Objectively assessed sleep quality parameters in Multiple Sclerosis at home: Association to disease, disease severity and physical activity

BACKGROUND

Multiple Sclerosis (MS) is a chronic inflammatory autoimmune, neurodegenerative disease that affects regular mobility and leads predominantly to physical disability. Poor sleep quality, commonly reported in MS patients, impacts their physical activity (PA). Accelerometers monitor 24-h activity patterns, offering insights into disease progression in daily life.

OBJECTIVE

To test if the sleep quality variables of MS patients, as assessed with wrist-worn accelerometers, differ from those of controls and are associated with PA and disease severity variables.

METHODS

Seven-day raw accelerometer data collected from 40 MS patients and 24 controls was processed using an open-source GGIR package, from which variables of sleep quality (sleep efficiency, wake after sleep onset (WASO), sleep regularity index (SRI), intradaily variability (IV)) and PA (of different intensities: inactivity, light (LPA), moderate (MPA), vigorous (VPA)) were analyzed. The variables were compared between the two study groups and in MS patients, correlation tested associations among the variables of sleep quality, PA, and disease severity (assessed with the Expanded Disability Status Scale, EDSS).

RESULTS

Sleep efficiency was the only variable that differed significantly between MS patients and controls (lower in MS, p = 0.01). Both SRI (positively) and IV (negatively) correlated with the time spent in LPA and MPA. WASO correlated negatively with inactivity.

CONCLUSION

This is one of the few studies with a wrist-worn accelerometer that shows a difference in sleep efficiency between MS patients and controls and, in MS, an association of sleep quality variables with PA variables.

Influence of motivational interviewing on postoperative mobilization in the enhanced recovery after surgery (ERAS®) pathway in elective colorectal surgery - a randomized patient-blinded pilot study

PURPOSE

Early mobilization is an essential component of the Enhanced Recovery after Surgery (ERAS®)-pathway. However, a large percentage of patients fail to achieve the ERAS® recommended goal (360 min out of bed from post-operative day 1/POD1). Motivational Interviewing (MI) is an evidence-based type of patient-centered consultation to promote intrinsic motivation. This study aims to evaluate if MI can improve postoperative mobilization.

METHODS

This two-arm, patient-blinded pilot randomized controlled trial included ERAS®-patients undergoing elective bowel resections. Conversations were validated by MI Treatment Integrity. Two validated motion sensors (movisens) and self-assessments were used to measure mobilization (POD1-POD3: Time out of bed, time on feet and step count).

RESULTS

97 patients were screened, 60 finally included and randomized. Cumulatively across POD1-3, the intervention group (IG) was longer out of bed than the control group (CG) (median: 685 vs. 420 min; p=0.022). The IG achieved the ERAS®-goal of 360 min/day more frequently across POD1-3 (27.4% vs. 10.61%; p=0.013). Time on feet was 131.5 min/day (median per POD) in IG vs. 95.8 min/day in the CG (p=0.212), step count was 1347 in IG vs. 754 steps/day in CG (p=0.298).

CONCLUSION

MI could be conducted low threshold and was well accepted by patients. MI can improve mobilization in the context of ERAS®. Despite better performance, it should be noted that only 27.4% of the IG reached the ERAS®-compliance goal of 360 min/day. The findings of this pilot study stipulate to further test the promising perioperative effects of MI within a multicenter superiority trial.

REGISTRATION

This study was registered prospectively in the German Clinical Trials Register on 25.02.2022. Trial registration number is "DRKS00027863".

Case study: Gait assessment of a patient with hallux rigidus before and after plantar modification

INTRODUCTION AND IMPORTANCE

Hallux rigidus (HR) is a degenerative arthritis affecting the first metatarsophalangeal joint (MTP), leading to pain and functional impairment, particularly during the propulsive phase of walking. The prevalence of HR is about 2.5 % in individuals over 50, but younger individuals can also be affected, as demonstrated in this case.

CASE PRESENTATION

We report the case of a 26-year-old patient with a body mass index (BMI) of 20.2, who has been suffering from HR for 5 years. The patient presented with walking difficulties, characterized by a limp and impaired propulsion phase, and pain in the right foot due to HR. A comprehensive gait assessment was conducted using a baropodometric platform and integrated smartphone motion sensors. Following the diagnosis, a non-surgical intervention involving the application of a compressed cotton felt foot orthosis at the MTP plantar area was initiated. This intervention aimed to alleviate pain and improve the functional mobility of the right big toe. Post-treatment assessments showed an increase in the big toe's mobility from 0 degrees to 35 degrees, as measured by a digital goniometer.

