Nick Gebruers

Monitoring of Physical Activity After Stroke: A Systematic Review of Accelerometry-Based Measures

OBJECTIVE To assess the clinimetric properties and clinical applicability of different accelerometry-based measurement techniques in persons with stroke. DATA SOURCES A systematic search of literature was performed using a specific search strategy by means of different electronic databases until October 2008 (PubMed, EMBASE, CINAHL, Cochrane Library of Clinical Trials). STUDY SELECTION A first selection was made by means of title and abstract. A second selection was performed by means of predefined inclusion criteria: (1) accelerometry in stroke population, (2) application of accelerometry in patients with stroke including clinimetric properties. The exclusion criteria were (1) dysphagia, (2) new engineering techniques or software alterations, (3) secondary sources, and (4) Case studies. DATA EXTRACTION The clinimetric properties and applicability of accelerometry were described based on the included publications. DATA SYNTHESIS Twenty-five articles (4 randomized controlled trials) were included. The information of the publications was divided into (1) gait, cadence, and ambulatory activity; (2) upper-extremity activity; and (3) topics related to stroke other than upper or lower extremity. Accelerometry was shown to be valid and had good test-retest reliability in a large number of settings. Numerous studies demonstrated correlations between accelerometry and common stroke scales. Trunk movements were measured as an outcome of disturbed gait. The vertical asymmetry index especially was able to differentiate between persons with stroke and healthy controls. Persons with stroke showed less ambulatory activity, measured as steps per day, than sedentary controls. Triaxial accelerometry was able to distinguish between varying activity levels. Upper-extremity use was lesser in persons with stroke. It was impossible to calculate a minimal clinical difference for arm use by a uniaxial accelerometer. Evidence was presented that finger-tapping and sit-to-stand measured by accelerometers could be used to define recovery from stroke. CONCLUSIONS The literature concerning accelerometry incorporated into stroke research is young, limiting the ability to draw consistent conclusions. Nonetheless, the available evidence suggests that accelerometers yield valid and reliable data about the physical activity of patients with stroke. Future research is necessary to investigate clinimetric properties like predictive value and responsiveness further before implementing accelerometry in clinical trials as an outcome for change.

Actigraphic Measurement of Motor Deficits in Acute Ischemic Stroke

Background: This study aimed to investigate the use of actigraphy (accelerometry) to measure disuse of the impaired arm in acute stroke patients. We correlated the National Institute of Health Stroke Scale (NIHSS) and the Fugl-Meyer Assessment arm section (FMA) findings with actigraphic data as a measure of validity. Methods: Thirty-nine acute ischemic stroke patients were included within 1 week after stroke onset. At inclusion, motor deficits were assessed by the NIHSS, FMA and 48-hour actigraphic recordings of both wrists were performed. Results: Moderate but highly significant correlations (Spearman’s rho) between actigraphic recordings and total NIHSS (ratio r = –0.59 and activity of impaired arm r = –0.75; p < 0.001) and FMA (ratio r = 0.54 and activity of impaired arm r = 0.69; p < 0.001) scores were found. Based on actigraphic motor activity scores, ROC curves were calculated following dichotomization of the population based on NIHSS = 7 and FMA = 45, showing good sensitivity and specificity, with negative predictive value of 100% and positive predictive value of 91% for the ratio variable. Conclusions: Moderate but highly significant correlations were found between actigraphy and the stroke scales NIHSS and FMA. Actigraphy was able to reliably discriminate less impaired from more impaired stroke patients with excellent sensitivity and specificity values. Actigraphy is a simple, valid, objective and reliable clinical research tool that can be used to determine motor impairment of the upper limb in stroke patients.

Volumetric evaluation of upper extremities in 250 healthy persons.

Background and purpose  Upper extremity oedema frequently occurs as a complication of several diseases. The aim of this study was to establish normative data for upper extremity volumes with a modified water displacement method. These data were used to develop predictive formulas helpful in detecting abnormal swelling.

