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BMC Neurology

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01-12-2022 | Stroke | Research article

Suitability of accelerometry as an objective measure for upper extremity use in stroke patients

Authors: Anne-Lisa Heye, Christine Kersting, Malte Kneer, Anne Barzel

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

Upper limb (UL) paresis is one of the most common stroke consequences and significantly restricts patients in everyday life. Instruments objectively measuring direct arm use in stroke patients are lacking, but might be helpful to understand patients’ impairment. Aiming to examine whether accelerometry is a suitable objective measure for everyday UL use in stroke patients, we conducted a systematic review on the association between accelerometer-derived measurements and clinical scales.

Methods

Articles were systematically searched in PubMed, Scopus, Cochrane Library, PeDro and LIVIVO through December 12^th, 2021, screened for inclusion by AH, and subsequently independently screened by CK and MK. Disagreements were discussed until consensus. We included English and German peer-reviewed articles dealing with the validity of accelerometers as a measurement of UL use in stroke patients and eligible systematic reviews. Studies exclusively using accelerometry as an outcome parameter, book contributions, conference abstracts and case studies were excluded. Data extraction was conducted by AH and confirmed by CK focussing on study type, objective, accelerometer device, sample size, stroke status, assessments conducted, measurement method, wearing time and key results. We analysed all eligible articles regarding the correlation between accelerometry and other clinical assessments and the validity in accordance with the type of accelerometer.

Results

Excluding duplicates, the initial search yielded 477 records. In the 34 eligible studies accelerometers was used with a predominance of tri-axial accelerometery (n = 12) and only few with two-axial application (n = 4). Regarding measures to examine association to accelerometer data different clinical scales were applied depending on the setting, the degree of impairment and/or the status of stroke. Cut-off values to determine correlations varied largely; most significant correlations are reported for the MAL [Range 0.31- 0.84] and the ARAT [Range 0.15–0.79].

Conclusions

Accelerometers can provide reliable data about daily arm use frequency but do not supply information about the movements´ quality and restrictions on everyday activities of stroke patients. Depending on the context, it is advisable to use both, accelerometry and other clinical measures. According to the literature there is currently no accelerometer device most suitable to measure UL activity. High correlations indicate that multi-dimensional accelerometers should be preferred.

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Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Anderson CS. Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989–1990. Stroke. 2002;33:1034–40. https://doi.org/10.1161/01.str.0000012515.66889.24.CrossRefPubMed

Meijer R, Ihnenfeldt DS, de Groot IJM, van Limbeek J, Vermeulen M, de Haan RJ. Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature. Clin Rehabil. 2003;17(2):119–29. https://doi.org/10.1191/0269215503cr585oa.CrossRefPubMed

Hartman-Maeir A, Soroker N, Ring H, Avni N, Katz N. Activities, participation and satisfaction one-year post stroke. Disabil Rehabil. 2007;29:559–66. https://doi.org/10.1080/09638280600924996.CrossRefPubMed

Doman CA, Waddell KJ, Bailey RR, Moore JL, Lang CE. Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke. Am J Occup Ther. 2016;70:7003290040p1–11. https://doi.org/10.5014/ajot.2016.020891.CrossRefPubMedPubMedCentral

Lang CE, Bland MD, Bailey RR, Schaefer SY, Birkenmeier RL. Assessment of upper extremity impairment, function, and activity after stroke: foundations for clinical decision making. J Hand Ther. 2013;26:104–14. https://doi.org/10.1016/j.jht.2012.06.005 (quiz 115).CrossRefPubMed

van der Pas SC, Verbunt JA, Breukelaar DE, van Woerden R, Seelen HA. Assessment of arm activity using triaxial accelerometry in patients with a stroke. Arch Phys Med Rehabil. 2011;92:1437–42. https://doi.org/10.1016/j.apmr.2011.02.021.CrossRefPubMed

Ward NS, Cohen LG. Mechanisms underlying recovery of motor function after stroke. Arch Neurol. 2004;61:1844–8. https://doi.org/10.1001/archneur.61.12.1844.CrossRefPubMedPubMedCentral

Kelly KM, Borstad AL, Kline D, Gauthier LV. Improved quality of life following constraint-induced movement therapy is associated with gains in arm use, but not motor improvement. Top Stroke Rehabil. 2018;25:467–74. https://doi.org/10.1080/10749357.2018.1481605.CrossRefPubMedPubMedCentral

Platz T, Schmuck L. Armrehabilitation. Nervenarzt. 2016;87:1057–61. https://doi.org/10.1007/s00115-016-0187-9.CrossRefPubMed

10.

Lang CE, Wagner JM, Edwards DF, Dromerick AW. Upper extremity use in people with hemiparesis in the first few weeks after stroke. J Neurol Phys Ther. 2007;31:56–63. https://doi.org/10.1097/NPT.0b013e31806748bd.CrossRefPubMed

11.

