The aim of this study was (1) to evaluate the relative and absolute reliability of gait parameters during walking in single- and dual-task conditions in patients with axial spondyloarthritis (axSpA), ...(2) to evaluate the absolute and relative reliability of dual task effects (DTE) parameters, and (3) to determine the number of trials required to ensure reliable gait assessment, in patients with axSpA. Twenty patients with axSpa performed a 10-m walk test in single- and dual-task conditions, three times for each condition. Spatiotemporal, symmetry, and DTE gait parameters were calculated from foot-worn inertial sensors. The relative reliability (intraclass correlation coefficients-ICC) and absolute reliability (standard error of measurement-SEM and minimum detectable change-MDC) were calculated for these parameters in each condition. Spatiotemporal gait parameters showed good to excellent reliability in both conditions (0.59 < ICC < 0.90). The reliability of symmetry and DTE parameters was low. ICC, SEM, and MDC were better when using the mean of the second and the third trials. Spatiotemporal gait parameters obtained from foot-worn inertial sensors assessed in patients with axSpA in single- and dual-task conditions are reliable. However, symmetry and DTE parameters seem less reliable and need to be interpreted with caution. Finally, better reliability of gait parameters was found when using the mean of the 2nd and the 3rd trials.
Studies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial ...spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.
Background
Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a ...viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA.
Objective
This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA.
Methods
PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device–measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study’s characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted.
Results
A total of 31 studies were initially identified; 13 (13/31, 42%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23%), lower back (3/13, 23%), right hip (3/13, 23%), waist (2/13, 15%), anterior thigh (1/13, 8%), or right arm (1/13, 8%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77% (10/13) of studies had a monitoring period of 1 week, including weekend days.
Conclusions
To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device–measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA.
Trial Registration
PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt
International Registered Report Identifier (IRRID)
RR2-10.2196/23359
Axial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle ...strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice.
This study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate.
A total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms
(mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground).
Age, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17).
Gait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine.
ClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212.
RR2-10.1007/s00296-019-04396-4.
Axial spondyloarthritis (axSpA) is a subgroup of inflammatory rheumatic diseases. Practicing regular exercise is critical to manage pain and stiffness, reduce disease activity, and improve physical ...functioning, spinal mobility, and cardiorespiratory function. Accordingly, monitoring physical activity and sedentary behavior in patients with axSpA is relevant for clinical outcomes and disease management.
This review aims to determine which wearable devices, assessment methods, and associated metrics are commonly used to quantify physical activity or sedentary behavior in patients with axSpA.
The PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane electronic databases will be searched, with no limit on publication date, to identify all the studies matching the inclusion criteria. Only original English-language articles published in a peer-reviewed journal will be included. The search strategy will include a combination of keywords related to the study population, wearable devices, physical activity, and sedentary behavior. We will use the Boolean operators "AND" and "OR" to combine keywords as well as Medical Subject Headings terms.
Search strategy was completed in June 2020 with 23 records obtained. Data extraction and synthesis are currently ongoing. Dissemination of study results in peer-reviewed journals is expected at the end of 2021.
This review will provide a comprehensive and detailed synthesis of published studies that examine the use of wearable devices for objective assessment of physical activity and sedentary behavior in patients with axSpA.
PROSPERO CRD42020182398; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=182398.
PRR1-10.2196/23359.
To identify candidate biomarkers of walking recovery with motor tract integrity measurements using fractional anisotropy (FA) from the corticospinal tract (CST) and alternative motor pathways in ...patients with moderate to severe subacute stroke.
Walking recovery was first assessed with generalized linear mixed model (GLMM) with repeated measures of walking scores (WS) over 2 years of follow-up in a longitudinal study of 29 patients with subacute ischemic stroke. Baseline FA measures from the ipsilesional and contralesional CST (i-CST and c-CST), cortico-reticulospinal pathway (i-CRP and c-CRP), and cerebellar peduncles were derived from a 60-direction diffusion MRI sequence on a 3T scanner. We performed correlation tests between WS and FA measures. Third, we investigated using GLMM whether motor tract integrity contributes to predict walking recovery.
We observed significant improvements of WS over time with a plateau reached at ≈6 months after stroke. WS significantly correlated with FA measures from i-CST, c-CST, i-CRP, and bilateral cerebellar peduncles. Walking recovery was predicted by FA measures from 3 tracts: i-CST, i-CRP, and contralesional superior cerebellar peduncle (c-SCP). Diffusion tensor imaging (DTI) predictors captured 80.5% of the unexplained variance of the model without DTI.
We identified i-CST and alternative motor-related tracts (namely i-CRP and c-SCP) as candidate biomarkers of walking recovery. The role of the SCP in walk recovery may rely on cerebellar nuclei projections to the thalamus, red nucleus, and reticular formation. Our findings suggest that a set of white matter tracts, part of subcortical motor networks, contribute to walking recovery in patients with moderate to severe stroke.
Ankylosing spondylitis (AS) is a chronic rheumatic disease which affects the axial skeleton and sacroiliac joints. By impacting spinal mobility and physical functions, AS could also potentially ...impair gait. However, while published data are rather sparse, it appears that discrepancies exist regarding AS consequences on gait characteristics, tasks and analysis techniques used to assess gait ability of patients with AS. The review questions are twofold: (1) How is gait assessed in patients with AS? and (2) What are the consequences of AS on gait?
Databases were systematically searched to identify studies satisfying the search criteria, using the synonyms of ankylosing spondylitis and gait. Two reviewers extracted from the articles study characteristics, methods and main results in relation to gait.
