Review article
Monitoring of Physical Activity After Stroke: A Systematic Review of Accelerometry-Based Measures

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Abstract

Gebruers N, Vanroy C, Truijen S, Engelborghs S, De Deyn PP. Monitoring of physical activity after stroke: a systematic review of accelerometry-based measures.

Objective

To assess the clinimetric properties and clinical applicability of different accelerometry-based measurement techniques in persons with stroke.

Data Sources

A systematic search of literature was performed using a specific search strategy by means of different electronic databases until October 2008 (PubMed, EMBASE, CINAHL, Cochrane Library of Clinical Trials).

Study Selection

A first selection was made by means of title and abstract. A second selection was performed by means of predefined inclusion criteria: (1) accelerometry in stroke population, (2) application of accelerometry in patients with stroke including clinimetric properties. The exclusion criteria were (1) dysphagia, (2) new engineering techniques or software alterations, (3) secondary sources, and (4) Case studies.

Data Extraction

The clinimetric properties and applicability of accelerometry were described based on the included publications.

Data Synthesis

Twenty-five articles (4 randomized controlled trials) were included. The information of the publications was divided into (1) gait, cadence, and ambulatory activity; (2) upper-extremity activity; and (3) topics related to stroke other than upper or lower extremity.

Accelerometry was shown to be valid and had good test-retest reliability in a large number of settings. Numerous studies demonstrated correlations between accelerometry and common stroke scales. Trunk movements were measured as an outcome of disturbed gait. The vertical asymmetry index especially was able to differentiate between persons with stroke and healthy controls. Persons with stroke showed less ambulatory activity, measured as steps per day, than sedentary controls. Triaxial accelerometry was able to distinguish between varying activity levels. Upper-extremity use was lesser in persons with stroke. It was impossible to calculate a minimal clinical difference for arm use by a uniaxial accelerometer. Evidence was presented that finger-tapping and sit-to-stand measured by accelerometers could be used to define recovery from stroke.

Conclusions

The literature concerning accelerometry incorporated into stroke research is young, limiting the ability to draw consistent conclusions. Nonetheless, the available evidence suggests that accelerometers yield valid and reliable data about the physical activity of patients with stroke. Future research is necessary to investigate clinimetric properties like predictive value and responsiveness further before implementing accelerometry in clinical trials as an outcome for change.

Section snippets

Definition of Review Questions

We systematically reviewed the literature regarding the use of accelerometry in stroke research to address the following questions: (1) Which clinimetric properties are investigated and what are these properties? (2) What is the clinical relevance/applicability of accelerometry-based measurements in stroke research?

In order to answer to these questions, we reviewed all studies dealing with accelerometry in patients with stroke that fulfilled the following inclusion and exclusion criteria. In

Results

Despite the fact that most articles reported on clinical trials, only 4 of the 25 selected articles had a randomized controlled trial design.21, 22, 23, 24 In order to discuss the clinical applicability of accelerometry, an overview of correlations between accelerometry and laboratory tests/questionnaires was given as well as a description of the clinimetric properties of accelerometry in different settings.

To facilitate reading, the Results section is divided into 3 major parts. The first part

Discussion

Before discussing the articles in the same order as presented in the Results section, shortcomings that apply to all 3 subdivisions are discussed. Many studies reported on small sample sizes potentially leading to the studies being underpowered.8, 23, 26, 34, 37 A problem related to the small sample sizes was the rigorous inclusion of patients with stroke, which diminished the generalizability of the presented results.

Normally, when a test-retest reliability is examined, one will expect to read

Conclusions

The literature concerning accelerometry incorporated into stroke research is young, limiting our ability to draw consistent conclusions. Nonetheless, the available evidence suggests that accelerometers yield valid and reliable data about the physical activity of patients with stroke. Accelerometers were generally experienced as user-friendly with limited burden for the patients. Accelerometry can be used in different settings (at home, hospital, community) and throughout the different stages of

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    Supported by the Artesis Hogeschool Antwerpen, Belgium (grant no. G817), and the Methusalem Excellence Grant of the Flemish government.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Reprints are not available from the author.

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