Mizuno Emi, Ogasawara Takayuki, Mukaino Masahiko, Yamaguchi Masumi, Tsukada Shingo, Sonoda Shigeru, Otaka Yohei
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan.
JMIR Form Res. 2024 May 29;8:e51546. doi: 10.2196/51546.
Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities.
This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity.
In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks.
A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=-0.41, P=.21) or 4 weeks post admission (ρ=-0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=-0.82, P=.002) and 4 weeks post admission (ρ=-0.73, P=.01).
Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings.
运动功能障碍不仅会导致患者活动水平显著下降，还会因失健状态而引发运动功能进一步恶化，这一问题在住院期间尤为突出。通过维持适当的活动水平可以对抗这种失健状态。在这种情况下，计划外的活动往往被忽视，但却至关重要。可穿戴技术，如智能服装，提供了一种监测这些活动的手段。
本研究旨在观察亚急性期中风患者的活动水平，重点关注住院康复环境中的计划训练课程和其他非训练时间。使用智能服装系统同时测量心率和加速度，以深入了解身体活动的量和强度。
在这项初步队列研究中，招募了11名接受亚急性中风康复治疗的个体。在入院时部署48小时连续测量系统，并在4周后重新评估，监测身体活动的加速度计数据（用加速度移动标准差[MSDA]量化）和心率强度（用心率储备百分比量化）。测量使用可穿戴活动监测系统hitoe（NTT公司和东丽工业株式会社）系统进行，该系统包括带有集成电极的测量服装（穿戴式或腕带式）、数据发射器和智能手机。使用功能独立性测量来评估患者的日常活动水平。本研究探讨了训练期和非训练期活动差异、与日常生活活动（ADL）和年龄的相关性以及4周后观察到的变化等因素。
4周训练计划后，每日总MSDA显著增加，平均心率储备百分比保持一致。训练期间的身体活动与入院时（ρ=0.86，P<0.001）和入院后4周（ρ=0.96，P<0.001）的ADL水平呈正相关，而入院时训练期（ρ=-0.41，P=0.21）或入院后4周（ρ=-0.25，P=0.45）年龄与MSDA之间的相关性不显著。相反，非训练活动与年龄呈负相关，入院时（ρ=-0.82，P=0.002）和入院后4周（ρ=-0.73，P=0.01）与年龄呈显著负相关。
住院康复活动水平与ADL水平呈正相关。进一步分析显示，计划训练活动与ADL水平之间存在强正相关，而非训练活动则无此相关性。相反，观察到非训练活动与年龄呈负相关。这些观察结果表明为老年患者提供活动机会的重要性，同时也可能表明需要调整活动量以适应这一人群可能有限的健康水平。有必要进行更大患者群体的未来研究以验证并进一步阐明这些发现。
