Physical Activity Monitoring in Patients with Neurological Disorders: A Review of Novel Body-Worn Devices

Aim: The aim was to conduct a systematic review to examine the literature reporting the validityand reliability of wearable physical activity monitoring in individuals with neurologicaldisorders. Method: A systematic search of the literature was performed using a specific searchstrategy in PubMed and CINAHL. A search constraint of articles published in English, includinghuman participants, published between January 2008 and March 2017 was applied. Peerreviewedstudies which enrolled adult participants with any neurological disorder were included.For the studies which sought to explore the validity of activity monitors, the outcomesmeasured using the monitor were compared to a criterion measure of physical activity. Thestudies methodological quality was assessed using an adapted version of the Quality Assessmentof Diagnostic Accuracy Studies (QUADAS) framework. Data extracted from each studyincluded the following: characteristics of the study participants, study setting, devices used,study protocol/methods, outcomes measured, and the validity/reliability of measurementproduced. Results: Twenty-three studies examining the validity and reliability of 16 differentmonitors were included. The identified studies comprised participants with a range of differentdisorders of neurological origin. The available evidence suggests that biaxial or triaxialaccelerometer devices positioned around the ankle produce the most accurate step countmeasurements in patients with neurological disorders. The findings regarding the reliabilityand validity of activity counts and energy expenditure are largely inconclusive in this population.Discussion: Ankle-worn biaxial or triaxial accelerometer-type devices provide the mostaccurate measurement of physical activity. However, further work is required in this field before wearable activity monitoring can be more widely implemented clinically. Standardisedactivity monitoring protocols are required for implementing these devices in clinical trials andclinical practice, and consensus is required as to the reporting and interpretation of derivedvariables