Instrumented clinical scales to promote objective measures of physical capability in clinical assessment and rehabilitation medicine

Abstract

The age-related decline of physical and cognitive capacities and the increasing number of older people imply significant socioeconomic costs. Detection of people at risk of developing Physical Capability (PC) decline is crucial for identifying therapeutic rehabilitation targets. Objective measures of Physical Performance (PP) extracted from wearable inertial sensors could integrate the conventional outcome. However, little use is made in everyday clinical practice, because of the lack of standardization, redundancy of information and the need for normative data. The main goal of this thesis was the design of a general model for providing an objective PC assessment tool, and to investigate the relationships among instrumented scores, clinical scores, and specific impairments and diseases. Participants underwent a battery of PP tests wearing an inertial sensor at L5, including Quiet Standing (QS), walking, Chair-Stand Test (CST) and Timed-Up-and-Go Test (TUG). Age and gender relationships have also been investigated. Exploratory Factor Analysis was used to define a conceptual model based on the set of sensor-based measures extracted from the InCHIANTI Study. The model was applied to a different cohort, which included a neurological population (Parkinson’s and Stroke), demonstrating its validity and clinical significance. One-week continuous monitoring of daily PA activity has also been recorded from a subset of the InCHIANTI participants. The sensor-based PP and daily PA outcomes were consistent with the conventional clinical scores. Instrumented functional testing showed the potential to i) advance the quality of current mobility assessments; ii) enhance our understanding of an individual’s true PC; and iii) disclose subtle changes in PC that would otherwise remain undetected. In conclusion, the development and implementation of an easy to use, objective and comprehensive tool for the assessment of the individuals’ PC has demonstrated to be feasible. This tool may enrich conventional clinical outcomes, facilitating the design of interventions and rehabilitation strategies.