Journal of Rehabilitation Medicine 51-6 | Page 32

J Rehabil Med 2019; 51: 426–433 ORIGINAL REPORT COMPARISON OF ACCELEROMETER-BASED ARM, LEG AND TRUNK ACTIVITY AT WEEKDAYS AND WEEKENDS DURING SUBACUTE INPATIENT REHABILITATION AFTER STROKE Margit ALT MURPHY, PhD 1,2 *, Sofi ANDERSSON, MSc 1,2 , Anna DANIELSSON, PhD 1,3 , Jan WIPENMYR, MSc 4 and Fredrik OHLSSON, PhD 4 From the 1 Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 2 Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 3 Departement of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 4 RISE Acreo, Gothenburg, Sweden Objective: To determine whether there are differen- ces in arm, leg and trunk activity measured by acce- leration between weekdays and weekends in people undergoing rehabilitation in the subacute stage after stroke. Design: Cross-sectional study. Patients: Twenty-eight individuals with stroke (mean age 55.4 years; severe to mild impairment) and 10 healthy controls. Methods: A set of 5 3-axial accelerometers were used on the trunk, wrists and ankles during 2 48-h sessions at weekdays and over a weekend. Day-time acceleration raw data were expressed as the signal magnitude area. Asymmetry between the affected and less-affected limb was calculated as a ratio. Results: Participants with stroke used their both arms and legs less at weekends than on weekdays (p  <  0.05, effect size 0.32–0.57). Asymmetry bet- ween the affected and less-affected arm was grea- ter at weekends (p < 0.05, effect size 0.32). All ac- tivity measures, apart from the less-affected arm on weekdays, were lower in stroke compared with controls (p  < 0.05, effect size 0.4–0.8). No statisti- cally significant differences were detected between weekday and weekend activity for the control group. One-third of participants perceived the trunk sensor as inconvenient to wear. Conclusion: Increased focus needs to be applied on activities carried out during weekends at rehabilita- tion wards. Key words: stroke; physical activity; accelerometry; rehabi- litation; weekday weekend differences; ambulatory monito- ring; wearable technology; patient preference. Accepted Mar 22, 2019; Epub ahead of print Apr 2, 2019 J Rehabil Med 2019; 51: 426–433 Correspondence address: Margit Alt Murphy, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Uni- versity of Gothenburg, Per Dubbsgatan 14, SE413 45 Gothenburg, Sweden. E-mail: [email protected] I ndividuals with stroke have difficulty achieving the recommended levels of physical activity, despite that the physical activity is a key component of primary and secondary prevention of stroke (1). Behavioural map- ping studies show that individuals with stroke spend LAY ABSTRACT Individuals with stroke have difficulty achieving the recommended levels of physical activity. The physical environment and support provided can also influence activity levels. This study aimed to determine whether there are differences between weekdays and weekends in arm, leg and trunk activity measured by accelera- tion in people undergoing rehabilitation in the subacute stage after stroke. The results showed that people with hemiparesis in the inpatient rehabilitation setting use not only their more-affected, but also their less-affected arm and leg less at weekends than on weekdays. Thus, the challenge during inpatient rehabilitation is to iden- tify patients who might need extra support to be able to maintain their physical activities at weekends, facilitate activity on all days of the week, and take full advantage of the recovery process. approximately 70–80% of waking hours in lying or sitting, both in subacute and chronic stages (2–6). In hospital settings, during a typical day of rehabilitation, patients were physically active for approximate 23 min and spent only 1 min in vigorous activity (7). Studies using accelerometers show that community-dwelling stroke survivors took approximately half the number of steps per day compared with healthy controls (8), and that individuals with stroke remain sedentary at least 1 year after stroke (9). Similarly, the paretic arm was used for a mean of 3 h per day and the non-paretic arm for 6 h per day early after stroke compared with 8.5 h in non-disabled controls (10). Wearable devices, such as accelerometers, are in- creasingly used to objectively measure activity levels in stroke. The majority of studies in stroke report step or activity counts or duration of activity/inactivity (e.g. time spent in walking, sitting or lying) measured with a single or a set of 2–3 activity sensors on the lower body (11). Similarly, duration of arm activity, measured as activity counts and a ratio of paretic to non-paretic arm, are frequently reported (12). Commonly, proprietary algorithms are used to generate step or activity counts, which makes comparison between devices and studies difficult (13). Thus, reporting accelerometer metrics in terms of acceleration (m/s 2 ) is advocated in order This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2553 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977