Comparison of Fitbit One and ActivPAL3TM in Adults With Multiple Sclerosis in a Free-Living Environment

Walking is the most common and preferred way for people with multiple sclerosis (MS) to be active. Consumer-grade wearable activity monitors may be used as a tool to assist people with MS to track their walking by counting the number of steps. The authors evaluated the validity of Fitbit One activity tracker in individuals with MS by comparing step counts measured over a 7-day period against ActivPAL3TM (AP). Twenty-five ambulatory adults with MS with an average age 51.7 (10.2) years and gait speed 0.98 (0.47) m/s, median Expanded Disability Status Scale 5.5 (2.5–6.5), and 15 years post-MS diagnosis wore Fitbit One (using both waist and ankle placement) and AP for 7 consecutive days. Validity of Fitbit One for measuring step counts against AP was assessed using intraclass correlation coefficients (ICCs), Bland–Altman plots, and t tests. Regardless of wearing location (waist or ankle), there was good agreement between steps recorded by Fitbit One and AP (ICC: .86 [.82, .90]). The ankle-worn Fitbit measured steps more accurately (ICC: .91 [.81, .95]) than the waist-worn Fitbit (ICC: .81 [.62, .85]) especially in individuals (n = 12) who walked slowly (gait speed = 0.74 m/s). Fitbit One as a user-friendly, inexpensive, consumer-grade activity tracker can accurately record steps in persons with MS in a free-living environment.

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Step count accuracy of StepWatch and FitBit One™ among individuals with a unilateral transtibial amputation

Prosthetics and Orthotics International ◽

10.1177/0309364618767138 ◽

2018 ◽

Vol 42 (5) ◽

pp. 518-526 ◽

Cited By ~ 6

Author(s):

Elisa S Arch ◽

Jaclyn M Sions ◽

John Horne ◽

Barry A Bodt

Keyword(s):

Intraclass Correlation ◽

Correlation Coefficients ◽

Living Environment ◽

Activity Level ◽

Step Count ◽

Free Living ◽

Transtibial Amputation ◽

Activity Monitors ◽

Step Counts ◽

Intraclass Correlation Coefficients

Background: Step counts, obtained via activity monitors, provide insight into activity level in the free-living environment. Accuracy assessments of activity monitors are limited among individuals with lower-limb amputations. Objectives: (1) To evaluate the step count accuracy of both monitors during forward-linear and complex walking and (2) compare monitor step counts in the free-living environment. Study design: Cross-sectional study. Methods: Adult prosthetic users with a unilateral transtibial amputation were equipped with StepWatch and FitBit One™. Participants completed an in-clinic evaluation to evaluate each monitor’s step count accuracy during forward linear and complex walking followed by a 7-day step count evaluation in the free-living environment. Results: Both monitors showed excellent accuracy during forward, linear walking (intraclass correlation coefficients = 0.97–0.99, 95% confidence interval = 0.93–0.99; percentage error = 4.3%–6.2%). During complex walking, percentage errors were higher (13.0%–15.5%), intraclass correlation coefficients were 0.88–0.90, and 95% confidence intervals were 0.69–0.96. In the free-living environment, the absolute percentage difference between monitor counts was 25.4%, but the counts had a nearly perfect linear relationship. Conclusion: Both monitors accurately counted steps during forward linear walking. StepWatch appears to be more accurate than FitBit during complex walking but a larger sample size may confirm these findings. FitBit consistently counted fewer steps than StepWatch during free-living walking. Clinical relevance The StepWatch and FitBit are acceptable tools for assessing forward, linear walking for individuals with transtibial amputation. Given the results’ consistenty in the free-living enviorment, both tools may ultimiately be able to be used to count steps in the real world, but more research is needed to confirm these findings.

