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