P107: Use of activity trackers to count steps of older emergency department patients: a feasibility and validity study

Introduction: Mobility is an evidence-based non-pharmacologic strategy shown to reduce delirium and functional decline among older patients in the acute care setting. Activity trackers have been used in previous studies to objectively measure mobility in older hospitalized patients. This study aims to compare the feasibility and validate the accuracy of three accelerometer-based activity trackers (Fitbit Zip, Fitbit Charge HR and StepWatch). This is the first step in a program of research to objectively measure as a potential marker of delirium risk. Methods: This is a prospective study of patients 65 years of age and older during their ED visit. We excluded those with critical illness, unable to communicate or provide consent; and any ambulatory impediments. Consenting participants wore the trackers for up to 8 hour, and completed a 6-meter walk test while a research assistant manually counted their steps. Our primary feasibility measure was the proportion of eligible patient for which we were able to recover the tracker and recorded their steps. The primary validation endpoint was the concordance between steps recorded by the tracker compared to a gold standard manual step count over a fixed distance. Sample size was based on the desired precision of the final estimate of feasibility. Intraclass correlation coefficient (ICC) was calculated to assess agreements between devices and manual count. We will report proportions with exact binomial 95% confidence intervals (CI) for feasibility and validity endpoints. Results: 41 participants were enrolled in this study. Mean age was 74.6 years (+/- 5.76) and 59% were females. The total subjects that wore the Fitbit Zip, Fitbit Charge HR and StepWatch during study participation was, 40/41 (97.5%, CI 0.87–0.99), 33/34 (97%, CI 0.84–0.99) and 31/32 (96.8%, CI 0.83–0.99), respectively. Total subjects with completed data extracted from the Fitbit Zip, Fitbit Charge HR and StepWatch was, 38/41 subjects (92.6%, CI 0.80–0.98), 34 (100%, CI 0.89–1.00), and 32 (100%, CI 0.89–1.00), respectively. All devices were recovered after use (100%, 95%CI 0.91–100). Conclusion: Our results suggest: 1) the use of gait-tracking devices in the ED is feasible, 2) consumer and research-grade devices showed good validity against the gold standard, and 3) the use of small, inexpensive, consumer-grade trackers to objectively measure mobility of older adults in the ED.

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P044: Use of a gait tracking device to count steps of older emergency department patient

CJEM ◽

10.1017/cem.2019.235 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S78-S79

Author(s):

J. Estrada-Codecido ◽

J. Lee

Keyword(s):

Emergency Department ◽

Preliminary Data ◽

Prospective Observational Study ◽

Eligible Patient ◽

Functional Decline ◽

Emergency Department Patient ◽

Step Count ◽

Potential Marker ◽

Tracking Device ◽

Tracking Devices

Introduction: Delirium is a common complication among older people who need care in the emergency department (ED). Mobility is an evidence-based non-pharmacologic strategy shown to reduce delirium and functional decline among older patients in the acute care setting. However, previous research has shown that compliance with mobility is important to achieve this decreased incidence of delirium. Gait tracking devices have been used in previous studies to accurately measure steps, engagement and intensity of physical activity in older hospitalized patients.The objectives of this study are to compare the feasibility and validate the accuracy of three accelerometer-based gait tracking devices. This is the first step in a program of research to objectively measure mobility among older ED patients as a potential marker of delirium risk. Methods: This is a prospective, observational study of patients 65 years of age and older during their ED visit. We excluded those with critical illness, unable to communicate or provide consent (language barrier, aphasia); and those with any ambulatory impediments. Consenting participants wear the gait trackers for the duration of their stay or for a minimum of 8 hour, and ambulate as normally as they would in their home. Devices were retrieved when the patient was admitted, discharged or, after 8 hours and the steps count was then recorded from an online interface. Our primary feasibility measure is the proportion of eligible patient for which we are be able to recover the tracker and record their steps. The primary validation endpoint will be the concordance between steps recorded by the gait tracking device compared to a gold standard manual step count over a fixed distance. We will report proportions with exact binomial 95% confidence intervals (CI) for feasibility and validity endpoints. Results: Preliminary data from an initial pilot phase includes 7 participants who wore a gait tracking device during their ED visit. Mean age was 79.7 years (+/−5.76) and 57% were females. Devices were worn by participants and recovered by research staff in all 7 cases (100%, 95% CI: 59 – 100). Data from online interface has been collected from 6 participants (85%, 95%CI: 42 – 99). Mean step count by observer was 86.17 +/− 4 (95% CI 82.2 – 90.2) and 70.3 +/− 4 (95%CI 66-74.3) by gait tracker. Conclusion: Our preliminary data suggests that use of gait-tracking devices in the ED is feasible.

