Monitoring postures and motions of hospitalized patients using sensor technology: a scoping review.

BACKGROUND: Sensor technology could provide solutions to monitor postures and motions and to help hospital patients reach their rehabilitation goals with minimal supervision. Synthesized information on device applications and methodology is lacking. OBJECTIVES: The purpose of this scoping review was to provide an overview of device applications and methodological approaches to monitor postures and motions in hospitalized patients using sensor technology. METHODS: A systematic search of Embase, Medline, Web of Science and Google Scholar was completed in February 2023 and updated in March 2024. Included studies described populations of hospitalized adults with short admission periods and interventions that use sensor technology to objectively monitor postures and motions. Study selection was performed by two authors independently of each other. Data extraction and narrative analysis focused on the applications and methodological approaches of included articles using a personalized standard form to extract information on device, measurement and analysis characteristics of included studies and analyse frequencies and usage. RESULTS: A total of 15.032 articles were found and 49 articles met the inclusion criteria. Devices were most often applied in older adults (n = 14), patients awaiting or after surgery (n = 14), and stroke (n = 6). The main goals were gaining insight into patient physical behavioural patterns (n = 19) and investigating physical behaviour in relation to other parameters such as muscle strength or hospital length of stay (n = 18). The studies had heterogeneous study designs and lacked completeness in reporting on device settings, data analysis, and algorithms. Information on device settings, data analysis, and algorithms was poorly reported. CONCLUSIONS: Studies on monitoring postures and motions are heterogeneous in their population, applications and methodological approaches. More uniformity and transparency in methodology and study reporting would improve reproducibility, interpretation and generalization of results. Clear guidelines for reporting and the collection and sharing of raw data would benefit the field by enabling study comparison and reproduction.

In a clinical setting, wearables are currently used to monitor postures and motions in a wide variety of study applications and hospital populations.Measurement of postures and motions in the hospital setting is characterized by methodological heterogeneity. This poses a significant challenge, impacting the interpretation of results and hindering meaningful comparisons between studiesFollowing guidelines for reporting and the collection and sharing of raw data would benefit the field.

Validation of the Activ8 Activity Monitor for Monitoring Postures, Motions, Transfers, and Steps of Hospitalized Patients.

Sedentary behaviors and low physical activity among hospitalized patients have detrimental effects on health and recovery. Wearable activity monitors are a promising tool to promote mobilization and physical activity. However, existing devices have limitations in terms of their outcomes and validity. The Activ8 device was optimized for the hospital setting. This study assessed the concurrent validity of the modified Activ8. Hospital patients performed an activity protocol that included basic (e.g., walking) and functional activities (e.g., room activities), with video recordings serving as the criterion method. The assessed outcomes were time spent walking, standing, upright, sedentary, and newly added elements of steps and transfers. Absolute and relative time differences were calculated, and Wilcoxon and Bland-Altman analyses were conducted. Overall, the observed relative time differences were lower than 2.9% for the basic protocol and 9.6% for the functional protocol. Statistically significant differences were detected in specific categories, including basic standing (p < 0.05), upright time (p < 0.01), and sedentary time (p < 0.01), but they did not exceed the predetermined 10% acceptable threshold. The modified Activ8 device is a valid tool for assessing body postures, motions, steps, and transfer counts in hospitalized patients. This study highlights the potential of wearable activity monitors to accurately monitor and promote PA among hospital patients.

A Mirror Therapy-Based Action Observation Protocol to Improve Motor Learning After Stroke.

BACKGROUND: Mirror therapy is a priming technique to improve motor function of the affected arm after stroke. OBJECTIVE: To investigate whether a mirror therapy-based action observation (AO) protocol contributes to motor learning of the affected arm after stroke. METHODS: A total of 37 participants in the chronic stage after stroke were randomly allocated to the AO or control observation (CO) group. Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible. All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO. Participants in the AO group observed mirrored video tapes of reaching movements performed by their unaffected arm, whereas participants in the CO group observed static photographs of landscapes. The experimental condition effect was investigated by evaluating the primary outcome measure: movement time (in seconds) of the reaching movement, measured by accelerometry. RESULTS: Movement time decreased significantly in both groups: 18.3% in the AO and 9.1% in the CO group. Decrease in movement time was significantly more in the AO compared with the CO group (mean difference = 0.14 s; 95% confidence interval = 0.02, 0.26; P = .026). CONCLUSION: The present study showed that a mirror therapy-based AO protocol contributes to motor learning after stroke.