CLINICAL DISCUSSION

The application of a soft support, such as compressed cotton felt, at the plantar area of MTP, demonstrated a potential non-surgical therapeutic approach to improve gait and reduce discomfort in HR patients.

CONCLUSION

This case study underscores the potential benefits of plantar modification in the management of HR.

Influence of mental workload on motion perception: A direct comparison of luminance-based and contrast-based stimuli

In order to study the impact of increased mental workload on motion detection, twenty-four observers performed a motion discrimination task in which they had to detect odd moving patches. Two types of moving patches were used, namely luminance-based and contrast-based patches. For both types of patches, the motion discrimination task was performed with and without an additional N-Back task aimed at increasing the mental workload. The dual task decreased discrimination performance for both types of patches, but the difference was significantly larger for contrast-based patches, i.e., for second-order motion stimuli, both as an absolute and relative increment. This suggests that motion discrimination requires larger cognitive resources for contrast-based than for luminance-based stimuli, thereby hinting at the higher complexity of the cognitive mechanisms underlying second-order motion detection.

Mobility in community-dwelling older adults; what are its determinants?

Background

Based on a conceptual framework, Kuspinar and colleagues analysed life-space mobility in community-dwelling older adults. However, a number of earlier mobility studies that used the same framework remained undiscussed. This correspondence article addresses similarities and differences between these studies, as well as highlight issues that need to be addressed to improve our understanding of mobility determinants in older adults.

Findings

Despite differences in methodological approach as well as in detailed results, the studies share one important outcome: regardless of the specific choice of potential mobility determinants, only a low to moderate proportion of mobility could be explained.

Conclusions

Our present understanding of the determinants of mobility in community-dwelling older adults is limited. A consistent terminology that takes into account the different aspects of mobility; the use of objective methods to assess real-life mobility; and monitoring changes in real-life mobility in response to interventions will contribute to furthering our understanding of mobility determinants.

Bilateral gait asymmetry associated with tibiotalocalcaneal arthrodesis versus ankle arthrodesis

BACKGROUND

Gait asymmetries have been reported following ankle arthrodesis. However, similar reports do not exist for tibiotalocalaneal arthrodesis (TTCA), which involves further articular fusion. This study aimed to assess the extent of gait asymmetry following TTCA when compared to ankle arthrodesis.

METHOD

Gait assessment was performed on 36 participants, including 12 ankle arthrodesis, 12 TTCA and 12 controls - using 3-D inertial sensors and pressure insoles. 48 gait parameters were monitored on both operated and non-operated sides. Questionnaires including AOFAS, FAAM, EQ-5D were used to assess both operative groups, comparatively.

RESULTS

Both operative groups reported significantly smaller stride, slower walking speed, altered stance phase with longer loading and shorter push-off compared to controls. Joint range of motion was significantly reduced on the operated side of both operative groups at hindfoot, forefoot and toe intersegments. However, the ankle arthrodesis group reported a significantly higher alteration compared to controls in maximum contact force and pressure distribution. Furthermore, bilateral comparison showed extended gait asymmetry in the ankle arthrodesis group with 29 out of 48 parameters being significantly different between the two sides, whereas only 16 out of 48 gait parameters showed bilateral difference in the TTCA group.

CONCLUSION

Both ankle salvage operations led to significant gait alteration and bilateral asymmetry. However, extended joint restriction in TTCA does not seem to worsen the gait outcomes. Further investigation is needed to understand the long-term impact of altered gait, on neighboring joints, following TTCA.

