Validity and Acceptability of Wearable Devices for Monitoring Step-Count and Activity Minutes Among People With Multiple Sclerosis

Multiple wearable devices that purport to measure physical activity are widely available to consumers. While they may support increases in physical activity among people with multiple sclerosis (MS) by providing feedback on their performance, there is little information about the validity and acceptability of these devices. Providing devices that are perceived as inaccurate and difficult to use may have negative consequences for people with MS, rather than supporting participation in physical activity. The aim of this study was, therefore, to assess the validity and acceptability of commercially available devices for monitoring step-count and activity time among people with MS. Nineteen ambulatory adults with MS [mean (SD) age 52.1 (11.9) years] participated in the study. Step-count was assessed using five commercially available devices (Fitbit Alta, Fitbit Zip, Garmin Vivofit 4, Yamax Digi Walker SW200, and Letscom monitor) and an activPAL3μ while completing nine everyday activities. Step-count was also manually counted. Time in light activity, moderate-to-vigorous activity, and total activity were measured during activities using an Actigraph GT3X accelerometer. Of the 19 participants who completed the validity study, fifteen of these people also wore the five commercially available devices for three consecutive days each, and participated in a semi-structured interview regarding their perception of the acceptability of the monitors. Mean percentage error for step-count ranged from 12.1% for the Yamax SW200 to −112.3% for the Letscom. Mean step-count as manually determined differed to mean step-count measured by the Fitbit Alta (p = 0.002), Garmin vivofit 4 (p < 0.001), Letscom (p < 0.001) and the research standard device, the activPAL3μ (p < 0.001). However, 95% limits of agreement were smallest for the activPAL3μ and largest for the Fitbit Alta. Median percentage error for activity minutes was 52.9% for the Letscom and 100% for the Garmin Vivofit 4 and Fitbit Alta compared to minutes in total activity. Three inductive themes were generated from participant accounts: Interaction with device; The way the device looks and feels; Functionality. In conclusion, commercially available devices demonstrated poor criterion validity when measuring step-count and activity time in people with MS. This negatively affected the acceptability of devices, with perceived inaccuracies causing distrust and frustration. Additional considerations when designing devices for people with MS include an appropriately sized and lit display and ease of attaching and charging devices.

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Intervention Mediators in a Randomized Controlled Trial to Increase Physical Activity and Fatigue Self-management Behaviors Among Adults With Multiple Sclerosis

Annals of Behavioral Medicine ◽

10.1093/abm/kaz033 ◽

2019 ◽

Author(s):

Matthew Plow ◽

Robert W Motl ◽

Marcia Finlayson ◽

Francois Bethoux

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Goal Setting ◽

Self Efficacy ◽

Outcome Expectations ◽

Step Count ◽

Self Management ◽

Post Test ◽

The Impact

Abstract Background People with multiple sclerosis (MS) often experience fatigue, which is aggravated by inactivity. Identifying mediators of changes in physical activity (PA) and fatigue self-management (FSM) behaviors could optimize future interventions that reduce the impact of MS fatigue. Purpose To examine the effects of telephone-delivered interventions on Social Cognitive Theory constructs and test whether these constructs mediated secondary outcomes of PA and FSM behaviors. Methods Participants with MS (n = 208; Mean age = 52.1; Female = 84.6%) were randomized into contact–control intervention (CC), PA-only intervention, and PA+FSM intervention. Step count (Actigraphy) and FSM behaviors as well as self-efficacy, outcome expectations, and goal setting for PA and FSM were measured at baseline, post-test (12 weeks), and follow-up (24 weeks). Path analyses using bias-corrected bootstrapped 95% confidence intervals (CI) determined whether constructs at post-test mediated behaviors at follow-up when adjusting for baseline measures. Results Path analysis indicated that PA-only (β = 0.50, p < .001) and PA+FSM interventions (β = 0.42, p < .010) had an effect on goal setting for PA, and that PA + FSM intervention had an effect on self-efficacy for FSM (β = 0.48, p = .011) and outcome expectations for FSM (β = 0.42, p = .029). Goal setting for PA at post-test mediated the effects of PA-only (β = 159.45, CI = 5.399, 371.996) and PA + FSM interventions (β = 133.17, CI = 3.104, 355.349) on step count at follow-up. Outcome expectations for FSM at post-test mediated the effects of PA + FSM intervention on FSM behaviors at follow-up (β = 0.02, CI = 0.001, 0.058). Conclusions Goal setting for PA and outcome expectations for FSM may be important constructs to target in telephone-delivered interventions designed to reduce the impact of MS fatigue. Trial registration Clinicaltrials.gov (NCT01572714)

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Using consumer-grade physical activity trackers to measure frailty progression in critical care survivors: An exploratory observational study (Preprint)

10.2196/preprints.19859 ◽

2020 ◽

Author(s):

Ben Kim ◽

Miranda Hunt ◽

John Muscedere ◽

David M Maslove ◽

Joon Lee

Keyword(s):