Effects of a mirror-induced visual illusion on a reaching task in stroke patients: implications for mirror therapy training.

BACKGROUND: Although most mirror therapy studies have shown improved motor performance in stroke patients, the optimal mirror training protocol still remains unclear. OBJECTIVE: To study the relative contribution of a mirror in training a reaching task and of unilateral and bimanual training with a mirror. METHODS: A total of 93 stroke patients at least 6 months poststroke were instructed to perform a reaching task as fast and as fluently as possible. They performed 70 practice trials after being randomly allocated to 1 of 5 experimental groups: training with (1) the paretic arm with direct view (Paretic-No Mirror), (2) the nonparetic arm with direct view (Nonparetic-No Mirror), (3) the nonparetic arm with mirror reflection (Nonparetic Mirror), (4) both sides and with a nontransparent screen preventing visual control of paretic side (Bilateral-Screen), and (5) both sides with mirror reflection of the nonparetic arm (Bilateral-Mirror). As baseline and follow-up, patients performed 6 trials using only their paretic side. Primary outcome measure was the movement time. RESULTS: We found the largest intervention effect in the Paretic-No Mirror condition. However, the Nonparetic-Mirror condition was not significantly different from the Paretic-No Mirror condition, while the Unaffected-No Mirror condition had significantly less improvement than the Paretic-No Mirror condition. In addition, movement time improved significantly less in the bimanual conditions and there was no difference between both bimanual conditions or between both mirror conditions. CONCLUSION: The present study confirms that using a mirror reflection can facilitate motor learning. In this task, bimanual movement using mirror training was less effective than unilateral training.

Effectiveness of audio feedback for partial weight-bearing in and outside the hospital: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of partial weight-bearing (PWB) training with audio feedback in patients after total hip arthroplasty (THA). DESIGN: Randomized controlled trial. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Patients (N=38) after THA with trochanteric osteotomy. INTERVENTION: Patients were trained with (n=18) or without (n=20) audio feedback to perform PWB at a 10% body weight (BW) target load. PWB training started on day 2 or 3 postoperatively and was given once per day during the entire hospital stay. MAIN OUTCOME MEASURES: Mean peak load (%BW), and the percentage of steps below, equal to, and above the target load. Weight-bearing was measured using an insole pressure system on postoperative day 7 in the hospital during PWB training (condition 1 [C1]) and when patients walked unsupervised (condition 2 [C2]), and on postoperative day 21 at home (condition 3 [C3]). RESULTS: PWB training with audio feedback resulted in better PWB (11.1% BW vs control, 21.9% BW; P=.006) at C1. The audio feedback group had more steps below the target load (21.4% vs control, 7.8%; P=.020) and fewer steps above the target load (15.6% vs control, 45.0%; P=.015). For C2 and C3, no significant differences were found between the patients receiving PWB training with and without audio feedback, for all outcome measures. CONCLUSIONS: Patients with THA who received audio feedback were able to accurately perform PWB at the prescribed target load during PWB training, but were unable to replicate the prescribed target load when they walked unsupervised in the hospital or at home.

Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study.

BACKGROUND: Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing. METHODS: Ten chronic (≥6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (>6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines. RESULTS: Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (±SD) energy expenditure during Wii Sports game play was 3.7 (±0.6) METs for tennis and 4.1 (±0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures>3 METs. CONCLUSIONS: With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.

Energy expenditure in adults with cerebral palsy playing Wii Sports.

OBJECTIVE: To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. DESIGN: Cross-sectional study. SETTING: University medical center. PARTICIPANTS: Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. INTERVENTION: Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. MAIN OUTCOME MEASURE: By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. RESULTS: Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. CONCLUSIONS: Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels.

Predictors of partial weight-bearing performance after total hip arthroplasty.