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Validity of Wrist-Worn Activity Trackers for Estimating VO2max and Energy Expenditure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16173037 ◽

2019 ◽

Vol 16 (17) ◽

pp. 3037 ◽

Cited By ~ 1

Author(s):

Stefanie Passler ◽

Julian Bohrer ◽

Lukas Blöchinger ◽

Veit Senner

Keyword(s):

Health Care ◽

Energy Expenditure ◽

Gold Standard ◽

Healthy Subjects ◽

Intraclass Correlation ◽

Standard Methods ◽

Paired Sample ◽

Activity Trackers ◽

Health Care Applications ◽

Scientific Validation

Activity trackers are a simple and mostly low-priced method to capture physiological parameters. Despite the high number of wrist-worn devices, there is a lack of scientific validation. The purpose of this study was to assess whether the activity trackers represent a valid alternative to gold-standard methods in terms of estimating energy expenditure (EE) and maximum oxygen uptake (VO2max). Twenty-four healthy subjects participated in this study. In total, five commercially available wrist-worn devices were tested with regard to their validity of EE and/or VO2max. Estimated values were compared with indirect calorimetry. Validity of the activity trackers was determined by paired sample t-tests, mean absolute percentage errors (MAPE), Intraclass Correlation Coefficient, and Bland-Altman plots. Within the tested devices, differences in scattering in VO2max and EE could be observed. This results in a MAPE > 10% for all evaluations, except for the VO2max-estimation of the Garmin Forerunner 920XT (7.3%). The latter significantly underestimates the VO2max (t(23) = –2.37, p = 0.027), whereas the Garmin Vivosmart HR significantly overestimates the EE (t(23) = 2.44, p = 0.023). The tested devices did not show valid results concerning the estimation of VO2max and EE. Hence, the current wrist-worn activity trackers are most likely not accurate enough to be used for neither purposes in sports, nor in health care applications.

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Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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Performance of Seven Consumer Sleep-Tracking Devices Compared with Polysomnography

SLEEP ◽

10.1093/sleep/zsaa291 ◽

2020 ◽

Author(s):

Evan D Chinoy ◽

Joseph A Cuellar ◽

Kirbie E Huwa ◽

Jason T Jameson ◽

Catherine H Watson ◽

...

Keyword(s):

Performance Measures ◽

Gold Standard ◽

High Performance ◽

Sleep Stage ◽

Sleep Laboratory ◽

Sleep Assessment ◽

Sleep Condition ◽

Different Populations ◽

Tracking Devices ◽

Better Than

Abstract Study Objectives Consumer sleep-tracking devices are widely used and becoming more technologically advanced, creating strong interest from researchers and clinicians for their possible use as alternatives to standard actigraphy. We therefore tested the performance of many of the latest consumer sleep-tracking devices, alongside actigraphy, versus the gold-standard sleep assessment technique, polysomnography (PSG). Methods In total, 34 healthy young adults (22 women; 28.1 ± 3.9 years, mean ± SD) were tested on three consecutive nights (including a disrupted sleep condition) in a sleep laboratory with PSG, along with actigraphy (Philips Respironics Actiwatch 2) and a subset of consumer sleep-tracking devices. Altogether, four wearable (Fatigue Science Readiband, Fitbit Alta HR, Garmin Fenix 5S, Garmin Vivosmart 3) and three non-wearable (EarlySense Live, ResMed S+, SleepScore Max) devices were tested. Sleep/wake summary and epoch-by-epoch agreement measures were compared with PSG. Results Most devices (Fatigue Science Readiband, Fitbit Alta HR, EarlySense Live, ResMed S+, SleepScore Max) performed as well as or better than actigraphy on sleep/wake performance measures, while the Garmin devices performed worse. Overall, epoch-by-epoch sensitivity was high (all ≥0.93), specificity was low-to-medium (0.18-0.54), sleep stage comparisons were mixed, and devices tended to perform worse on nights with poorer/disrupted sleep. Conclusions Consumer sleep-tracking devices exhibited high performance in detecting sleep, and most performed equivalent to (or better than) actigraphy in detecting wake. Device sleep stage assessments were inconsistent. Findings indicate that many newer sleep-tracking devices demonstrate promising performance for tracking sleep and wake. Devices should be tested in different populations and settings to further examine their wider validity and utility.

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Using Commercial Physical Activity Trackers for Health Promotion Research: Four Case Studies

Health Promotion Practice ◽

10.1177/1524839918769559 ◽

2018 ◽

Vol 20 (3) ◽

pp. 381-389 ◽

Cited By ~ 5

Author(s):

Gabrielle Turner-McGrievy ◽

Danielle E. Jake-Schoffman ◽

Camelia Singletary ◽

Marquivieus Wright ◽

Anthony Crimarco ◽

...

