Accuracy and Precision of Actigraphy and SMARTwheels for Measuring Push Counts Across a Series of Wheelchair Propulsion Trials in Non-disabled Young Adults
Keywords:Wheelchair, Actigraphy, Physical Activity, Health Promotion, Disability
Background: There has been a growing interest in “Lifestyle Physical Activity” (LPA) among wheelchair users. LPA can be quantified via “pushes” as an outcome metric. This study examined the accuracy and precision of research-grade devices for counting pushes across a series of wheelchair propulsion trials.
Methods: Eleven non-disabled, young adults completed 19, 1-minute wheelchair propulsion trials at self-selected speeds with a wheelchair equipped with a SMARTwheel (SW) device while being video recorded. Participants also wore 2 ActiGraph accelerometers, one on the wrist and one on the upper arm. Video footage enabled manual counting of the number of pushes (gold standard). Total pushes were averaged across 16 workloads (3 trials of repeated workloads were excluded) for each device and compared to manually counted pushes.
Results: Compared to manually counted pushes, SW demonstrated the greatest accuracy (mean difference [MD] compared to video of 2.3 pushes [4.5% error]) and precision (standard deviation of the mean difference [SDMD]) compared to video of 4 pushes, (Coefficient of Variation [CV] =.04), followed by the upper arm-worn accelerometer (MD of 4.4 pushes [10.4% error] and SDMD of 10, [CV= .06]) and the wrist-worn accelerometer (MD of 12.6 pushes [27.8% error] and SDMD of 13 [CV=.15]).
Conclusions: SW demonstrated greater accuracy and precision than ActiGraph accelerometers placed on the upper arm and wrist. The accelerometer placed on the upper arm was more accurate and precise than the accelerometer placed on the wrist. Future investigations should be conducted to identify the source(s) of inaccuracy among wearable push counters.
Cowan RE, Silveira SL, Helle T, Laessoe U, Goeg KR, Bangshaab J, et al. Lifestyle physical activity in manual wheelchair users - an overlooked public health opportunity. Spinal Cord. 2022;60(2):190-2. DOI: https://doi.org/10.1038/s41393-021-00729-y
Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020-8. DOI: https://doi.org/10.1001/jama.2018.14854
Klaren RE, Motl RW, Dlugonski D, Sandroff BM, Pilutti LA. Objectively quantified physical activity in persons with multiple sclerosis. Arch Phys Med Rehabil. 2013;94(12):2342-8. DOI: https://doi.org/10.1016/j.apmr.2013.07.011
Motl RW, McAuley E, Snook EM. Physical activity and multiple sclerosis: a meta-analysis. Mult Scler. 2005;11(4):459-63. DOI: https://doi.org/10.1191/1352458505ms1188oa
Motl RW. Lifestyle physical activity in persons with multiple sclerosis: the new kid on the MS block. Mult Scler. 2014;20(8):1025-9. DOI: https://doi.org/10.1177/1352458514525873
Buchholz AC, McGillivray CF, Pencharz PB. Physical activity levels are low in free-living adults with chronic paraplegia. Obes Res. 2003;11(4):563-70. DOI: https://doi.org/10.1038/oby.2003.79
Cooper RA. SMARTWheel: From concept to clinical practice. Prosthet Orthot Int. 2009;33(3):198-209. DOI: https://doi.org/10.1080/03093640903082126
Benning NH, Knaup, Petra, Rupp, Rudiger. Comparison of accuracy of activity measurements with wearable activity trackers in wheelchair users: a preliminary evaluation. GMS Medizinische Informatik, Biometrie und Epidemiologie. 2020;16(2).