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A study investigating the validity of an accelerometer in quantification of step count in adult hospital inpatients recovering from critical illness

Clinical Rehabilitation ◽

10.1177/0269215519829893 ◽

2019 ◽

Vol 33 (5) ◽

pp. 936-942 ◽

Cited By ~ 4

Author(s):

Jayne Lesley Anderson ◽

L Samantha Yoward ◽

Angela J Green

Keyword(s):

Critical Illness ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Step Count ◽

Step Counts ◽

Intraclass Correlation Coefficients ◽

Count Range ◽

Mean Differences ◽

Hospital Inpatients ◽

Adult Hospital

Objective: To determine the validity of the ActiGraph GT3X accelerometer in step count quantification when compared to observed step count in hospitalised adults recovering from critical illness. Setting: Large National Health Service (NHS) Hospitals Trust. Subjects: In total, 20 hospital ward-based adults (age: mean 62.3, SD 11.5) who had required greater than 48 hours of mechanical ventilation in the intensive care unit. Main measures: Participants walked self-selected distances and speeds as part of a semi-structured movement protocol not exceeding 3 hours. Two ActiGraph GT3X accelerometers were worn, one on the thigh and one on the ankle of the non-dominant leg. Accelerometer-recorded step counts were compared against observed step counts. Results: In total, 31 separate walking episodes were analysed. A mean (SD) of 45.87 (±19.72) steps was calculated for observed step count (range 15–90). Mean differences (95% limits of agreement) of −0.84 steps (−3.88 to 2.2) for the ankle placement and −17.7 steps (−40.63 to 5.25) for the thigh were calculated. Intraclass correlation coefficients (95% confidence intervals) of 0.99 (0.99 to 1.0) and 0.46 (−0.1 to 0.78) were determined for the ankle and thigh, respectively. Placement sites were well tolerated by 95% of participants. Conclusion: An ankle-mounted ActiGraph GT3X accelerometer demonstrates validity in quantification of step count in hospitalised adults recovering from critical illness. A thigh placement was not considered valid.

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Accuracy of Pedometers and Walking Activity in Adults with Mental Retardation

Adapted Physical Activity Quarterly ◽

10.1123/apaq.21.2.167 ◽

2004 ◽

Vol 21 (2) ◽

pp. 167-179 ◽

Cited By ~ 28

Author(s):

Heidi I. Stanish

Keyword(s):

Physical Activity ◽

Gender Differences ◽

Down Syndrome ◽

Mental Retardation ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Step Counts ◽

Intraclass Correlation Coefficients ◽

Walking Activity ◽

Individuals With Mental Retardation

Walking is a common physical activity reported by individuals with mental retardation (MR). This study examined the accuracy and feasibility of pedometers for monitoring walking in 20 adults with MR. Also, step counts and distance walked were recorded for one week. Pedometer counts were highly consistent with actual step counts during normal and fast paced walking on two ground surfaces. Intraclass correlation coefficients were above .95. A t-test revealed no gender differences in walking activity. A 2 × 2 ANOVA indicated that participants with Down Syndrome (DS) accumulated significantly fewer step counts than those without DS and participants walked more on weekdays than weekends.

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Real-world keystroke dynamics are a potentially valid biomarker for clinical disability in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520968797 ◽

2020 ◽

pp. 135245852096879

Author(s):

KH Lam ◽

KA Meijer ◽

FC Loonstra ◽

EME Coerver ◽

J Twose ◽

...

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Surrogate Marker ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Clinical Aspects ◽

Keystroke Dynamics ◽

Intraclass Correlation Coefficients ◽

Magnetic Resonance Imaging Mri ◽

Clinical Measures

Background: Clinical measures in multiple sclerosis (MS) face limitations that may be overcome by utilising smartphone keyboard interactions acquired continuously and remotely during regular typing. Objective: The aim of this study was to determine the reliability and validity of keystroke dynamics to assess clinical aspects of MS. Methods: In total, 102 MS patients and 24 controls were included in this observational study. Keyboard interactions were obtained with the Neurokeys keyboard app. Eight timing-related keystroke features were assessed for reliability with intraclass correlation coefficients (ICCs); construct validity by analysing group differences (in fatigue, gadolinium-enhancing lesions on magnetic resonance imaging (MRI), and patients vs controls); and concurrent validity by correlating with disability measures. Results: Reliability was moderate in two (ICC = 0.601 and 0.742) and good to excellent in the remaining six features (ICC = 0.760–0.965). Patients had significantly higher keystroke latencies than controls. Latency between key presses correlated the highest with Expanded Disability Status Scale ( r = 0.407) and latency between key releases with Nine-Hole Peg Test and Symbol Digit Modalities Test (ρ = 0.503 and r = −0.553, respectively), ps < 0.001. Conclusion: Keystroke dynamics were reliable, distinguished patients and controls, and were associated with clinical disability measures. Consequently, keystroke dynamics are a promising valid surrogate marker for clinical disability in MS.

