Cormac G. Ryan

The validation of a novel activity monitor in the measurement of posture and motion during everyday activities

Background: Accurate measurement of physical activity patterns can be used to identify sedentary behaviour and may facilitate interventions aimed at reducing inactivity. Objective: To evaluate the activPAL physical activity monitor as a measure of posture and motion in everyday activities using observational analysis as the criterion standard. Methods: Wearing three activPAL monitors, 10 healthy participants performed a range of randomly assigned everyday tasks incorporating walking, standing and sitting. Each trial was captured on a digital camera and the recordings were synchronised with the activPAL. The time spent in different postures was visually classified and this was compared with the activPAL output. Results: Intraclass correlation coefficients (ICC 2,1) for interdevice reliability ranged from 0.79 to 0.99. Using the Bland and Altman method, the mean percentage difference between the activPAL monitor and observation for total time spent sitting was 0.19% (limits of agreement −0.68% to 1.06%) and for total time spent upright was −0.27% (limits of agreement −1.38% to 0.84%). The mean difference for total time spent standing was 1.4% (limits of agreement −6.2% to 9.1%) and for total time spent walking was −2.0% (limits of agreement −16.1% to 12.1%). A second-by-second analysis between observer and monitor found an overall agreement of 95.9%. Conclusion: The activPAL activity monitor is a valid and reliable measure of posture and motion during everyday physical activities.

The validity and reliability of a novel activity monitor as a measure of walking

Background: The accurate measurement of physical activity is crucial to understanding the relationship between physical activity and disease prevention and treatment. Objective: The primary purpose of this study was to investigate the validity and reliability of the activPAL physical activity monitor in measuring step number and cadence. Methods: The ability of the activPAL monitor to measure step number and cadence in 20 healthy adults (age 34.5±6.9 years; BMI 26.8±4.8 (mean±SD)) was evaluated against video observation. Concurrently, the accuracy of two commonly used pedometers, the Yamax Digi-Walker SW-200 and the Omron HJ-109-E, was compared to observation for measuring step number. Participants walked on a treadmill at five different speeds (0.90, 1.12, 1.33, 1.56, and 1.78 m/s) and outdoors at three self selected speeds (slow, normal, and fast). Results: At all speeds, inter device reliability was excellent for the activPAL (ICC (2,1)⩾0.99) for both step number and cadence. The absolute percentage error for the activPAL was <1.11% for step number and cadence regardless of walking speed. The accuracy of the pedometers was adversely affected by slow walking speeds. Conclusion: The activPAL monitor is a valid and reliable measure of walking in healthy adults. Its accuracy is not influenced by walking speed. The activPAL may be a useful device in sports medicine.

The clinical effects of Kinesio ® Tex taping: A systematic review

Kinesio® Tex tape (KTT) is used in a variety of clinical settings. The purpose of this study was to investigate the effect of KTT from randomized controlled trials (RCTs) in the management of clinical conditions. A systematic literature search of CINAHL; MEDLINE; OVID; AMED; SCIENCE DIRECT; PEDRO; www.internurse.com; SPORT DISCUS; BRITISH NURSING INDEX; www.kinesiotaping.co.uk; www.kinesiotaping.com; COCHRANE CENTRAL REGISTER OF CLINICAL TRIALS; and PROQUEST was performed up to April 2012. The risk of bias and quality of evidence grading was performed using the Cochrane collaboration methodology. Eight RCTs met the full inclusion/exclusion criteria. Six of these included patients with musculoskeletal conditions; one included patients with breast-cancer-related lymphedema; and one included stroke patients with muscle spasticity. Six studies included a sham or usual care tape/bandage group. There was limited to moderate evidence that KTT is no more clinically effective than sham or usual care tape/bandage. There was limited evidence from one moderate quality RCT that KTT in conjunction with physiotherapy was clinically beneficial for plantar fasciitis related pain in the short term; however, there are serious questions around the internal validity of this RCT. There currently exists insufficient evidence to support the use of KTT over other modalities in clinical practice.