Keyword(s):

Physical Activity ◽

Health Promotion ◽

Case Studies ◽

Low Cost ◽

Lessons Learned ◽

Assessment Tools ◽

Sensewear Armband ◽

Research And Practice ◽

Activity Trackers ◽

Tracking Devices

Background. Wearable physical activity (PA) trackers are becoming increasingly popular for intervention and assessment in health promotion research and practice. The purpose of this article is to present lessons learned from four studies that used commercial PA tracking devices for PA intervention or assessment, present issues encountered with their use, and provide guidelines for determining which tools to use. Method. Four case studies are presented that used PA tracking devices (iBitz, Zamzee, FitBit Flex and Zip, Omron Digital Pedometer, Sensewear Armband, and MisFit Flash) in the field—two used the tools for intervention and two used the tools as assessment methods. Results. The four studies presented had varying levels of success with using PA devices and experienced several issues that impacted their studies, such as companies that went out of business, missing data, and lost devices. Percentage ranges for devices that were lost were 0% to 29% and was 0% to 87% for those devices that malfunctioned or lost data. Conclusions. There is a need for low-cost, easy-to-use, accurate PA tracking devices to use as both intervention and assessment tools in health promotion research related to PA.

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Gait Analysis Using Accelerometry Data from a Single Smartphone: Agreement and Consistency between a Smartphone Application and Gold-Standard Gait Analysis System

Sensors ◽

10.3390/s21227497 ◽

2021 ◽

Vol 21 (22) ◽

pp. 7497

Author(s):

Roy T. Shahar ◽

Maayan Agmon

Keyword(s):

Gait Analysis ◽

Gold Standard ◽

Concurrent Validity ◽

Gait Cycle ◽

Intraclass Correlation ◽

Smartphone Application ◽

Healthy Adults ◽

Community Dwelling ◽

Human Gait ◽

Spatio Temporal

Spatio-temporal parameters of human gait, currently measured using different methods, provide valuable information on health. Inertial Measurement Units (IMUs) are one such method of gait analysis, with smartphone IMUs serving as a good substitute for current gold-standard techniques. Here we investigate the concurrent validity of a smartphone placed in a front-facing pocket to perform gait analysis. Sixty community-dwelling healthy adults equipped with a smartphone and an application for gait analysis completed a 2-min walk on a marked path. Concurrent validity was assessed against an APDM mobility lab (APDM Inc.; Portland, OR, USA). Bland–Altman plots and intraclass correlation coefficients (agreement and consistency) for gait speed, cadence, and step length indicate good to excellent agreement (ICC2,1 > 0.8). For right leg stance and swing % of gait cycle and double support % of gait cycle, results were moderate (0.52 < ICC2,1 < 0.62). For left leg stance and swing % of gait cycle left results show poor agreement (ICC2,1 < 0.5). Consistency of results was good to excellent for all tested parameters (ICC3,1 > 0.8). Thus we have a valid and reliable instrument for measuring healthy adults’ spatio-temporal gait parameters in a controlled walking environment.

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Validity, Reliability and Sensitivity to Change of Three Consumer-grade Activity Trackers in Controlled and Free-living Conditions among Older Adults (Preprint)

10.2196/preprints.27155 ◽

2021 ◽

Author(s):

Kaja Kastelic ◽

Marina Dobnik ◽

Stefan Loefler ◽

Christian Hofer ◽

Nejc Šarabon

Keyword(s):

Physical Activity ◽

Older Adults ◽

Intraclass Correlation ◽

Sleep Time ◽

Living Conditions ◽

Percentage Error ◽

Sensitivity To Change ◽

Free Living ◽

Activity Trackers ◽

Free Living Conditions

BACKGROUND Wrist worn consumer-grade activity trackers are popular devices, developed mainly for personal use, but with the potential to be used also for clinical and research purposes. OBJECTIVE The objective of this study was to explore the validity, reliability and sensitivity to change of movement behaviours metrics from three popular activity trackers (POLAR Vantage M, Garmin Vivosport and Garmin Vivoactive 4s) in controlled and free-living conditions when worn by older adults. METHODS Participants (n = 28; 74 ± 5 years) underwent a videotaped laboratory protocol while wearing all three activity trackers. On a separate occasion, participants wore one (randomly assigned) activity tracker and a research grade physical activity monitor ActiGraph wGT3X-BT simultaneously for six consecutive days for comparisons. RESULTS Both Garmin activity trackers showed excellent performance for step counts, with mean absolute percentage error (MAPE) below 20 % and intraclass correlation coefficient (ICC2,1) above 0.90 (P < .05), while Polar Vantage M substantially over counted steps (MAPE = 84 % and ICC2,1 = 0.37 for free-living conditions). MAPE for sleep time was within 10 % for all the trackers tested, while far beyond 20 % for all the physical activity and calories burned outputs. Both Garmin trackers showed fair agreement (ICC2,1 = 0.58–0.55) for measuring calories burned when compared with ActiGraph. CONCLUSIONS Garmin Vivoactive 4s showed overall best performance, especially for measuring steps and sleep time in healthy older adults. Minimal detectible change was consistently lower for an average day measures than for a single day measure, but still relatively high. The results provided in this study could be used to guide choice on activity trackers aiming for different purposes – individual use/care, longitudinal monitoring or in clinical trial setting.

