Impact of anatomical placement of an accelerometer on prediction of physical activity energy expenditure in lower-limb amputees

Ladlow, Peter; Nightingale, Tom E.; McGuigan, M. Polly; Bennett, Alexander N.; Phillip, Rhodri; Bilzon, James L. J.

doi:10.1371/journal.pone.0185731

Cited by 14 publications

(28 citation statements)

References 34 publications

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“…The AHR uses a uni-axial accelerometer unlike the GT3X+ which is a tri-axial accelerometer, uni-axial accelerometers have been shown to have less sensitivity when predicting PAEE [39]. It is also known that the anatomical location of an accelerometer is important in the accuracy of measuring PAEE [19, 40]. The anatomical locations of the monitors used in this study are not comparable, as the AHR device was worn on the chest whilst the GT3X+ was worn on the hip of the shortest residual limb.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous research identified that wearing a GT3X+ on the hip of the shortest residual limb as the most accurate anatomical position around the pelvis to predict PAEE in individuals with unilateral and bilateral amputation [19]. When activity counts from the GT3X+ were combined with significant covariates this created population specific estimation models, capable of accurately estimating ambulatory PAEE (mean absolute percentage error); unilateral (21±17%), bilateral (16±15%) and controls (15±7%).…”

Section: Discussionmentioning

confidence: 99%

“…An Actigraph GT3X+ tri-axial accelerometer (Actigraph, Pensacola, FL, USA) was worn around the waist, above the hip (along the anterior axillary line) on the side of the shortest residual limb, as recommended by Ladlow et al . [19], using an elasticated belt. Following the Nyquist principle, the devices were initialised with a sampling frequency of 30 Hz, thereby allowing the capture of general human movement [32] and a similar sampling frequency to the AHR monitor.…”

Section: Methodsmentioning

confidence: 99%

“…The testing protocol is described in more detail elsewhere [19]. The Metamax 3B and the two activity monitors were synchronised before use and a Polar HR monitor was worn throughout the protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Having access to an objective measurement of PAEE can facilitate our understanding of a number of other clinically important areas with greater accuracy than we might have had before. Recently, our group demonstrated that the Actigraph GT3X+ accelerometer, worn at the hip on the shortest residual limb, provides a valid estimation of PAEE in individuals with unilateral and bilateral traumatic lower-limb amputation [19]. However, accelerometry data alone doesn’t capture the physiological strain associated with certain ambulatory behaviours, such as walking up a gradient [20].…”

Section: Introductionmentioning

confidence: 99%

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Predicting ambulatory energy expenditure in lower limb amputees using multi-sensor methods

et al. 2019

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PurposeTo assess the validity of a derived algorithm, combining tri-axial accelerometry and heart rate (HR) data, compared to a research-grade multi-sensor physical activity device, for the estimation of ambulatory physical activity energy expenditure (PAEE) in individuals with traumatic lower-limb amputation.MethodsTwenty-eight participants [unilateral (n = 9), bilateral (n = 10) with lower-limb amputations, and non-injured controls (n = 9)] completed eight activities; rest, ambulating at 5 progressive treadmill velocities (0.48, 0.67, 0.89, 1.12, 1.34m.s-1) and 2 gradients (3 and 5%) at 0.89m.s-1. During each task, expired gases were collected for the determination of and subsequent calculation of PAEE. An Actigraph GT3X+ accelerometer was worn on the hip of the shortest residual limb and, a HR monitor and an Actiheart (AHR) device were worn on the chest. Multiple linear regressions were employed to derive population-specific PAEE estimated algorithms using Actigraph GT3X+ outputs and HR signals (GT3X+HR). Mean bias±95% Limits of Agreement (LoA) and error statistics were calculated between criterion PAEE (indirect calorimetry) and PAEE predicted using GT3X+HR and AHR.ResultsBoth measurement approaches used to predict PAEE were significantly related (P<0.01) with criterion PAEE. GT3X+HR revealed the strongest association, smallest LoA and least error. Predicted PAEE (GT3X+HR; unilateral; r = 0.92, bilateral; r = 0.93, and control; r = 0.91, and AHR; unilateral; r = 0.86, bilateral; r = 0.81, and control; r = 0.67). Mean±SD percent error across all activities were 18±14%, 15±12% and 15±14% for the GT3X+HR and 45±20%, 39±23% and 34±28% in the AHR model, for unilateral, bilateral and control groups, respectively.ConclusionsStatistically derived algorithms (GT3X+HR) provide a more valid estimate of PAEE in individuals with traumatic lower-limb amputation, compared to a proprietary group calibration algorithm (AHR). Outputs from AHR displayed considerable random error when tested in a laboratory setting in individuals with lower-limb amputation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicting ambulatory energy expenditure in lower limb amputees using multi-sensor methods

et al. 2019

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Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Anderson¹,

