Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility

H A Hayes; M McFadden; L Gerace; T A Brusseau

doi:10.1080/17483107.2023.2290637

Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility

Disabil Rehabil Assist Technol. 2023 Dec 6:1-7. doi: 10.1080/17483107.2023.2290637. Online ahead of print.

Authors

H A Hayes¹, M McFadden², L Gerace¹, T A Brusseau³

Affiliations

¹ Department of Physical Therapy and Athletic Training, University of UT, Salt Lake City, UT, USA.
² Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA.
³ Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.

PMID: 38055316
DOI: 10.1080/17483107.2023.2290637

Abstract

Purpose: Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke.

Methods: A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other.

Analysis: Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation.

Results: The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001).

Conclusions: The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population.

Keywords: Actigraph; Activpal; Stroke; accuracy; activity monitor; hemiparetic; non-hemiparetic; sedentary time; standing time; step count; stepwatch; sub-acute.

Plain language summary

The stepwatch activity monitor worn on the hemiparetic limb provided the best accuracy and excellent reliability for step counts in this population of subacute stroke.For percent standing time all devices overestimated with poor reliability.For percent other time, the AP had the best accuracy and good reliability on the non-hemiparetic limb.The use of multiple devices may be warranted to capture a more accurate understanding of activity level in this population of individuals with sub-acute stroke.Clinicians and researchers need to be aware of the biases of these devices in this population.