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Can We Rely on Flight Time to Measure Jumping Performance or Neuromuscular Fatigue-Overload in Professional Female Soccer Players?

Applied Sciences ◽

10.3390/app10134424 ◽

2020 ◽

Vol 10 (13) ◽

pp. 4424

Author(s):

Estrella Armada-Cortés ◽

Javier Peláez Barrajón ◽

José Antonio Benítez-Muñoz ◽

Enrique Navarro ◽

Alejandro F. San Juan

Keyword(s):

Gold Standard ◽

Vertical Jump ◽

Intraclass Correlation ◽

Smartphone Application ◽

Flight Time ◽

Neuromuscular Fatigue ◽

Football Players ◽

Validity And Reliability ◽

Jumping Performance ◽

Significant Difference

The main purpose of this study was to compare the validity of the take-off velocity method (TOV) measured with a force platform (FP) (gold standard) versus the flight time method (FT) in a vertical jump to measure jumping performance or neuromuscular fatigue-overload in professional female football players. For this purpose, we used a FP and a validated smartphone application (APP). A total of eight healthy professional female football players (aged 27.25 ± 6.48 years) participated in this study. All performed three valid trials of a countermovement jump and squat jump and were measured at the same time with the APP and the FP. The results show that there is a lack of validity and reliability between jump height (JH) calculated through the TOV method with the FP and the FT method with the FP (r = 0.028, p > 0.84, intraclass correlation coefficient (ICC) = −0.026) and between the JH measured with the FP through the TOV method and the APP with the FT method (r = 0.116, p > 0.43, ICC = −0.094 (−0.314–0.157)). A significant difference between the JH measured through the TOV with the FP versus the APP (p < 0.05), and a trend between the JH obtained with the FP through the TOV and the FT (p = 0.052) is also shown. Finally, the JH with the FP through the FT and the APP did not differ (p > 0.05). The eta-squared of the one-way ANOVA was η2 = 0.085. It seems that only the TOV measured with a FP could guarantee the accuracy of the jump test in SJ+CMJ and SJ, so it is recommended that high-level sportswomen and men should be assessed with the FP through TOV as gold standard technology to ensure correct performance and/or fatigue-overload control during the sport season.

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Concurrent Validity of an Automated Footprint Detection Algorithm to Measure Plantar Contact Area During Walking

Journal of the American Podiatric Medical Association ◽

10.7547/17-118 ◽

2019 ◽

Vol 109 (6) ◽

pp. 416-425 ◽

Cited By ~ 2

Author(s):

Daniel E. Lidstone ◽

Louise M. Porcher ◽

Jessica DeBerardinis ◽

Janet S. Dufek ◽

Mohamed B. Trabia

Keyword(s):

Contact Area ◽

Gold Standard ◽

Concurrent Validity ◽

High Speed ◽

Intraclass Correlation ◽

Detection Algorithm ◽

Automatic Identification ◽

Identification Algorithm ◽

Gold Standard Method ◽

Strong Agreement

Background: Monitoring footprints during walking can lead to better identification of foot structure and abnormalities. Current techniques for footprint measurements are either static or dynamic, with low resolution. This work presents an approach to monitor the plantar contact area when walking using high-speed videography. Methods: Footprint images were collected by asking the participants to walk across a custom-built acrylic walkway with a high-resolution digital camera placed directly underneath the walkway. This study proposes an automated footprint identification algorithm (Automatic Identification Algorithm) to measure the footprint throughout the stance phase of walking. This algorithm used coloration of the plantar tissue that was in contact with the acrylic walkway to distinguish the plantar contact area from other regions of the foot that were not in contact. Results: The intraclass correlation coefficient (ICC) demonstrated strong agreement between the proposed automated approach and the gold standard manual method (ICC = 0.939). Strong agreement between the two methods also was found for each phase of stance (ICC > 0.78). Conclusions: The proposed automated footprint detection technique identified the plantar contact area during walking with strong agreement with a manual gold standard method. This is the first study to demonstrate the concurrent validity of an automated identification algorithm to measure the plantar contact area during walking.

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