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Validation of the Brazilian version of the neurological fatigue index for multiple sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160030 ◽

2016 ◽

Vol 74 (4) ◽

pp. 320-328 ◽

Cited By ~ 2

Author(s):

Josiane Lopes ◽

Edson Lopes Lavado ◽

Damacio Ramón Kaimen-Maciel

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Assessment Instrument ◽

Fatigue Index ◽

Intraclass Correlation Coefficients ◽

Culturally Adapted ◽

Brazilian Version ◽

Impact Scale ◽

Back Translation

ABSTRACT The Neurological Fatigue Index for Multiple Sclerosis (NFI-MS) is a new fatigue assessment instrument. The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the NFI-MS (NFI-MS/BR). Method Two hundred and forty subjects with MS were recruited for this study. The adaptation of the NFI-MS was performed by translation and back translation methodology. In psychometric analysis was performed the administration of the questionnaires Epworth Sleep Scale, Fatigue Severity Scale, Modified Fatigue Impact Scale, Multiple Sclerosis Impact Scale-29, NFI-MS/BR and Pittsburgh Sleep Quality Index with retest of the NFI-MS/BR after 7 days. Results Reliability was assessed (intraclass correlation coefficients between 0.77 and 0.86), and validity by testing 41 hypotheses about expected correlations between subscales and confirmed 36. The majority of correlations were demonstrated. Conclusion The NFI-MS/BR is a cross-culturally adapted, valid, and reliable instrument for assessing MS fatigue among Brazilian subjects.

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The timed 25-foot walk in a large cohort of multiple sclerosis patients

Multiple Sclerosis Journal ◽

10.1177/13524585211017013 ◽

2021 ◽

pp. 135245852110170

Author(s):

Anissa Kalinowski ◽

Gary Cutter ◽

Nina Bozinov ◽

Jessica A Hinman ◽

Michael Hittle ◽

...

Keyword(s):

Multiple Sclerosis ◽

Predictive Validity ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Control Analysis ◽

Intraclass Correlation Coefficients ◽

Multiple Sclerosis Patients ◽

Case Control Analysis ◽

Test Retest Reliability ◽

Nested Case Control

Background: The timed 25-foot walk (T25FW) is a key clinical outcome measure in multiple sclerosis patient management and clinical research. Objectives: To evaluate T25FW performance and factors associated with its change in the Multiple Sclerosis Outcome Assessments Consortium (MSOAC) Placebo Database ( n = 2465). Methods: We created confirmed disability progression (CDP) variables for T25FW and Expanded Disability Status Scale (EDSS) outcomes. We used intraclass correlation coefficients (ICCs) and Bland Altman plots to evaluate reliability. We evaluated T25FW changes and predictive validity using a mixed-effects model, survival analysis, and nested case–control analysis. Results: The mean baseline score for the T25FW in this study population was 9.2 seconds, median = 6.1 (standard deviation = 11.0, interquartile range (IQR) = 4.8, 9.0). The T25FW measure demonstrated excellent test–retest reliability (ICC = 0.98). Walk times increased with age, disability, disease type, and disease duration; relapses were not associated with an increase. Patients with T25FW progression had a faster time to EDSS-CDP compared to those without (hazards ratio (HR): 2.6; confidence interval (CI): 2.2, 3.1). Changes in the T25FW were more likely to precede changes in EDSS. Conclusion: This research confirms the association of the T25FW with disability and provides some evidence of predictive validity. Our findings support the continued use of the T25FW in clinical practice and clinical trials.

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Reliability and Validity of Trunk Assessment for People With Multiple Sclerosis

Physical Therapy ◽

10.1093/ptj/86.1.66 ◽

2006 ◽

Vol 86 (1) ◽

pp. 66-76 ◽

Cited By ~ 35

Author(s):

Geert Verheyden ◽

Godelieve Nuyens ◽

Alice Nieuwboer ◽

Pol Van Asch ◽

Piet Ketelaer ◽

...