Young NL, Williams J, Yoshida KK, Bombardier C, Wright JG. The context of measuring disability: Does it matter whether capability or performance is measured? J Clin Epidemiol. 1996;49:1097–101. https://doi.org/10.1016/0895-4356(96)00214-4.CrossRefPubMed

12.

Bailey RR, Klaesner JW, Lang CE. Quantifying Real-World Upper-Limb Activity in Nondisabled Adults and Adults With Chronic Stroke. Neurorehabil Neural Repair. 2015;29:969–78. https://doi.org/10.1177/1545968315583720.CrossRefPubMedPubMedCentral

13.

Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30:2131–40. https://doi.org/10.1161/01.str.30.10.2131.CrossRefPubMed

14.

Uswatte G, Taub E, Morris D, Vignolo M, McCulloch K. Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke. 2005;36:2493–6. https://doi.org/10.1161/01.STR.0000185928.90848.2e.CrossRefPubMed

15.

van der Lee JH, Beckerman H, Knol DL, de Vet HCW, Bouter LM. Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients. Stroke. 2004;35:1410–4. https://doi.org/10.1161/01.STR.0000126900.24964.7e.CrossRefPubMed

16.

Rand D, Eng JJ, Tang P-F, Jeng J-S, Hung C. How active are people with stroke?: use of accelerometers to assess physical activity. Stroke. 2009;40:163–8. https://doi.org/10.1161/STROKEAHA.108.523621.CrossRefPubMed

17.

Rand D, Eng JJ. Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation. Neurorehabil Neural Repair. 2012;26:76–84. https://doi.org/10.1177/1545968311408918.CrossRefPubMed

18.

Barth J, Geed S, Mitchell A, Lum PS, Edwards DF, Dromerick AW. Characterizing upper extremity motor behavior in the first week after stroke. PLoS ONE. 2020;15:e0221668–e0221668. https://doi.org/10.1371/journal.pone.0221668.CrossRefPubMedPubMedCentral

19.

Uswatte G, Taub E. Implications of the learned nonuse formulation for measuring rehabilitation outcomes: Lessons from constraint-induced movement therapy. Rehabilitation Psychology. 2005;50(1):34–42. https://doi.org/10.1037/0090-5550.50.1.34.

20.

Taub E, Crago JE, Burgio LD, Groomes TE, Cook EW, DeLuca SC, Miller NE. An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. J Exp Anal Behav. 1994;61:281–93. https://doi.org/10.1901/jeab.1994.61-281.CrossRefPubMedPubMedCentral

21.

Adams SA, Matthews CE, Ebbeling CB, Moore CG, Cunningham JE, Fulton J, Hebert JR. The effect of social desirability and social approval on self-reports of physical activity. Am J Epidemiol. 2005;161:389–98. https://doi.org/10.1093/aje/kwi054.CrossRefPubMed

22.

Lemmens RJM, Timmermans AAA, Janssen-Potten YJM, Smeets RJEM, Seelen HAM. Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review. BMC Neurol. 2012;12:21. https://doi.org/10.1186/1471-2377-12-21.CrossRefPubMedPubMedCentral

23.

Gebruers N, Vanroy C, Truijen S, Engelborghs S, de Deyn PP. Monitoring of physical activity after stroke: a systematic review of accelerometry-based measures. Arch Phys Med Rehabil. 2010;91(2):288–97. https://doi.org/10.1016/j.apmr.2009.10.025.CrossRefPubMed

24.

Uswatte G, Foo WL, Olmstead H, Lopez K, Holand A, Simms LB. Ambulatory monitoring of arm movement using accelerometry: an objective measure of upper-extremity rehabilitation in persons with chronic stroke. Arch Phys Med Rehabil. 2005;86:1498–501. https://doi.org/10.1016/j.apmr.2005.01.010.CrossRefPubMed

25.

Uswatte G, Giuliani C, Winstein C, Zeringue A, Hobbs L, Wolf SL. Validity of accelerometry for monitoring real-world arm activity in patients with subacute stroke: evidence from the extremity constraint-induced therapy evaluation trial. Arch Phys Med Rehabil. 2006;87:1340–5. https://doi.org/10.1016/j.apmr.2006.06.006.CrossRefPubMed

26.

Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. Arch Phys Med Rehabil. 2012;93:1975–81. https://doi.org/10.1016/j.apmr.2012.03.016.CrossRefPubMed

27.

Gebruers N, Truijen S, Engelborghs S, Nagels G, Brouns R, de Deyn PP. Actigraphic measurement of motor deficits in acute ischemic stroke. Cerebrovasc Dis. 2008;26:533–40. https://doi.org/10.1159/000160210.CrossRefPubMed

28.