Interaction between motion scales: When performance in motion discrimination is worse for a compound stimulus than for its integrating components

Motion direction discrimination becomes impaired when combinations of drifting high spatial frequency (HSF) and static low spatial frequency (LSF) patterns are merged into a compound stimulus. Such impairment has been suggested to occur due to an interaction between motion sensors tuned to coarse and fine scale spatial patterns. This interaction is modulated by different stimulus parameters like temporal frequency, size, the spectral components mixed, and their relative contrast. The present research precisely aims to explore in a deeper way the interaction's dependency upon the spatial frequency and the relative contrast of the components when both move coherently. Two experiments were therefore performed measuring duration thresholds (Experiment 1) and proportion of correct responses (Experiment 2) in a motion direction discrimination task. Stimuli were vertical Gabor patches of 4 deg diameter horizontally drifting with a speed of 2 deg/sec. Simple LSF and HSF stimuli as well as complex stimuli where both components moved coherently (LSFm + HSFm) were used. These were grouped in the following LSF and HSF pairs: 0.25-0.75, 0.5-1.5, 1-3 and 2-6 c/deg. Each component had a Michelson contrast of 28% or 7%, giving rise to different relative contrast combinations. Most interestingly, the results show a decrease in performance for complex stimuli with respect to each of their simple components when the LSF component has a lower contrast than the HSF one. The decrease depends on the particular spatial frequencies mixed in a stimulus. Further knowledge about the inhibitory mechanism is thus provided, revealing its joint dependency upon contrast and spatial frequency.

Prediction of energy expenditure during activities of daily living by a wearable set of inertial sensors

Physical inactivity is responsible for 7-10% of all premature deaths worldwide. Thus, valid, reliable and unobtrusive methods for monitoring activities of daily living (ADL) to predict total energy expenditure (TEE) is desired. Multiple methods exist to quantify TEE, but microelectromechanical systems (MEMSs) are the only method, which has shown promising results and are applicable for long-term monitoring in the field. However, no perfect method exists for predicting TEE on a daily basis. The present study evaluates TEE estimation based on a MEMS (Xsens Link system) taking gender and heart rate into account. Fifteen individuals performed seven ADL wearing the Xsens Link system, a heart rate belt and an oxygen mask. Multiple linear regression models were established for sedentary and dynamic activities and evaluated by leave-one-out cross-validation and compared with indirect calorimetry. The linear regression model showed better prediction for dynamic activities (adjusted R² 0.95±0.16) compared to sedentary activities (adjusted R² 0.61±0.19). The root-mean-square error for the TEE estimation ranged between 0.02 and 0.08 kJ/min/kg for the sedentary and dynamic models, respectively. The study showed a viable approach to predict TEE in ADL compared to previously published results. Further studies are warranted to reduce the number of sensors in the estimation of TEE.

Preoperative gait asymmetry in end-stage unilateral ankle osteoarthrosis patients

BACKGROUND

Gait asymmetries following unilateral ankle surgeries have been reported in published literature. Preoperative compensatory gait patterns are usually assumed to be the cause; however, this hypothesis is not backed by objective data. This study aims to assess gait symmetry in patients with unilateral ankle osteoarthrosis (AOA).

METHOD

20 participants, including 10 controls and 10 AOA patients, were assessed using 3-D inertial sensors and pressure insoles. 46 gait parameters and foot sub-region relative motions were studied.

RESULTS

Compared with the controls, significant differences were reported in 23 parameters on the affected side and 20 on the unaffected side. AOA bilateral comparison reported differences in 14 parameters, mostly in the toe region. Asymmetries were also found in forefoot relative motion.

CONCLUSION

Gait alterations are reported in AOA. One-third of measured parameters and forefoot relative motion reported marked gait asymmetries. Clarification of the origin of postoperative gait imbalances is likely to help clinicians optimize rehabilitation programs.

Developing recommendations for monitoring wildlife underpass usage using trail cameras

The growing rate of wildlife underpass use for the mitigation of road-induced wildlife mortality necessitates the development of low-cost monitoring tools for determination of mitigation success. Trail cameras are one such tool that can provide valuable insight into the usage patterns and effectiveness of wildlife underpasses. We deployed trail cameras in wildlife underpasses in Guelph, ON, to develop recommendations for camera monitoring protocols. The trail cameras used high interval time lapse and motion sensors from April to October of 2016 to capture crossing by a variety of species through two slotted, small animal underpasses. Daily and seasonal underpass usage patterns of 21 species and species groups suggest that to comprehensively monitor underpass usage, cameras must be active continuously and utilize high frequency time lapse and motion sensors simultaneously to capture crossing events by both endothermic and ectothermic species. Although these recommendations are dependent on the specific objectives and target conservation species, these results can be used to guide a range of underpass monitoring programs.