Sitting patterns at work: objective measurement of adherence to current recommendations

Long uninterrupted sedentary periods, independent of total sedentary time, are risk factors for poor health. There is little objective data relating to workplace sedentary behaviour and adherence to current recommendations. The sitting behaviour of office workers (n = 83) was quantified objectively using body-worn accelerometers (activPAL™) over a working week. Adherence to three different recommendations (maximum length of a sitting event of: 20 min; 30 min; 55 min) were assessed. Participants were seated at work for 5.3 ± 1.0 h/d (mean ± 1 SD), equivalent to 66 ± 12% of the working day, accrued in 27 ± 7events/d individual sitting events. Dependent on the recommendation applied, 5–20% of sitting events and 25–67% of time was accumulated in sitting events longer than current guidelines. No participants met the 20 or 30 min recommendations on every working day but seven (8%) participants met the 55 min recommendation. In conclusion, office workers spend a considerable period of their day sitting, accumulated in uninterrupted sitting events longer than current recommendations. Statement of Relevance: Emerging evidence suggests prolonged sitting has negative health effects. In this study of office workers, 25–67% of time sitting was accumulated in events longer than minimum recommended durations. Adverse sitting behaviour is prevalent in the office, making it an appropriate setting to target the reduction of this behaviour.

Pain neurophysiology education for the management of individuals with chronic low back pain: A systematic review and meta-analysis

Pain neurophysiology education (PNE) is a form of education for patients with chronic low back pain (CLBP). The purpose of this systematic review was to investigate the evidence for PNE in the management of pateints with CLBP. A literature search of MEDLINE, CINAHL and AMED was performed from 1996(01)-2010(09). RCT appraisal and synthesis was assessed using the Cochrane Back Review Group (CBRG) guidelines. The main outcome measures were pain, physical-function, psychological-function, and social-function. Two moderate quality RCTs (n=122) were included in the final review. According to the CBRG criteria there was very low quality evidence that PNE is beneficial for pain, physical-function, psychological-function, and social-function. Meta-analysis found PNE produced statistically significant but clinically small improvements in short-term pain of 5mm (0, 10.0mm) [mean difference (95%CI)] on the 100mm VAS. This review was limited by the small number of studies (n=2) that met the inclusion criteria and by the fact that both studies were produced by the same group that published the PNE manual. These factors contributed to the relatively low grading of the evidence. There is a need for more studies investigating PNE by different research groups to support early promising findings. Until then firm clinical recommendations cannot be made.

Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial.

The aim of this single-blind pilot RCT was to investigate the effect of pain biology education and group exercise classes compared to pain biology education alone for individuals with chronic low back pain (CLBP). Participants with CLBP were randomised to a pain biology education and group exercise classes group (EDEX) [n = 20] or a pain biology education only group (ED) [n = 18]. The primary outcome was pain (0-100 numerical rating scale), and self-reported function assessed using the Roland Morris Disability Questionnaire, measured at pre-intervention, post-intervention and three month follow up. Secondary outcome measures were pain self-efficacy, pain related fear, physical performance testing and free-living activity monitoring. Using a linear mixed model analysis, there was a statistically significant interaction effect between time and intervention for both pain (F[2,49] = 3.975, p < 0.05) and pain self-efficacy (F[2,51] = 4.011, p < 0.05) with more favourable results for the ED group. The effects levelled off at the three month follow up point. In the short term, pain biology education alone was more effective for pain and pain self-efficacy than a combination of pain biology education and group exercise classes. This pilot study highlights the need to investigate the combined effects of different interventions.

Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls: an observational study

QUESTION Is there a difference in the level and pattern of free-living physical activity between individuals with chronic low back pain and matched controls? DESIGN Observational, cross-sectional study. PARTICIPANTS Fifteen individuals with chronic low back pain and fifteen healthy controls matched for age, gender, and occupation. OUTCOME MEASURES Participants wore an activity monitor for seven days. Level of physical activity was measured as time standing and walking, and number of steps averaged over a 24-hour day (midnight to midnight), day time (9.00 am - 4.00 pm), and evening time (6.00 pm - 10.00 pm), and work days versus non-work days. Pattern of physical activity was measured as number of steps and cadence during short (< 20 continuous steps), moderate (20-100 continuous steps), long (> 100-499 continuous steps), and extra long walks (>or= 500 continuous steps). RESULTS Over an average 24-hour day, the chronic low back pain group spent 0.7 fewer hours (95% CI 0.3 to 1.1) walking, and took 3480 fewer steps (95% CI 1754 to 5207) than the healthy controls. They took 793 fewer steps/day (95% CI -4 to 1591) during moderate walks, and 1214 fewer steps/day (95% CI 425 to 2003) during long walks, and 11 fewer steps/min (95% CI 4 to 17) during extra long walks than the healthy controls. CONCLUSION Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls.

Multimodal group rehabilitation compared to usual care for patients with chronic neck pain: A pilot study

The aim of this pilot randomised controlled trial (RCT) was to compare multimodal group rehabilitation to usual care physiotherapy for patients with chronic neck pain (CNP). Participants (n=14) were randomly assigned to one of two interventions, multimodal group rehabilitation or usual care physiotherapy. Multimodal group rehabilitation involved stability, strengthening and proprioceptive exercises along with an educational programme. Patients attended for 1h, once a week for six weeks. The usual care group was treated as deemed appropriate by their physiotherapist. A blinded assessor recorded baseline and post-intervention scores of disability and pain using the neck disability index (NDI) and the 0-10 pain numerical rating scale (NRS), respectively. One participant from each group dropped out before receiving any intervention. Post-intervention both groups significantly improved in both function and pain scores (p ≤ 0.01). The mean change in the NDI scores for the multimodal group versus the usual care group were 12.3 ± 5.3% and 7.4 ± 4.8%, and pain NRS score changes were 4.6 ± 2.3 and 4.5 ± 2.2, respectively. There was no significant difference in improvements in disability (p = 0.84) or pain (p = 0.67) between groups. These results warrant further investigation of multimodal group rehabilitation for CNP, and provide data to inform an appropriately powered full-scale RCT with long-term follow-up.

An investigation of association between chronic musculoskeletal pain and cardiovascular disease in the Health Survey for England (2008)

Chronic musculoskeletal pain (CMP) may be associated with cardiovascular disease (CVD). This study aimed to investigate the association between CMP and CVD, and the contribution of physical activity and sedentary behaviour to any association.

The relationship between psychological distress and free-living physical activity in individuals with chronic low back pain.

The aim of this cross-sectional pilot-study was to investigate the relationship between psychological distress and free-living physical activity (PA) in individuals with chronic low back pain (CLBP). Thirty-eight participants with non-specific CLBP (29=distressed; 9=non-distressed) were recruited. PA levels were measured using an accelerometer (activPAL activity monitor) over a one week period. The following parameters of physical activity were recorded: time upright (standing or walking), time standing, time walking, and step count. Psychological distress was assessed using a modified version of the distress risk assessment method (DRAM) which is a combination of somatic anxiety and depressive symptoms. The Distressed group spent significantly less time upright over a mean 24h day (-1.47h, 95% CI -2.70 to -0.23h, p<0.05), attributable to 1.01h less standing and 0.46h less walking. Depressive symptoms were a statistically significant independent predictor of time upright (beta=-0.49, p<0.05). This pilot-study found that individuals with CLBP and elevated levels of distress spend less time upright than their non-distressed counterparts. Clinically, when treating individuals with CLBP and elevated distress levels, free-living PA may be low and interventions aimed at increasing upright activity may be appropriate.