Abstract
PurposeTo assess the influence of the anatomical placement of a tri-axial accelerometer on the prediction of physical activity energy expenditure (PAEE) in traumatic lower-limb amputees during walking and to develop valid population-specific prediction algorithms.MethodsThirty participants, consisting of unilateral (n = 10), and bilateral (n = 10) amputees, and non-injured controls (n = 10) volunteered to complete eight activities; resting in a supine position, walking on a flat (0.48, 0.67, 0.89, 1.12, 1.34 m.s-1) and an inclined (3 and 5% gradient at 0.89 m.s-1) treadmill. During each task, expired gases were collected and an Actigraph GT3X+ accelerometer was worn on the right hip, left hip and lumbar spine. Linear regression analyses were conducted between outputs from each accelerometer site and criterion PAEE (indirect calorimetry). Mean bias ± 95% limits of agreement were calculated. Additional covariates were incorporated to assess whether they improved the prediction accuracy of regression models. Subsequent mean absolute error statistics were calculated for the derived models at all sites using a leave-one out cross-validation analysis.ResultsPredicted PAEE at each anatomical location was significantly (P< 0.01) correlated with criterion PAEE (P<0.01). Wearing the GT3X+ on the shortest residual limb demonstrates the strongest correlation (unilateral; r = 0.86, bilateral; r = 0.94), smallest ±95% limits of agreement (unilateral; ±2.15, bilateral ±1.99 kcal·min-1) and least absolute percentage error (unilateral; 22±17%, bilateral 17±14%) to criterion PAEE.ConclusionsWe have developed accurate PAEE population specific prediction models in lower-limb amputees using an ActiGraph GT3X+ accelerometer. Of the 3 anatomical locations considered, wearing the accelerometer on the side of the shortest residual limb provides the most accurate prediction of PAEE with the least error in unilateral and bilateral traumatic lower-limb amputees.
Highlights
There is a paucity of research investigating the impact of regular physical activity (PA) on the health and well-being of individuals following recovery from traumatic lower-limb amputation
We have developed accurate physical activity energy expenditure (PAEE) population specific prediction models in lower-limb amputees using an ActiGraph GT3X+ accelerometer
This study aimed to evaluate the effect of anatomical positioning around the pelvis of the GT3X+ accelerometer on the prediction of PAEE in unilateral and bilateral amputees and to develop population specific algorithms for a range of ambulatory velocities in a controlled-laboratory environment
Summary
There is a paucity of research investigating the impact of regular physical activity (PA) on the health and well-being of individuals following recovery from traumatic lower-limb amputation. In order to enhance research and practice in this field, it is important to develop valid and reliable tools to estimate free-living physical activity energy expenditure (PAEE) in lower-limb amputees This has proven inherently difficult to measure, even in humans without mobilityrelated physical impairments. Recent investigations into the daily PA and heart rate responses of people with vascular [5] and traumatic [6] unilateral trans-tibial amputations have demonstrated that both amputee groups are less active than matched controls without known physical impairments. These studies highlight the impact of physical disability and associated mobility restriction on volitional PA behaviour
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