Keyword(s):

Multiple Sclerosis ◽

Construct Validity ◽

Intraclass Correlation ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Altman Analysis ◽

Bland Altman Analysis ◽

Intraclass Correlation Coefficients ◽

Test Retest Reliability

Abstract Background and Purpose. Standardized scales are a prerequisite for rehabilitation and research. This study was designed to determine the reliability and validity of scores on items of the trunk assessment of the Melsbroek Disability Scoring Test (MDST) and Trunk Impairment Scale (TIS) in people with multiple sclerosis (MS). Subjects. Thirty people with MS participated in the study. Methods. Interrater and test-retest reliability and construct validity were assessed. Results. Kappa and weighted kappa values for the items of the trunk assessment of the MDST ranged from .74 to .95, and the kappa and weighted kappa values for the TIS items ranged from .46 to 1.00. Intraclass correlation coefficients for interrater and test-retest agreement were .93 and .92, respectively, for the trunk assessment of the MDST and .97 and .95, respectively, for the TIS. Bland-Altman analysis showed consistency of scores without observer bias. Construct validity was established. Discussion and Conclusion. The MDST and TIS provide reliable assessments of the trunk and are valid scales for measuring trunk performance in people with MS. [Verheyden G, Nuyens G, Nieuwboer A, et al. Reliability and validity of trunk assessment for people with multiple sclerosis.

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Self-administered Expanded Disability Status Scale with functional system scores correlates well with a physician-administered test

Multiple Sclerosis Journal ◽

10.1177/135245850100700311 ◽

2001 ◽

Vol 7 (3) ◽

pp. 201-206 ◽

Cited By ~ 122

Author(s):

James Bowen ◽

Laura Gibbons ◽

Ann Gianas ◽

George H Kraft

Keyword(s):

Multiple Sclerosis ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Functional System ◽

Epidemiological Studies ◽

Female Age ◽

Intraclass Correlation Coefficients ◽

Disability Status ◽

Definite Multiple Sclerosis ◽

Clinically Definite Multiple Sclerosis

Background: Patient-administered measures are needed to assess disability cost-effectively in large epidemiological studies. Setting: An outpatient clinic in a large multiple sclerosis center. Methods: A self-administered EDSS questionnaire was developed (EDSS-S). Consecutive patients with clinically definite multiple sclerosis completed the EDSS-S (n=95). During the same visit, a physician completed an EDSS (EDSS-P). Scores below 4.0 were determined using functional system (FS) scores. Scores above 4.0 were calculated by two methods, using gait alone and using gait and functional system scores combined. Results: EDSS-P scores ranged from 0-9.5 (mean 5.1, median 5.0, 78% female, age 17-78, mean age 45). Mean EDSS-P, EDSS-S and intraclass correlation coefficients of agreement were: EDSS using ambulation alone (4.6, 5.1, 0.89), EDSS using ambulation and FS scores (4.6, 5.3, 0.87), bowel/bladder FS scores (1.6, 1.7, 0.79), pyramidal FS scores (2.1, 2.4, 0.67), sensory FS scores (1.6, 2.1, 0.60), cerebellar FS scores (1.1, 1.6, 0.55), brainstem FS scores (0.5, 1.2, 0.45), vision FS scores (1.9, 1.3, 0.38), cerebral FS scores (0.6, 2.3, 0.27). Conclusions: Very good correlation was seen between patient and physician scores for EDSS and the bowel/bladder FS score. Four other FS scores correlated moderately. In general, patients scored themselves more disabled than physicians.

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Heart Rate Measures From Wrist-Worn Activity Trackers in a Laboratory and Free-Living Setting: Validation Study

JMIR mhealth and uhealth ◽

10.2196/14120 ◽

2019 ◽

Vol 7 (10) ◽

pp. e14120 ◽

Cited By ~ 4

Author(s):

Andre Matthias Müller ◽

Nan Xin Wang ◽

Jiali Yao ◽

Chuen Seng Tan ◽

Ivan Cherh Chiet Low ◽

...

