CAN A MOVEMENT SENSOR CAPTURE FUNCTIONAL ACTIVITY TYPICALLY

UNDERTAKEN IN HOSPITAL BY PATIENTS RECOVERING FROM CRITICAL ILLNESS?

Jayne AndersonLecturer Practitioner Physiotherapist HEYHT

PhD Student York St John University

Aims

• Rationale for the research• Methodology• Proposed analysis of results• Anticipated value of the research

‘Functional activity’ in the hospital setting

• Sitting over the edge of the bed

• Getting out of bed• Transferring from a bed to

a chair• Moving from sitting to

standing• Walking variable

distances• Climbing stairs

How active are patients in hospital?

‘Older acutely hospitalised medical patients with walking ability spent 17 hours a day of their ‘in hospital’ time in bed’ 1

‘Total time upright (not necessarily walking) in the first four days following upper abdominal surgery: 3 minutes on day 1, 8.2 minutes on day 2, 7.6 minutes on day 3 and 34.4 minutes on day 4’ 2

1 Pedersen M.M, Bodilson A.C, Petersen J et al., Twenty-four-hour mobility during acute hospitalization in older medical patients. J Gerontology A Biol Sci Med Sci. 2013 March; 68(3): 331-337.

2 Browning L, Denehy L, Scholes R.L. The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Australian Journal of Physiotherapy 2007; 53: 47-52

What about those recovering from critical illness?

‘Of 61 participants who walked 100ft on their last day of an intensive care unit stay, 14 did not walk at all on the first full day back on the ward , 22 walked less than 100ft and 25 ambulated 100ft or more’

Hopkins, R.O, Miller III R.R, Rodriguez L et al. Physical therapy on the wards after early physical mobility in the intensive care unit. Physical Therapy 2012; 92 (12): 1518-1523

The ActigraphTM GT3X Accelerometer

• Inclinometer– Body position

• Physical activity count

• Step count

Methodology [1]• How well does the ActigraphTM GT3X

accelerometer detect physical activity, body position and postural transition?

• Validation study• Healthy population• n = 30• Ethics - YSJU, REC and NHS R and D approval • Location – Ward 7, Castle Hill Hospital,

Cottingham, East Yorkshire

Methodology [2]• Informed consent process• Accelerometers worn around the waist and ankle• Healthy participants will undertake a movement

protocol– Lying to sitting over the edge of a bed– Sitting to standing– Walking a ten metre distance

• All movements will undergo video recording time synchronised with the accelerometers

Proposed analysis of the results [1]• Data captured from the accelerometers will

be compared against the time synchronised video footage.

• Inclinometer setting:– 0 - not wearing– 1 - standing – 2 - lying– 3 - sitting

Proposed analysis of the results [2]

• Agreement between accelerometer data and that observed from video analysis– Categorical data - inclinometer (Kappa

statistic)– Continuous data - step count (Bland Altman)

• Repeatability of measurements– Value of the area under the curve

Anticipated value of the research• Identification of prolonged sedentary behaviour

• Measurement of outcome in trials of new rehabilitation interventions

• These functional activities are not solely undertaken Patients recovering from critical illness.

• Effective utilisAtion of rehabilitation resources

• Feedback for the Clinician

• Feedback for the paTient

I - M - P - A - C - T

Any Questions?