Miller

Murray

et al. 2020

PM&R

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Introduction Over half of all people with lower limb amputation (LLA) experience at least one fall annually. Furthermore, the majority of LLAs result from dysvascular health complications, contributing to balance deficits. However, fall‐related research specific to dysvascular LLA remains limited. Objective To characterize falls among adults with dysvascular LLA, using an existing Fall‐Type Classification Framework and to describe the functional characteristics of participants across the framework categories. Design Secondary data analysis from two randomized controlled trials. Setting Outpatient setting. Participants People (n = 69) 6 months to 5 years from dysvascular lower extremity amputation, who were ≥50 years of age and independently ambulatory using a prosthesis. Intervention None. Outcome Descriptions of self‐reported falls were collected on a weekly basis for 12 weeks, and analyzed using an existing Fall‐Type Classification Framework. Fall frequencies, estimated count, and estimated proportions were compared across all framework categories, with 95% confidence intervals. Functional measures (Timed Up and Go, Two Minute Walk, Five Meter Walk, and average step count) were collected, and averages for each participant who experienced a fall were calculated. Results Thirty participants (43.5%) reported 42 falls within 12 weeks. A variety of fall types were described. Incidence of falls was highest for intrinsic destabilization sources, from incorrect weight shift patterns during transfer activities. Conclusion Patients with dysvascular LLAs experience a variety of fall types. The high frequency of intrinsically sourced, incorrect weight‐shift falls during transfer activities emphasizes the need to focus rehabilitation efforts on improving postural control in patients with dysvascular LLAs during activities such as reaching, turning, and transferring.

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Influence of traumatic lower‐limb amputation on physical activity, body composition, and cardiometabolic risks: A descriptive preliminary study

Ladlow

Nightingale

McGuigan

et al. 2023

PM&R

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Background Following traumatic lower‐limb amputation (LLA), humans are predisposed to numerous unfavorable changes in health, including the development of secondary chronic health conditions such as metabolic disorders and cardiovascular disease. Objective To determine within and between group differences in cardiometabolic component risks, body composition, and physical activity (PA) in individuals with traumatic unilateral and bilateral LLA, compared to noninjured controls. Design Prospective observational cohort study. Setting A military complex trauma rehabilitation center. Participants Sixteen males with traumatic LLA (8 unilateral, mean age 30 ± 5 years and 8 bilateral, mean age 29 ± 3 years). Thirteen active age‐matched males with no LLA (28 ± 5 years) acted as controls and performed habitual activities of daily living. Intervention Participants with LLA attended two 4‐week periods of inpatient rehabilitation, separated by two 6‐week periods of home‐based recovery. Main Outcome Measures Venous blood samples were taken prior to and following a 75 g oral glucose load, for determination of biomarkers, including insulin and glucose, at baseline and 20 weeks. Body composition (dual X‐ray absorptiometry) was measured at baseline, 10 weeks, and 20 weeks. Daily PA was recorded using a triaxial accelerometer for 7 days during inpatient rehabilitation and while at home. Energy expenditure was estimated using population‐specific equations. Results Individuals with bilateral LLA demonstrated more unfavorable mean body composition values, lower PA, and increased cardiometabolic health risk compared to controls. Cardiometabolic syndrome was identified in 63% of individuals with bilateral LLA. No statistically significant differences in cardiometabolic component risk factors, body composition, and estimated daily PA were reported between unilateral LLA and control groups (p > .05). While at home, mean PA counts.day−1 reduced by 17% (p = .018) and 42% (p = .001) in the unilateral and bilateral LLA groups, respectively. Conclusions Despite extensive inpatient rehabilitation, cardiometabolic component risks are elevated in individuals with bilateral LLA but are comparable between unilateral LLA and active noninjured control groups. Innovative strategies that improve/support the long‐term PA and cardiometabolic health of severely injured individuals with bilateral LLA are warranted.

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Impact of anatomical placement of an accelerometer on prediction of physical activity energy expenditure in lower-limb amputees

Cited by 14 publications

References 34 publications

Predicting ambulatory energy expenditure in lower limb amputees using multi-sensor methods

Predicting ambulatory energy expenditure in lower limb amputees using multi-sensor methods

Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Influence of traumatic lower‐limb amputation on physical activity, body composition, and cardiometabolic risks: A descriptive preliminary study

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