A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study

The links between increased participation in Physical Activity (PA) and improvements in health are well established. As this body of evidence has grown, so too has the search for measures of PA with high levels of methodological effectiveness (i.e. validity, reliability and responsiveness to change). The aim of this “review of reviews” was to provide a comprehensive overview of the methodological effectiveness of currently employed measures of PA, to aid researchers in their selection of an appropriate tool. A total of 63 review articles were included in this review, and the original articles cited by these reviews were included in order to extract detailed information on methodological effectiveness.

Self-report measures of PA have been most frequently examined for methodological effectiveness, with highly variable findings identified across a broad range of behaviours. The evidence-base for the methodological effectiveness of objective monitors, particularly accelerometers/activity monitors, is increasing, with lower levels of variability observed for validity and reliability when compared to subjective measures. Unfortunately, responsiveness to change across all measures and behaviours remains under-researched, with limited information available.

Other criteria beyond methodological effectiveness often influence tool selection, including cost and feasibility. However, researchers must be aware of the methodological effectiveness of any measure selected for use when examining PA. Although no “perfect” tool for the examination of PA in adults exists, it is suggested that researchers aim to incorporate appropriate objective measures, specific to the behaviours of interests, when examining PA in free-living environments.

Users' experiences of wearable activity trackers: a cross-sectional study

Background

Wearable activity trackers offer considerable promise for helping users to adopt healthier lifestyles. This study aimed to explore users’ experience of activity trackers, including usage patterns, sharing of data to social media, perceived behaviour change (physical activity, diet and sleep), and technical issues/barriers to use.

Methods

A cross-sectional online survey was developed and administered to Australian adults who were current or former activity tracker users. Results were analysed descriptively, with differences between current and former users and wearable brands explored using independent samples t-tests, Mann-Whitney, and chi square tests.

Results

Participants included 200 current and 37 former activity tracker users (total N = 237) with a mean age of 33.1 years (SD 12.4, range 18–74 years). Fitbit (67.5%) and Garmin devices (16.5%) were most commonly reported. Participants typically used their trackers for sustained periods (5–7 months) and most intended to continue usage. Participants reported they had improved their physical activity (51–81%) more commonly than they had their diet (14–40%) or sleep (11–24%), and slightly more participants reported to value the real time feedback (89%) compared to the long-term monitoring (78%). Most users (70%) reported they had experienced functionality issues with their devices, most commonly related to battery life and technical difficulties.

Conclusions

Results suggest users find activity trackers appealing and useful tools for increasing perceived physical activity levels over a sustained period.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4888-1) contains supplementary material, which is available to authorized users.

Doubly labelled water assessment of energy expenditure: principle, practice, and promise

The doubly labelled water method for the assessment of energy expenditure was first published in 1955, application in humans started in 1982, and it has become the gold standard for human energy requirement under daily living conditions. The method involves enriching the body water of a subject with heavy hydrogen (2H) and heavy oxygen (18O), and then determining the difference in washout kinetics between both isotopes, being a function of carbon dioxide production. In practice, subjects get a measured amount of doubly labelled water (2H 218 O) to increase background enrichment of body water for 18O of 2000 ppm with at least 180 ppm and background enrichment of body water for 2H of 150 ppm with 120 ppm. Subsequently, the difference between the apparent turnover rates of the hydrogen and oxygen of body water is assessed from blood-, saliva-, or urine samples, collected at the start and end of the observation interval of 1-3 weeks. Samples are analyzed for 18O and 2H with isotope ratio mass spectrometry. The doubly labelled water method is the indicated method to measure energy expenditure in any environment, especially with regard to activity energy expenditure, without interference with the behavior of the subjects. Applications include the assessment of energy requirement from total energy expenditure, validation of dietary assessment methods and validation of physical activity assessment methods with doubly labelled water measured energy expenditure as reference, and studies on body mass regulation with energy expenditure as a determinant of energy balance.

Accuracy and precision of smartphone applications and commercially available motion sensors in multiple sclerosis

BACKGROUND

There is increased interest in the application of smartphone applications and wearable motion sensors among multiple sclerosis (MS) patients.

OBJECTIVE

This study examined the accuracy and precision of common smartphone applications and motion sensors for measuring steps taken by MS patients while walking on a treadmill.