Physical Activity ◽

Critical Illness ◽

Observational Study ◽

Wearable Devices ◽

Step Count ◽

Wearable Device ◽

Strongly Correlated ◽

Daily Step ◽

Daily Step Count

BACKGROUND Critical illness has been suggested as a sentinel event for frailty development for at-risk older adults. Frail critical illness survivors suffer increased adverse health outcomes but monitoring the recovery post-Intensive Care Unit (ICU) is challenging. Clinicians and funders of healthcare system envision an increased role of wearable devices in monitoring clinically relevant measures as the sensor technology is advancing rapidly. Use of wearable devices also generated great interest among older patients and they are the fastest growing group of consumer-grade wearable device users. Recent research studies indicate that consumer-grade wearable devices offer a possibility of measuring frailty. OBJECTIVE To examine the data collected from wearable devices for the progression of frailty among the critical illness survivors. METHODS An observational study was conducted with 12 critical illness survivors from Kingston General Hospital in Canada. Frailty was measured by Clinical Frailty Scale (CFS) at ICU admission (AD), hospital discharge (DC), and 4-week follow-up (FU). Wearable device was worn between DC and FU. The wearable device collected data on steps, physical activity, sleep and heart rate (HR). Patient assessments were reviewed including the severity of illness, cognition level, delirium, activities of daily living, and comorbidity. RESULTS The CFS increased significantly following critical illness compared pre-ICU frailty level (P=.02, d=-0.53). Frail survivors over the 4-week follow-up period had significantly lower daily step counts than non-frail survivors (P=.02, d=1.81). There was no difference in sleep and HR measures. Daily step count was strongly correlated with the CFS at FU (r=-0.72, P=.04). Average HR was strongly correlated with the CFS at DC (r=-0.72, P=.046). HR standard deviation was strongly correlated (r=0.78, P<0.05) with the CFS change from AD to FU. No assocation was found between the CFS and sleep measures. The pattern of increasing step count over the FU period was correlated with the worsening of frailty (r=.62, P=.03). CONCLUSIONS This study demonstrated association between frailty and data generated from a consumer-grade wearable device. Daily step count and HR showed strong association with the frailty progression of the critical illness survivors over time. Understanding this assocation could unlock a new avenue for clinicians to monitor and identify a vulnerable subset of the population that might benefit from an early intervention. CLINICALTRIAL

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The Role of Perceived Energy and Self-Beliefs for Physical Activity and Sports Activity of Patients With Multiple Sclerosis and Chronic Stroke

Frontiers in Psychology ◽

10.3389/fpsyg.2020.570221 ◽

2021 ◽

Vol 11 ◽

Author(s):

Julia Schüler ◽

Wanja Wolff ◽

Julian Pfeifer ◽

Romina Rihm ◽

Jessica Reichel ◽

...

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Self Efficacy ◽

Neurological Diseases ◽

Chronic Stroke ◽

Self Control ◽

World Health ◽

Negative Consequences ◽

Sports Activity ◽

Health Organization

Physical activity counteracts some of the negative consequences associated with chronic neurological diseases. Here, we describe the levels of physical activity (PA) and sports activity (Sport) in patients with multiple sclerosis (pMS, n = 59) and chronic stroke (pStroke, n = 67) and test compliance with the recommendation for health-promoting physical activity of the World-Health Organization (WHO). Secondly, we tested for differences between the groups of patients, and thirdly, we examined relationships between PA and Sport with psychological indicators of perceived energy (fatigue and vitality) and self-beliefs (self-efficacy and self-control). Psychological constructs were assessed with validated measures from different disciplines in Psychology. A statistical aim was to describe interpretations gained by (non-) parametric Bayesian and Null-Hypothesis-Significance Testing statistics (NHST) on the example of the conducted tests for differences and relationships. Descriptive analyses revealed that pMS and pStroke complied with recommendations of the WHO, but with large variance indicating that patient groups are not homogenous. Tests for differences showed that the PA difference between pMS and pStroke can be attributed to the higher proportion of women in the pMS sample as they engage more in household chores (important part of PA). Tests for relationships showed that for pStroke, vitality, self-control, and self-efficacy were positively related to the level of sports activity. Furthermore, pStroke who were sport active had lower fatigue and higher self-control and self-efficacy scores than sport inactive people. Although they address slightly different questions, the Bayesian and the NHST approach led to similar general conclusions.

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Physical activity monitoring devices: energy expenditure comparison in a setting of free-living activities

International Journal of Physical Education Fitness and Sports ◽

10.26524/ijpefs1945 ◽

2019 ◽

Vol 8 (4) ◽

pp. 45-54

Author(s):

Matteo Vandoni ◽

Vittoria Carnevale Pellino ◽

Stefano Dell'Anna ◽

Elena Ricagno ◽

Giulia Liberali ◽

...