OBJECTIVE: To determine which patient characteristics, postoperative characteristics, and walking features influence patients' partial weight-bearing performance after total hip arthroplasty. DESIGN: A descriptive prospective study. PATIENTS: Fifty patients with total hip arthroplasty were included; partial weight-bearing was performed at a 10% body weight target load (n=33) and at a 50% body weight target load (n=17). METHODS: Patient (age, gender, body weight, upper arm muscle strength) and postoperative (pain, fatigue, anxiety) characteristics, and walking features (step frequency, total walking time, total number of steps, walking aid) were measured postoperatively on day 7 (with and without a physical therapist) and on day 21 (at home). Multilevel regression analyses were conducted to identify determinants that influence partial weight-bearing. RESULTS: Gender (female) (regression coefficient B=8.18, p=0.03) and total walking time (B=0.58, p<0.001) were positively, and pain during walking was negatively (B=-2.43, p=0.02), associated with the mean peak load. For partial weight-bearing at 10% body weight, postoperative overall anxiety (B=6.40, p=0.002) and total steps (B=0.05, p=0.02) were positively associated with the percentage of steps above the target load. For partial weight-bearing at home, postoperative overall anxiety was negatively associated with the percentage of steps above the target load (B=-5.32, p=0.001). CONCLUSION: Gender, pain during walking, walking time, postoperative anxiety and total number of steps influence the patient's partial weight-bearing performance.

Validity and interobserver reliability of visual observation to assess partial weight-bearing.

OBJECTIVE: To determine the validity and interobserver reliability of visual observation to assess partial weight-bearing. DESIGN: Validation and interobserver reliability study. SETTING: University medical center. PARTICIPANTS: Patients (N=10) with a total hip arthroplasty operated 1 to 12 months prior to the study referred by 10 physical therapists (5 experienced and 5 inexperienced in training patients in partial weight-bearing). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The amount of weight-bearing assessed by visual estimation (visual analog scale score) in percentage body weight (BW). Actual weight-bearing (percentage BW) as measured with the Pedar Mobile system. The mean difference (systematic error) between visual estimation and the Pedar system and the SD of the differences (random error) were determined by the limits of agreement (LOA) method with multiple observations per subject. The intraclass correlation coefficient (ICC) was calculated as a measure for the interobserver reliability. RESULTS: The mean difference +/- SD between visual observation and the reference method was -9.5+/-20.1 percentage BW (95% confidence interval, -24.0 to 5.0 percentage BW) with LOA ranging from -49.8 to 30.8 percentage BW. The ICC was .57. The therapists' experience in partial weight-bearing training had no effect on the mean difference (P=.349) between the 2 methods. CONCLUSIONS: Visual observation is not a valid and reliable method to assess partial weight-bearing.

The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital.

OBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthroplasty (THA) with trochanteric osteotomy. INTERVENTION: Patients were verbally instructed by a physical therapist to perform partial weight bearing at a 10% body weight (BW) target load (n=33) or at a 50% BW target load (n=17). MAIN OUTCOME MEASURES: Mean peak load (%BW) and percentage of patients and mean percentage of steps below, equal to, and above the target load. Weight bearing was measured when patients walked with (condition 1) and without (condition 2) a physical therapist in the hospital and walked at home (condition 3). RESULTS: The mean peak load was significantly higher than the target in the 10% BW group for all 3 conditions (condition 1, 19.2% BW; condition 2, 20.0% BW; condition 3, 26.8% BW). In the 50% BW group, the mean peak load was significantly lower than the target in conditions 1 (28.1% BW) and 2 (32.5% BW). No significant difference in weight bearing was found when walking with or without a physical therapist (change in 10% BW, -0.1% BW; change in 50% BW, -3.17% BW). At home, the mean peak load was significantly larger compared with walking without a physical therapist in the hospital (change in 10% BW, -7.0% BW; change in 50% BW, -11.5% BW). CONCLUSIONS: Partial weight bearing at a specific target load was not achieved by patients with a THA when given verbal instructions. Especially when using a low target load and when walking at home with no supervision of a physical therapist, patients loaded the operated leg higher and more frequently above the target load. Other training methods (eg, biofeedback) have to be evaluated to use as training tools for partial weight bearing at specific target loads.