METHODS

Forty-five MS patients (Expanded Disability Status Scale (EDSS) = 1.0-5.0) underwent two 500-step walking trials at comfortable walking speed on a treadmill. Participants wore five motion sensors: the Digi-Walker SW-200 pedometer (Yamax), the UP2 and UP Move (Jawbone), and the Flex and One (Fitbit). The smartphone applications were Health (Apple), Health Mate (Withings), and Moves (ProtoGeo Oy).

RESULTS

The Fitbit One had the best absolute (mean = 490.6 steps, 95% confidence interval (CI) = 485.6-495.5 steps) and relative accuracy (1.9% error), and absolute (SD = 16.4) and relative precision (coefficient of variation (CV) = 0.0), for the first 500-step walking trial; this was repeated with the second trial. Relative accuracy was correlated with slower walking speed for the first (r_s = -.53) and second (r_s = -.53) trials.

CONCLUSION

The results suggest that the waist-worn Fitbit One is the most precise and accurate sensor for measuring steps when walking on a treadmill, but future research is needed (testing the device across a broader range of disability, at different speeds, and in real-life walking conditions) before inclusion in clinical research and practice with MS patients.

Validation and reliability of two activity monitors for energy expenditure assessment

OBJECTIVES

This study explores the reliability and validity of the SenseWear Armband (SWA) and Actical (ACT) for free-living total energy expenditure, and energy expenditure during rest and light-to-moderate exercises (walking, ergocycling).

DESIGN

Participants wore the 2 devices during 7 days (free-living) and then participated to 3 days of testing in our laboratory.

METHODS

SWA and ACT estimates of total energy expenditure was compared to the doubly labeled water technique (7 days), and energy expenditure during rest (60min), treadmill (45min; intensities ∼22% to ∼41% VO2peak) and ergocycling (45min; ∼50% VO2peak) were compared to indirect calorimetry over the following 3 days. Paired T-tests and intra-class correlation coefficient (ICC) with 95% confidence interval (CI95) were computed.

RESULTS

Twenty adults were recruited (BMI 23.1±2.3kg/m(2)). Compared to doubly labelled water, SWA overestimated energy expenditure by 94kcal/d (±319; P=0.2) and ACT underestimated by -244kcal/d (±258; P=0.001). Energy expenditure during rest (SWA 210±116, ACT 124±133kcal/d; p<0.05) and treadmill (according on intensity: SWA 54±46 to 67±38, ACT 68±25 to 84±40kcal; p<0.05) were overestimated and underestimated during ergocycling (SWA -93±65, ACT -269±111kcal; p<0.05) compared to indirect calorimetry. High ICC were observed at rest (SWA 0.994 CI95 0.987-0.997; ACT 0.998 CI95 0.996-0.999) and during ergocycling (SWA 0.941 CI95 0.873-0.975; ACT 0.854 CI95 0.687-0.939).

CONCLUSION

Acceptable estimation of total energy expenditure was observed with the SWA. Both devices were reliable but not accurate for energy expenditure's estimations during rest and for specific exercises.

Automated evaluation of physical therapy exercises using multi-template dynamic time warping on wearable sensor signals

We develop an autonomous system to detect and evaluate physical therapy exercises using wearable motion sensors. We propose the multi-template multi-match dynamic time warping (MTMM-DTW) algorithm as a natural extension of DTW to detect multiple occurrences of more than one exercise type in the recording of a physical therapy session. While allowing some distortion (warping) in time, the algorithm provides a quantitative measure of similarity between an exercise execution and previously recorded templates, based on DTW distance. It can detect and classify the exercise types, and count and evaluate the exercises as correctly/incorrectly performed, identifying the error type, if any. To evaluate the algorithm's performance, we record a data set consisting of one reference template and 10 test executions of three execution types of eight exercises performed by five subjects. We thus record a total of 120 and 1200 exercise executions in the reference and test sets, respectively. The test sequences also contain idle time intervals. The accuracy of the proposed algorithm is 93.46% for exercise classification only and 88.65% for simultaneous exercise and execution type classification. The algorithm misses 8.58% of the exercise executions and demonstrates a false alarm rate of 4.91%, caused by some idle time intervals being incorrectly recognized as exercise executions. To test the robustness of the system to unknown exercises, we employ leave-one-exercise-out cross validation. This results in a false alarm rate lower than 1%, demonstrating the robustness of the system to unknown movements. The proposed system can be used for assessing the effectiveness of a physical therapy session and for providing feedback to the patient.