Keyword(s):

Physical Activity ◽

Energy Expenditure ◽

Wearable Devices ◽

Activity Monitoring ◽

Percentage Error ◽

Free Living ◽

Sensewear Armband ◽

Absolute Percentage Error ◽

Physical Activity Monitoring ◽

Monitoring Devices

The aim of this study was to evaluate the validity of Energy Expenditure (EE) estimation provided by 3 wearable devices [Fitbit-One (FO), Sensewear Armband (AR) and Actiheart (AC)] in a setting of free-living activities. 43 participants (24 females; 23.4±.4,5yrs) performed 9 activities: sedentary (watching video, reading), walking (on treadmill and outdoor), running (on treadmill and outdoor) and moderate-to-vigorous activities (Wii gaming, taking the stairs and playing football). Mean Absolute Percentage Error (MAPE) and Pearson’s correlation were calculated to assess the validity of each instrument in comparison to a portable metabolic analyser (PMA). In overall comparison MAPE’s were 7,7% for AR (r=.86; p<.0001), 8,6% for FO (r=.69; P<.001), and 11.6% for AC (r=.81; p<.0001). These findings support the accuracy of the wearables. The AR was the most accurate in the whole protocol. However, MAPE results suggest that devices algorithms should be improved for better measure of EE during moderate-to-vigorous activities.

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Physical activity monitoring devices: energy expenditure comparison in a setting of free-living activities

International Journal of Physical Education Fitness and Sports ◽

10.26524/jpefs1945 ◽

2019 ◽

Vol 8 (4) ◽

pp. 45-54

Author(s):

Matteo Vandoni ◽

Vittoria Carnevale Pellino ◽

Stefano Dell'Anna ◽

Elena Ricagno ◽

Giulia Liberali ◽

...

Keyword(s):

Physical Activity ◽

Energy Expenditure ◽

Wearable Devices ◽

Activity Monitoring ◽

Percentage Error ◽

Free Living ◽

Sensewear Armband ◽

Absolute Percentage Error ◽

Physical Activity Monitoring ◽

Monitoring Devices

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“So this is my new life”: A Qualitative Examination of Women Living with Multiple Sclerosis and the Coping Strategies They Use When Accessing Physical Activity

Disability Studies Quarterly ◽

10.18061/dsq.v30i3/4.1269 ◽

2010 ◽

Vol 30 (3/4) ◽

Cited By ~ 7

Author(s):

Margaret Schneider ◽

Nadine Young

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Structured Interview ◽

Daily Basis ◽

Management Plan ◽

Perceived Barriers ◽

Physician Patient Relationship ◽

Interpretive Analysis ◽

Patient’S Experience ◽

The Impact

<p>The purpose of this study was to explore the lived experiences of women living with multiple sclerosis and their perceived barriers to accessing physical activity. Seven women were invited to complete a background questionnaire and a semi-structured interview to discuss these experiences, and to examine any perceived barriers (i.e., internal and external) that they encountered in relation to physical activity. The key themes that emerged from the interpretive analysis were the apparent importance of: 1) self-management; 2) treatments; and 3) attitude, when accessing such opportunities. The findings suggest that it is important for physicians to understand the patient’s experience of living with multiple sclerosis and the impact of the disease can have on other aspects of their life (e.g., access to physical activity). Acknowledgement of this experience and the issues that these women struggle with on a daily basis could enhance the physician/patient relationship, and encourage a more collaborative effort in terms of establishing an illness management plan for navigating the illness journey.</p>

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Physical activity monitoring to assess disability progression in multiple sclerosis

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217320975185 ◽

2020 ◽

Vol 6 (4) ◽

pp. 205521732097518

Author(s):

Charlotte M Stuart ◽

Aravinthan Varatharaj ◽

Janine Domjan ◽

Sheaba Philip ◽

Ian Galea ◽

...

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Brain Atrophy ◽

Outcome Measurement ◽

Activity Monitoring ◽

Step Count ◽

Brain Volume Loss ◽

Metabolic Equivalents ◽

Physical Activity Monitoring ◽

Convergent And Divergent Validity

Background Clinical outcome measurement in multiple sclerosis (MS) usually requires a physical visit. Remote activity monitoring (RAM) using wearable technology provides a rational alternative, especially desirable when distance is involved or in a pandemic setting. Objective To validate RAM in progressive MS using (1) traditional psychometric methods (2) brain atrophy. Methods 56 people with progressive MS participated in a longitudinal study over 2.5 years. An arm-worn RAM device measured activity over six days, every six months, and incorporated triaxial accelerometry and transcutaneous physiological variable measurement. Five RAM variables were assessed: physical activity duration, step count, active energy expenditure, metabolic equivalents and a composite RAM score incorporating all four variables. Other assessments every six months included EDSS, MSFC, MSIS-29, Chalder Fatigue Scale and Beck’s Depression Inventory. Annualized brain atrophy was measured using SIENA. Results RAM was tolerated well by people with MS; the device was worn 99.4% of the time. RAM had good convergent and divergent validity and was responsive, especially with respect to step count. Measurement of physical activity over one day was as responsive as six days. The composite RAM score positively correlated with brain volume loss. Conclusion Remote activity monitoring is a valid and acceptable outcome measure in MS.

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