Medical Standards for Actigraphy

Transcription

1 Medical Standards for Actigraphy Gemeinsame Jahrestagung SGK, SGHC & SGP Lausanne, Milo Puhan, MD, PhD Chair of Epidemiology & Public Health, Director EBPI Seite 1

2 Key questions Why do we want to measure physical activity? Which aspects of physical activity are we interested in? Which tools measure aspects of physical activity we are interested in? How to select the appropriate tool for actigraphy? Seite 2

3 Definitions of physical activity Classic definition (narrow) Any bodily movement produced by skeletal muscles that results in energy expenditure Caspersen et al., Public Health Rep 1985, 100: More modern definition Construct that is characterized by types, intensity and duration of bodily movements in diffferent contexts and by the person s experience (e.g. symptoms) Seite 3

4 Physical activity Exercise capacity What people do What people can do Seite 4

5 Why do we want to measure physical activity? To identify people with low levels of PA To give feedback about PA and encourage people to do more PA To assess effects (treatments, exposures) R Treatment, exposure Control To assess individual patterns of PA Seite 5

6 Which aspects of physical activity are we interested in? R Treatment, exposure Control Seite 6

7 Which aspects of physical activity are we interested in? Moderate Light Sedentary Quantification R Treatment, exposure Control Context Experience Seite 7

8 Which tools measure aspects of physical activity we are interested in? Subjective methods Objective methods Energy expenditure Questionnaires - Step counters - Accelerometers - Multisensor systems - Activity monitors plus additional (big) data Doubly labelled water (field validation studies) Oxygen consumption (V O 2, lab validation studies) Seite 8

9 Questionnaires not a priori bad but use them wisely - Cheap, easy to use - Quantification of PA, activities of daily living, context of PA, symptoms associated with PA - Mostly used in studies up to 5 years ago - Goal of measurement often unclear - Many with major methodological shortcomings! Williams et al. Health and Quality of Life Outcomes 2012, 10:28 Seite 9

10 Typically low correlation of questionnaires with accerelometers LAPAQ questionnaire Stel et al. J Clin Epidemiol 2004; 57: LAPAQ validation in primary care. Siebeling et al. Clin Epi 2012:4:171-80

11 Shortness of breath associated with ADL (CRQ) Seite 11

12 Step counters, accelerometers and multisensor devices Step counters (mechanical, electronic) Accelerometers measure acceleration in 1-3 axes Multisensor: plus bodily reactions (e.g. sweating) Seite 12

13 Activity counts and other outputs = up & down = front & back = left & right Work Bicycle Cinema work With child resting household Dinner Dish washing

14 IMI FP7 Validation studies in patients with COPD Minute-by-minute correlations (R) between activity monitor outputs and metabolic equivalents of task (METs) per patient (white dots) Van Remoortel et al. PLoS ONE 2012; 7(6): e39198 Seite 14

15 IMI FP7 Accurate devices in patients with COPD Name Type Wearing spot Output Actigraph GT3X Triaxial acelerometer Waist (right) Steps, activity singals, energy DynaPort MiniMod Triaxi acelerometer Waist (back) expenditure (METs) Sense Wear Armband Multisensor- device Left arm (triceps) Step counters and uni- and biaxial accelerometers underestimate PA or are not very accurate in patients with COPD Van Remoortel et al. PLoS ONE 2012; 7(6): e39198 Rabinovich et al. Eur Respir J 2013; 42: Seite 15

16 EFPIA Universitäten und Partnerorganisationen Epidemiology, Biostatistics and Prevention Institute IMI FP : Development of PA measurement tools in COPD Phase 1 Systematic Reviews Qualitative research Activity monitors evaluation Phase 2 Instrument development & validation Phase 3 Validation studies in 5 RCTs Patient-centered concept of PA Amount of activity Amount Walking outdoors, Household Chores Leisure activities, Dressing, Bathing Symptoms / difficulty Dyspnea/Fatigue / Difficulties with specific activities Need for adaptation Need for breaks, Slow down, Help from others, Aids Amount Difficulty Hybrid tool Dobbels et al. Eur Resp J 2014; 44(5): Gimeno Santos et al. Eur Resp J 2015 ;46(4):

17 An outlook: Contextualize PA? Links to Seite 17

18 How to select the appropriate tool for actigraphy? Why measure What to measure Tools, from simple to advanced Identify low levels of PA Feedback/ encourage PA Quantification Kontext Experience Quantification Kontext Experience Assess effects Assess individual patterns Quantification Kontext Experience Quantification Kontext Experience +