192 titles were extracted from databases and 21 studies were included in the review. 16 studies (76%) used clinical gait measurements and 5 (23%) used laboratory gait measurements. Only 7 involved a healthy control group. Studies used various protocols, instructions and parameters when assessing gait. Gait of patients with AS was associated with decreased stride length, pelvic movements and lower limbs angles in the sagittal plane, and increased hip abduction and external rotation compared to healthy controls.
Only few studies have assessed gait characteristics in patients with AS and published data evidence that kinematic parameters of gait is altered, but no consensus exists regarding gait analysis methods for patients with AS. Guidelines are provided to improve the design and methodology for future studies on gait and AS.
La pratique régulière d’une activité physique et la diminution de la sédentarité sont des interventions thérapeutiques majeures des rhumatismes inflammatoires chroniques (RIC) permettant de diminuer ...les douleurs et d’améliorer la fonction et la qualité de vie. L’activité physique pourrait également avoir des effets positifs sur les comorbidités associées aux RIC comme le risque cardio-vasculaire, le risque infectieux ou les dysfonctions urinaires et sexuelles. L’activité physique est également un levier thérapeutique permettant d’améliorer les perturbations du sommeil, particulièrement présentes dans les RIC. Un des défis majeurs de la promotion de l’activité physique est de maintenir la pratique et les effets de celle-ci dans la durée. Cette revue narrative a pour objectif de décrire les effets de l’activité physique sur les comorbidités et symptômes des RIC et de proposer des pistes de promotion de l’activité physique dans le futur.
Increasing physical activity and decreasing sedentary behaviors are major therapeutic interventions in inflammatory rheumatic diseases (IRD). Interventions targeting physical activity and sedentary behaviors can contribute to decrease pain, improve function and quality of life. Physical activity can also have positive effects on comorbidities associated with IRD, such as cardiovascular disease, risk of infections and urinary and sexual dysfunctions. Physical activity can also improve sleep disturbances, which are particularly common in IRD. Currently, a major challenge in physical activity promotion is the initiation and long-term maintenance of physical activity. The aims of this narrative review are to illustrate the effects of physical activity on comorbidities and symptoms in IRD and to provide suggestions for the promotion of physical activity in the future.
Ankylosing spondylitis is a subtype of inflammatory rheumatic disease, affecting predominantly the axial skeleton and sacroiliac joints. The main clinical manifestations are spinal stiffness and ...inflammatory back pain, which can potentially affect gait ability of patients with ankylosing spondylitis. However, published studies show discrepancies regarding gait characteristics in ankylosing spondylitis and heterogeneity in terms of task requirement, types of equipment, data collection, and analysis techniques used to assess gait ability of patients with ankylosing spondylitis.
This review aimed to determine (1) the consequences of ankylosing spondylitis on gait and (2) how gait is assessed in patients with ankylosing spondylitis.
Three electronic databases-PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane-were searched systematically with no limit on the publication date in order to identify studies satisfying the search criteria. The research focused on original research, using Boolean operators "AND" and "OR" in the combination of the Medical Subject Headings descriptors found in titles or abstracts: (Gait OR Walk OR Walking OR locomotor OR locomotion) AND (ankylosing spondylitis OR spondyloarthritis). Only English-language original articles were included.
As of September 2018, the search was completed, and 168 records were obtained. After screening titles and abstracts, 19 full texts were reviewed. Of those, 17 were included in the review. We are currently in the process of data extraction and synthesis.
The systematic review will provide a synthesis and comprehensive evaluation of published studies on gait characteristics in patients with ankylosing spondylitis. This work is also intended to help identify the likely relevant directions for future research.
PROSPERO CRD42018102540; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102540.
DERR1-10.2196/12470.
Les patients porteurs d’un rhumatisme inflammatoire chronique tel que la polyarthrite rhumatoïde ou la spondyloarthrite présentent une combinaison de niveaux d’activité physique limités et des ...comportements sédentaires qui affectent à la fois les critères d’évaluation de la maladie et les comorbidités. L’innocuité de l’activité physique chez les patients atteints de rhumatismes inflammatoires chroniques a été démontrée dès les années 1990. Outre ses effets positifs sur la douleur, la fonction et la qualité de vie, il a été montré que l’activité physique a des effets bénéfiques sur la plupart des pathologies chroniques dans la population générale (maladies cardiovasculaires, infections et cancers) mais aussi les comorbidités liées à la douleur chronique telles que la fibromyalgie, l’anxiété ou les troubles du sommeil. Cette revue met l’accent sur la nécessité d’une approche holistique pour mettre en œuvre efficacement des modifications de comportement à long terme afin d’améliorer à la fois l’activité physique et de lutter contre les comportements sédentaires.
Patients with chronic inflammatory rheumatic diseases such as rheumatoid arthritis and spondyloarthritis display both dramatically low physical activity engagement and highly frequent sedentary behaviors which both negatively affects disease related outcomes measures and comorbidities. Physical activity has been shown to be safe in rheumatic disease. Besides, its positive effects on pain, function and health-related quality of life, physical activity has been shown to improve most of the canonical comorbidities in the general population (i.e. cardiovascular diseases, infections and cancer) but also chronic pain-related comorbidities such as fibromyalgia, anxiety or sleep disorders. This narrative review emphasizes the need for a global approach, taking into account both physical activity and sedentary behaviors to effectively implement long-term behavioral changes in patients with chronic inflammatory rheumatic diseases.
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