning of the affected arm after stroke. Methods. A total of 37 participants in the chronic stage after stroke were randomly allocated to the AO or control observation (CO) group. Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible. All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO. Participants in the AO group observed mirrored video tapes of reaching movements performed by their unaffected arm, whereas participants in the CO group observed static photographs of landscapes. The experimental condition effect was investigated by evaluating the primary outcome measure: movement time (in seconds) of the reaching movement, measured by accelerometry. Results. Movement time decreased significantly in both groups: 18.3% in the AO and 9.1% in the CO group. Decrease in movement time was significantly more in the AO compared with the CO group (mean difference = 0.14 s; 95% confidence interval = 0.02, 0.26; P = .026). Conclusion. The present study showed that a mirror therapy–based AO protocol contributes to motor learning after stroke.
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Affiliation(s)
- Wouter J. Harmsen
- Erasmus MC, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
| | | | - Ruud W. Selles
- Erasmus MC, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
- Erasmus MC, Department of Plastic and Reconstructive Surgery, Rotterdam, the Netherlands
| | | | - Gerard M. Ribbers
- Erasmus MC, Department of Rehabilitation Medicine, Rotterdam, the Netherlands
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
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Abstract
This study assessed whether self-propelled wheelchair driving can be validly detected by a new method using a set of two commonly used accelerometers.In a rehabilitation centre, 10 wheelchair-bound persons with spinal cord injury (SCI) (aged 29-63 years) performed a series of representative daily activities according to a protocol including self-propelled wheelchair driving and other activities. Two ActiGraph GT3X+ accelerometers were used; one was attached at the wrist, the other to the spokes of the wheelchair wheel. Based on the movement intensity of the two accelerometers, a custom-made algorithm in MatLab differentiated between self-propelled wheelchair driving and other activities (e.g. being pushed or arm movements not related to wheelchair driving). Video recordings were used for reference. Validity scores between the accelerometer output and the video analyses were expressed in terms of agreement, sensitivity and specificity scores.Overall agreement for the detection of self-propelled wheelchair driving was 85%; sensitivity was 88% and specificity 83%. Disagreement between accelerometer output and video analysis was largest for wheelchair driving at very low speed on a treadmill, wheelchair driving on a slope on a treadmill, and being pushed in the wheelchair whilst making excessive arm movements.Valid detection of self-propelled wheelchair driving is provided by two accelerometers and a simple algorithm. Disagreement with the video analysis was largest during three atypical daily activities.
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Affiliation(s)
- H Kooijmans
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Selles RW, Michielsen ME, Bussmann JBJ, Stam HJ, Hurkmans HL, Heijnen I, de Groot D, Ribbers GM. Effects of a Mirror-Induced Visual Illusion on a Reaching Task in Stroke Patients. Neurorehabil Neural Repair 2014; 28:652-9. [DOI: 10.1177/1545968314521005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. Although most mirror therapy studies have shown improved motor performance in stroke patients, the optimal mirror training protocol still remains unclear. Objective. To study the relative contribution of a mirror in training a reaching task and of unilateral and bimanual training with a mirror. Methods. A total of 93 stroke patients at least 6 months poststroke were instructed to perform a reaching task as fast and as fluently as possible. They performed 70 practice trials after being randomly allocated to 1 of 5 experimental groups: training with (1) the paretic arm with direct view (Paretic-No Mirror), (2) the nonparetic arm with direct view (Nonparetic-No Mirror), (3) the nonparetic arm with mirror reflection (Nonparetic Mirror), (4) both sides and with a nontransparent screen preventing visual control of paretic side (Bilateral-Screen), and (5) both sides with mirror reflection of the nonparetic arm (Bilateral-Mirror). As baseline and follow-up, patients performed 6 trials using only their paretic side. Primary outcome measure was the movement time. Results. We found the largest intervention effect in the Paretic-No Mirror condition. However, the Nonparetic-Mirror condition was not significantly different from the Paretic-No Mirror condition, while the Unaffected-No Mirror condition had significantly less improvement than the Paretic-No Mirror condition. In addition, movement time improved significantly less in the bimanual conditions and there was no difference between both bimanual conditions or between both mirror conditions. Conclusion. The present study confirms that using a mirror reflection can facilitate motor learning. In this task, bimanual movement using mirror training was less effective than unilateral training.
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Affiliation(s)
- Ruud W. Selles
- Erasmus MC- University Medical Center, Rotterdam, Netherlands
| | | | | | - Henk J. Stam
- Erasmus MC- University Medical Center, Rotterdam, Netherlands
| | | | - Iris Heijnen
- Rehabilitation Centre Blixembosch, Libra Zorggroep, Eindhoven, Netherlands
| | - Danielle de Groot
- Rehabilitation Centre Leijpark, Libra Zorggroep, Tilburg, Netherlands
| | - Gerard M. Ribbers
- Erasmus MC- University Medical Center, Rotterdam, Netherlands
- Rijndam Rehabilitation Centre, Rotterdam, Netherlands
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Bussmann JBJ, van den Berg-Emons RJG. To total amount of activity….. and beyond: perspectives on measuring physical behavior. Front Psychol 2013; 4:463. [PMID: 23885248 PMCID: PMC3717476 DOI: 10.3389/fpsyg.2013.00463] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/03/2013] [Indexed: 12/31/2022] Open
Abstract
The aim of this paper is to describe and discuss some perspectives on definitions, constructs, and outcome parameters of physical behavior. The paper focuses on the following constructs: Physical activity and active lifestyle vs. sedentary behavior and sedentary lifestyle; Amount of physical activity vs. amount of walking; Detailed body posture and movement data vs. overall physical activity data; Behavioral context of activities; Quantity vs. quality; Physical behavior vs. physiological response. Subsequently, the following outcome parameters provided by data reduction procedures are discussed: Distribution of length of bouts; Variability in bout length; Time window; Intensity and intensity threshold. The overview indicates that physical behavior is a multi-dimensional construct, and it stresses the importance and relevance of constructs and parameters other than total amount of physical activity. It is concluded that the challenge for the future will be to determine which parameters are most relevant, valid and responsive. This is a matter for physical behavior researchers to consider, that is critical to multi-disciplinary collaboration.
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Affiliation(s)
- Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam Rotterdam, Netherlands
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Kooijmans H, Post MWM, van der Woude LHV, de Groot S, Stam HJ, Bussmann JBJ. Randomized controlled trial of a self-management intervention in persons with spinal cord injury: design of the HABITS (Healthy Active Behavioural Intervention in SCI) study. Disabil Rehabil 2012; 35:1111-8. [PMID: 23033846 DOI: 10.3109/09638288.2012.718406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the effectiveness of a 16-week self-management intervention on physical activity level and self-management skills (self-efficacy, proactive coping and problem solving skills) in persons with chronic SCI. METHOD AND DESIGN Multicenter randomized controlled trial (RCT). Eighty persons with a SCI for at least 10 years and aged 18 to 65 will randomly be assigned to the intervention (self-management) or the control group (information provision). During the 16-week self-management intervention (one home-visit, five group and five individual sessions) active lifestyle will be stimulated and self-management skills will be taught. Data will be collected at baseline (T0), 16 (T1) and 42 (T2) weeks after baseline. Primary outcome measure is level of daily physical activity (self-report/objectively measured). Secondary outcome measures are self-managements skills, stage of behaviour change and attitude. CONCLUSION This is the first RCT on self-management in people with chronic spinal cord injury. This trial will provide knowledge on the effects of a self-management intervention on physical active lifestyle in persons with a long-term SCI.
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Affiliation(s)
- H Kooijmans
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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