Benning NH, Knaup P, Rupp R. Measurement Performance of Activity Measurements with Newer Generation of Apple Watch in Wheelchair Users with Spinal Cord Injury. Methods Inf Med. 2021;60(S 02):e103-e10. DOI: https://doi.org/10.1055/s-0041-1740236
Glasheen E, Domingo A, Kressler J. Accuracy of Apple Watch fitness tracker for wheelchair use varies according to movement frequency and task. Ann Phys Rehabil Med. 2021;64(1):101382. DOI: https://doi.org/10.1016/j.rehab.2020.03.007
Karinharju KS, Boughey AM, Tweedy SM, Clanchy KM, Trost SG, Gomersall SR. Validity of the Apple Watch((R)) for monitoring push counts in people using manual wheelchairs. J Spinal Cord Med. 2021;44(2):212-20. DOI: https://doi.org/10.1080/10790268.2019.1576444
DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80(11):1411-9. DOI: https://doi.org/10.1016/S0003-9993(99)90252-6
Lemons VR, Wagner FC, Jr. Respiratory complications after cervical spinal cord injury. Spine (Phila Pa 1976). 1994;19(20):2315-20. DOI: https://doi.org/10.1097/00007632-199410150-00011
Tollefsen E, Fondenes O. Respiratory complications associated with spinal cord injury. Tidsskr Nor Laegeforen. 2012;132(9):1111-4. DOI: https://doi.org/10.4045/tidsskr.10.0922
Veeger HE, Meershoek LS, van der Woude LH, Langenhoff JM. Wrist motion in handrim wheelchair propulsion. J Rehabil Res Dev. 1998;35(3):305-13.
Koontz AM, Cooper RA, Boninger ML, Yang Y, Impink BG, van der Woude LH. A kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces. J Rehabil Res Dev. 2005;42(4):447-58. DOI: https://doi.org/10.1682/JRRD.2004.08.0106
Rammer JR, Krzak JJ, Slavens BA, Winters JM, Riedel SA, Harris GF. Considering Propulsion Pattern in Therapeutic Outcomes for Children Who Use Manual Wheelchairs. Pediatr Phys Ther. 2019;31(4):360-8. DOI: https://doi.org/10.1097/PEP.0000000000000649
Rankin JW, Kwarciak AM, Richter WM, Neptune RR. The influence of wheelchair propulsion technique on upper extremity muscle demand: a simulation study. Clin Biomech (Bristol, Avon). 2012;27(9):879-86. DOI: https://doi.org/10.1016/j.clinbiomech.2012.07.002
Sanderson DJ, Sommer HJ, 3rd. Kinematic features of wheelchair propulsion. J Biomech. 1985;18(6):423-9. DOI: https://doi.org/10.1016/0021-9290(85)90277-5
de Groot S, Vegter RJ, van der Woude LH. Effect of wheelchair mass, tire type and tire pressure on physical strain and wheelchair propulsion technique. Med Eng Phys. 2013;35(10):1476-82. DOI: https://doi.org/10.1016/j.medengphy.2013.03.019
van Drongelen S, Arnet U, Veeger DH, van der Woude LH. Effect of workload setting on propulsion technique in handrim wheelchair propulsion. Med Eng Phys. 2013;35(3):283-8. DOI: https://doi.org/10.1016/j.medengphy.2012.04.017
Veeger HE, van der Woude LH, Rozendal RH. Load on the upper extremity in manual wheelchair propulsion. J Electromyogr Kinesiol. 1991;1(4):270-80. DOI: https://doi.org/10.1016/1050-6411(91)90014-V
Veeger HE, van der Woude LH, Rozendal RH. Effect of handrim velocity on mechanical efficiency in wheelchair propulsion. Med Sci Sports Exerc. 1992;24(1):100-7. DOI: https://doi.org/10.1249/00005768-199201000-00017
Bertolaccini GDS, Carvalho Filho IFP, Christofoletti G, Paschoarelli LC, Medola FO. The influence of axle position and the use of accessories on the activity of upper limb muscles during manual wheelchair propulsion. Int J Occup Saf Ergon. 2018;24(2):311-5. DOI: https://doi.org/10.1080/10803548.2017.1294369
Fritsch C. How Was Studied the Effect of Manual Wheelchair Configuration on Propulsion Biomechanics: A Systematic Review on Methodologies. Frontiers in Rehabilitation Services. 2022;3:863113. DOI: https://doi.org/10.3389/fresc.2022.863113
Klaesner J, Morgan KA, Gray DB. The development of an instrumented wheelchair propulsion testing and training device. Assist Technol. 2014;26(1):24-32. DOI: https://doi.org/10.1080/10400435.2013.792020
Gauthier C, Grangeon M, Ananos L, Brosseau R, Gagnon DH. Quantifying cardiorespiratory responses resulting from speed and slope increments during motorized treadmill propulsion among manual wheelchair users. Ann Phys Rehabil Med. 2017;60(5):281-8. DOI: https://doi.org/10.1016/j.rehab.2017.02.007
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