Connell LA, Tyson SF. Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review. Arch Phys Med Rehabil. 2012;93(2):221–8. https://doi.org/10.1016/j.apmr.2011.09.015.CrossRefPubMed

29.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6: e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

30.

Waddell KJ, Lang CE. Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic. Arch Phys Med Rehabil. 2018;99:1913–6. https://doi.org/10.1016/j.apmr.2017.12.025.CrossRefPubMedPubMedCentral

31.

Barth J, Klaesner JW, Lang CE. Relationships between accelerometry and general compensatory movements of the upper limb after stroke. J Neuroeng Rehabil. 2020;17:138. https://doi.org/10.1186/s12984-020-00773-4.CrossRefPubMedPubMedCentral

32.

Uswatte G, Taub E, Morris D, Light K, Thompson PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurol. 2006;67:1189–94. https://doi.org/10.1212/01.wnl.0000238164.90657.c2.CrossRef

33.

Reiterer V, Sauter C, Klösch G, Lalouschek W, Zeitlhofer J. Actigraphy – A Useful Tool for Motor Activity Monitoring in Stroke Patients. Eur Neurol. 2008;60:285–91. https://doi.org/10.1159/000157882.CrossRefPubMed

34.

Chen H-L, Lin K-C, Hsieh Y-W, Wu C-Y, Liing R-J, Chen C-L. A study of predictive validity, responsiveness, and minimal clinically important difference of arm accelerometer in real-world activity of patients with chronic stroke. Clin Rehabil. 2018;32:75–83. https://doi.org/10.1177/0269215517712042.CrossRefPubMed

35.

Uswatte G, Hobbs QL. A behavioral observation system for quantifying arm activity in daily life after stroke. Rehabil Psychol. 2009;54:398–403. https://doi.org/10.1037/a0017501.CrossRefPubMedPubMedCentral

36.

Wang T, Lin K-C, Wu C-Y, Chung C, Pei Y, Teng Y. Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke. Arch Phys Med Rehabil. 2011;92:1086–91. https://doi.org/10.1016/j.apmr.2011.01.020.CrossRefPubMed

37.

Chin LF, Hayward KS, Soh AJA, Tan CM, Wong CJR, Loh JW, et al. An accelerometry and observational study to quantify upper limb use after stroke during inpatient rehabilitation. Physiother Res Int. 2019;24: e1784. https://doi.org/10.1002/pri.1784.CrossRefPubMed

38.

Connell LA, McMahon NE, Simpson LA, Watkins CL, Eng JJ. Investigating measures of intensity during a structured upper limb exercise program in stroke rehabilitation: an exploratory study. Arch Phys Med Rehabil. 2014;95:2410–9. https://doi.org/10.1016/j.apmr.2014.05.025.CrossRefPubMedPubMedCentral

39.

Gebruers N, Truijen S, Engelborghs S, de Deyn PP. Is activity loss predictive for development of upper limb oedema after stroke? J Rehabil Med. 2011;43:398–403. https://doi.org/10.2340/16501977-0780.CrossRefPubMed

40.

Urbin MA, Waddell KJ, Lang CE. Acceleration metrics are responsive to change in upper extremity function of stroke survivors. Arch Phys Med Rehabil. 2015;96:854–61. https://doi.org/10.1016/j.apmr.2014.11.018.CrossRefPubMed

41.

Narai E, Hagino H, Komatsu T, Togo F. Accelerometer-Based Monitoring of Upper Limb Movement in Older Adults With Acute and Subacute Stroke. J Geriatr Phys Ther. 2016;39:171–7. https://doi.org/10.1519/JPT.0000000000000067.CrossRefPubMed

42.

Simpson LA, Eng JJ, Backman CL, Miller WC. Rating of Everyday Arm-Use in the Community and Home (REACH) scale for capturing affected arm-use after stroke: development, reliability, and validity. PLoS ONE. 2013;8: e83405. https://doi.org/10.1371/journal.pone.0083405.CrossRefPubMedPubMedCentral

43.

Thrane G, Emaus N, Askim T, Anke A. Arm use in patients with subacute stroke monitored by accelerometry: association with motor impairment and influence on self-dependence. J Rehabil Med. 2011;43:299–304. https://doi.org/10.2340/16501977-0676.CrossRefPubMed

44.

Bailey RR, Birkenmeier RL, Lang CE. Real-world affected upper limb activity in chronic stroke: an examination of potential modifying factors. Top Stroke Rehabil. 2015;22:26–33. https://doi.org/10.1179/1074935714Z.0000000040.CrossRefPubMedPubMedCentral

45.

