Accelerometer Calibration: The Importance of Considering Functionality.

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To compare the accuracy and precision of a hip-worn accelerometer to predict energy cost during structured activities across motor performance and disease conditions. 118 adults self-identifying as healthy (n = 44) and those with arthritis (n = 23), multiple sclerosis (n = 18), Parkinson's disease (n = 17), and stroke (n =18) underwent measures of motor performance and were categorized into groups: Group 1, usual; Group 2, moderate impairment; and Group 3, severe impairment. The participants completed structured activities while wearing an accelerometer and a portable metabolic measurement system. Accelerometer-predicted energy cost (metabolic equivalent of tasks [METs]) were compared with measured METs and evaluated across functional impairment and disease conditions. Statistical significance was assessed using linear mixed effect models and Bayesian information criteria to assess model fit. All activities' accelerometer counts per minute (CPM) were 29.5-72.6% less for those with disease compared with those who were healthy. The predicted MET bias was similar across disease, -0.49 (-0.71, -0.27) for arthritis, -0.38 (-0.53, -0.22) for healthy, -0.44 (-0.68, -0.20) for MS, -0.34 (-0.58, -0.09) for Parkinson's, and -0.30 (-0.54, -0.06) for stroke. For functional impairment, there was a graded reduction in CPM for all activities: Group 1, 1,215 CPM (1,129, 1,301); Group 2, 789 CPM (695, 884); and Group 3, 343 CPM (220, 466). The predicted MET bias revealed similar results across the Group 1, -0.37 METs (-0.52, -0.23); Group 2, -0.44 METs (-0.60, -0.28); and Group 3, -0.33 METs (-0.55, -0.13). The Bayesian information criteria showed a better model fit for functional impairment compared with disease condition. Using functionality to improve accelerometer calibration could decrease variability and warrants further exploration to improve accelerometer prediction of physical activity.