Keyword(s):

Heart Rate ◽

Low Cost ◽

Vigorous Physical Activity ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Free Living ◽

Time Points ◽

Intraclass Correlation Coefficients ◽

Activity Trackers ◽

Data Points

Background Wrist-worn activity trackers are popular, and an increasing number of these devices are equipped with heart rate (HR) measurement capabilities. However, the validity of HR data obtained from such trackers has not been thoroughly assessed outside the laboratory setting. Objective This study aimed to investigate the validity of HR measures of a high-cost consumer-based tracker (Polar A370) and a low-cost tracker (Tempo HR) in the laboratory and free-living settings. Methods Participants underwent a laboratory-based cycling protocol while wearing the two trackers and the chest-strapped Polar H10, which acted as criterion. Participants also wore the devices throughout the waking hours of the following day during which they were required to conduct at least one 10-min bout of moderate-to-vigorous physical activity (MVPA) to ensure variability in the HR signal. We extracted 10-second values from all devices and time-matched HR data from the trackers with those from the Polar H10. We calculated intraclass correlation coefficients (ICCs), mean absolute errors, and mean absolute percentage errors (MAPEs) between the criterion and the trackers. We constructed decile plots that compared HR data from Tempo HR and Polar A370 with criterion measures across intensity deciles. We investigated how many HR data points within the MVPA zone (≥64% of maximum HR) were detected by the trackers. Results Of the 57 people screened, 55 joined the study (mean age 30.5 [SD 9.8] years). Tempo HR showed moderate agreement and large errors (laboratory: ICC 0.51 and MAPE 13.00%; free-living: ICC 0.71 and MAPE 10.20%). Polar A370 showed moderate-to-strong agreement and small errors (laboratory: ICC 0.73 and MAPE 6.40%; free-living: ICC 0.83 and MAPE 7.10%). Decile plots indicated increasing differences between Tempo HR and the criterion as HRs increased. Such trend was less pronounced when considering the Polar A370 HR data. Tempo HR identified 62.13% (1872/3013) and 54.27% (5717/10,535) of all MVPA time points in the laboratory phase and free-living phase, respectively. Polar A370 detected 81.09% (2273/2803) and 83.55% (9323/11,158) of all MVPA time points in the laboratory phase and free-living phase, respectively. Conclusions HR data from the examined wrist-worn trackers were reasonably accurate in both the settings, with the Polar A370 showing stronger agreement with the Polar H10 and smaller errors. Inaccuracies increased with increasing HRs; this was pronounced for Tempo HR.

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What Are the Minimal Detectable Changes in SDMT and Verbal Fluency Tests for Assessing Changes in Cognitive Performance in Persons with Multiple Sclerosis and Non-Multiple Sclerosis Controls?

European Neurology ◽

10.1159/000508607 ◽

2020 ◽

Vol 83 (3) ◽

pp. 263-270

Author(s):

Eloi Magnin ◽

Yoshimasa Sagawa ◽

Thierry Moulin ◽

Pierre Decavel

Keyword(s):

Multiple Sclerosis ◽

Verbal Fluency ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Short Term ◽

Cognitive Assessments ◽

Minimum Detectable Change ◽

Intraclass Correlation Coefficients ◽

Environmental Variations ◽

Test Retest Reliability

Introduction: Cognitive impairment is frequent in persons with multiple sclerosis (PwMS) and can impact on activities of daily living. The capacity to differentiate real changes from background statistical noise induced by human, instrumentational, and environmental variations inherent to the evaluation would improve cognitive assessments. Objective: To assess the short-term reproducibility of cognitive tests in non-multiple sclerosis (non-MS) persons and PwMS. Methods: Sixty-two PwMS and 19 non-MS persons performed 2 measurements, 1 week apart, of the Symbol Digit Modalities Test (SDMT) and phonological and semantic verbal fluency. Test-retest reliability was evaluated by the intraclass correlation coefficients (ICC) and agreement by standard error of measurement (SEM) and minimum detectable change (MDC). Results: The reliability of the cognitive variables studied had moderate to high ICC values (ICC > 0.8) in both populations. The threshold to consider a significant cognitive modification evaluated by SEM and MDC was lower in PwMS compared with non-MS persons. Conclusions: SDMT and verbal fluency have good short-term reproducibility in PwMS. Specific SEM and MDC cutoffs based on the same design of evaluation (especially retest timing) and to the targeted pathological population (MS vs. healthy) should systematically be used to consider cognitive modification as significant in research protocol as well as in clinical practice.

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