Using an Accelerometer-Based Step Counter in Post-Stroke Patients: Validation of a Low-Cost Tool

Francesco Negrini, Giulio Gasperini, Eleonora Guanziroli, Jacopo Antonino Vitale, Giuseppe Banfi, Franco Molteni, Francesco Negrini, Giulio Gasperini, Eleonora Guanziroli, Jacopo Antonino Vitale, Giuseppe Banfi, Franco Molteni

Abstract

Monitoring the real-life mobility of stroke patients could be extremely useful for clinicians. Step counters are a widely accessible, portable, and cheap technology that can be used to monitor patients in different environments. The aim of this study was to validate a low-cost commercial tri-axial accelerometer-based step counter for stroke patients and to determine the best positioning of the step counter (wrists, ankles, and waist). Ten healthy subjects and 43 post-stroke patients were enrolled and performed four validated clinical tests (10 m, 50 m, and 6 min walking tests and timed up and go tests) while wearing five step counters in different positions while a trained operator counted the number of steps executed in each test manually. Data from step counters and those collected manually were compared using the intraclass coefficient correlation and mean average percentage error. The Bland-Altman plot was also used to describe agreement between the two quantitative measurements (step counter vs. manual counting). During walking tests in healthy subjects, the best reliability was found for lower limbs and waist placement (intraclass coefficient correlations (ICCs) from 0.46 to 0.99), and weak reliability was observed for upper limb placement in every test (ICCs from 0.06 to 0.38). On the contrary, in post-stroke patients, moderate reliability was found only for the lower limbs in the 6 min walking test (healthy ankle ICC: 0.69; pathological ankle ICC: 0.70). Furthermore, the Bland-Altman plot highlighted large average discrepancies between methods for the pathological group. However, while the step counter was not able to reliably determine steps for slow patients, when applied to the healthy ankle of patients who walked faster than 0.8 m/s, it counted steps with excellent precision, similar to that seen in the healthy subjects (ICCs from 0.36 to 0.99). These findings show that a low-cost accelerometer-based step counter could be useful for measuring mobility in select high-performance patients and could be used in clinical and real-world settings.

Keywords: accelerometer; gait; rehabilitation; step counter; stroke.

Conflict of interest statement

The authors have no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of the data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Bland–Altman plots for difference vs. average of the two measurements methods (step counter and manual counting) during timed up and go test (TUG) for the five different step counter positionings for the pathological group (n = 43). Dashed lines represent +95% (upper line) and −95% (lower line) of the limits of agreements. Legend: LoA, Limits of Agreement.
Figure 2
Figure 2
Comparison of the mean absolute percentage error in the 50 m walking test (50 m WT) for the healthy group (n = 10), pathological group (n = 43), and group V3 (n = 17). Legend: P: pathological group; H: healthy group; *: p < 0.05.
Figure 3
Figure 3
Comparison of the mean absolute percentage error in the timed up and go test for the healthy group (n = 10), pathological group (n = 43), and group V3 (n = 17). Legend: P: pathological group; H: healthy group; *: p < 0.05; **: p < 0.001.

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