Bhatnagar K, Bever CT, Tian J, Zhan M, Conroy SS. Comparing Home Upper Extremity Activity With Clinical Evaluations of Arm Function in Chronic Stroke. Archives of Rehabilitation Research and Clinical Translation. 2020;2:100048. https://doi.org/10.1016/j.arrct.2020.100048.CrossRefPubMedCentral

46.

Gebruers N, Truijen S, Engelborghs S, de Deyn PP. Predictive value of upper-limb accelerometry in acute stroke with hemiparesis. J Rehabil Res Dev. 2013;50:1099–106. https://doi.org/10.1682/JRRD.2012.09.0166.CrossRefPubMed

47.

Gebruers N, Truijen S, Engelborghs S, de Deyn PP. Prediction of upper limb recovery, general disability, and rehabilitation status by activity measurements assessed by accelerometers or the Fugl-Meyer score in acute stroke. Am J Phys Med Rehabil. 2014;93:245–52. https://doi.org/10.1097/PHM.0000000000000045.CrossRefPubMed

48.

Urbin MA, Bailey RR, Lang CE. Validity of body-worn sensor acceleration metrics to index upper extremity function in hemiparetic stroke. J Neurol Phys Ther. 2015;39:111–8. https://doi.org/10.1097/NPT.0000000000000085.CrossRefPubMedPubMedCentral

49.

Lang CE, Waddell KJ, Klaesner JW, Bland MD. A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers. J Vis Exp. 2017. https://doi.org/10.3791/55673.CrossRefPubMedPubMedCentral

50.

Hayward KS, Eng JJ, Boyd LA, Lakhani B, Bernhardt J, Lang CE. Exploring the Role of Accelerometers in the Measurement of Real World Upper-Limb Use After Stroke. Brain Impairment. 2016;17:16–33. https://doi.org/10.1017/BrImp.2015.21.CrossRef

51.

Noorkõiv M, Rodgers H, Price CI. Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies. J Neuroeng Rehabil. 2014;9(11):144. https://doi.org/10.1186/1743-0003-11-144.CrossRef

52.

Cohen J. Statistical power analysis for the behaviour sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

53.

Portney LG, Watkins MP. Foundations of clinical research: applications to practice. Upper Saddle River, NJ: Pearson/Prentice Hall; 2009.

54.

Thiel C, Gabrys L, Vogt L. Registrierung körperlicher Aktivität mit tragbaren Akzelerometern. Deutsche Zeitschrift für Sportmedizin. 2016;67:S44-48. https://doi.org/10.5960/dzsm.2016.220.CrossRef

55.

Johansson D, Malmgren K, Alt MM. Wearable sensors for clinical applications in epilepsy, Parkinson’s disease, and stroke: a mixed-methods systematic review. J Neurol. 2018;265(8):1740–52. https://doi.org/10.1007/s00415-018-8786-y.CrossRefPubMedPubMedCentral

56.

Heil DP, Brage S, Rothney MP. Modeling physical activity outcomes from wearable monitors. Med Sci Sports Exerc. 2012;44:50–60. https://doi.org/10.1249/MSS.0b013e3182399dcc.CrossRef

57.

Mâsse LC, Fuemmeler BF, Anderson CB, Matthews CE, Trost SG, Catellier DJ, Treuth M. Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Med Sci Sports Exerc. 2005;37:S544–54. https://doi.org/10.1249/01.mss.0000185674.09066.8a.CrossRefPubMed

58.

Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005;37:S531–43. https://doi.org/10.1249/01.mss.0000185657.86065.98.CrossRefPubMed

59.

Redmond DP, Hegge FW. Observations on the design and specification of a wrist-worn human activity monitoring system. Behav Res Methods Instrum Comput. 1985;17:659–69. https://doi.org/10.3758/BF03200979.CrossRef

60.

Franck JA, Smeets RJEM, Seelen HAM. Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study. PLoS One. 2019;14:e0214651. https://doi.org/10.1371/journal.pone.0214651.CrossRefPubMedPubMedCentral

61.

Da-Silva RH, Moore SA, Rodgers H, Shaw L, Sutcliffe L, van Wijck F, Price CI. Wristband Accelerometers to motiVate arm Exercises after Stroke (WAVES): a pilot randomized controlled trial. Clin Rehabil. 2019;33:1391–403. https://doi.org/10.1177/0269215519834720.CrossRefPubMed

62.

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;50:705–12. https://doi.org/10.2340/16501977-2358.CrossRefPubMed

Title: Suitability of accelerometry as an objective measure for upper extremity use in stroke patients
Authors: Anne-Lisa Heye
Christine Kersting
Malte Kneer
Anne Barzel
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Stroke
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02743-w

2024 ASCO Annual Meeting

Springer Medicine

Suitability of accelerometry as an objective measure for upper extremity use in stroke patients

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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