Incidence and Time Path of Lymphedema in Sentinel Node Negative Breast Cancer Patients: A Systematic Review

OBJECTIVE To systematically assess the incidence/prevalence and time path of lymphedema in patients with sentinel node-negative breast cancer. DATA SOURCES A systematic literature search up to November 2013 was performed using 4 different electronic databases: PubMed, Embase, Cochrane Clinical Trials, and Web of Science. STUDY SELECTION Inclusion criteria were as follows: (1) research studies that included breast cancer patients who were surgically treated using the sentinel lymph node biopsy (SLNB) technique; (2) sentinel node-negative patients; (3) studies that investigated lymphedema as a primary or secondary outcome; (4) data extraction for the incidence or time path of lymphedema was possible; and (5) publication date starting from January 1, 2001. Exclusion criteria were as follows: (1) reviews or case studies; (2) patients who had an SLNB followed by an axillary lymph node dissection (ALND); (3) results of ALND patients and SLNB patients not described separately; and (4) studies not written in English. DATA EXTRACTION After scoring the methodological quality of the selected studies, the crude data concerning the incidence of lymphedema were extracted. Data concerning the time points and the incidence of lymphedema were also extracted. DATA SYNTHESIS Twenty-eight articles were included, representing 9588 SLNB-negative patients. The overall incidence of lymphedema in patients with sentinel node-negative breast cancer ranged from 0% to 63.4%. The studies that have assessed lymphedema at predefined time points, instead of a mean follow-up time, demonstrated an incidence range at ≤3, 6, 12, 18, or >18 months postsurgery of 3.2% to 5%, 2% to 10%, 3% to 63.4%, 6.6% to 7%, and 6.9% to 8.2%, respectively. CONCLUSIONS In SLNB patients, lymphedema is still a problem, mostly occurring 6 to 12 months after surgery. Because of different assessments and criteria, there is a wide range in incidence. Clear definitions of lymphedema are absolutely necessary to tailor therapy.

Overweight in Adolescents: Differences per Type of Education. Does One Size Fit All?

OBJECTIVE To assess the lifestyle and prevalence of overweight among 16- to 18-year-old adolescents attending 4 different types of secondary education (SE). DESIGN Cross-sectional school-based survey. PARTICIPANTS A community sample of 994 adolescents (body mass index [BMI]: 15-43 kg/m2). VARIABLES MEASURED Overweight and obesity were assessed by BMI. Health-related quality of life (HRQL) was assessed using the 36-item short-form (SF-36) questionnaire. The Dutch eating behavior questionnaire was administered. Lifestyle was assessed using the Baecke questionnaire and self-reported activities. ANALYSIS Prevalence of overweight, HRQL and lifestyle were assessed per type of education. Gender differences and differences between BMI-categories were analyzed. RESULTS Students in Vocational SE were significantly more likely to be overweight (18%) or obese (7.5%) compared to students in other types of SE (chi square-27.0, P < .001). HRQL was significantly lower among obese girls compared to overweight (P = .009) or normal weight girls (P < .01). Obese and overweight adolescents scored higher in restrained eating than their normal weight peers (P < .001) but lower in externally induced eating (P = .001). CONCLUSIONS AND IMPLICATIONS Lifestyle and prevalence of overweight and obesity seems to differ between different types of education. This could be of importance when making health policy decisions. Health programs should focus on types of education with the highest prevalence of overweight and obesity and should be tailor-made to the specific needs of the targeted type of education.

Therapy modalities to reduce lymphoedema in female breast cancer patients: a systematic review and meta-analysis

The aim of the present study was to evaluate the effects of compression bandages, sleeves, intermittent pneumatic compression (IPC) and active exercise on the reduction of breast cancer-related lymphoedema (BCRL). A systematic literature search up to the year January 2016 was performed in CINAHL, Cochrane Register of Controlled Trials, Embase, International Clinical Trials Registry Platform (WHO), PEDro and PubMed. Inclusion criteria were (1) RCTs, (2) reported adequate statistics for meta-analysis, (3) English or German language. Exclusion criteria were (1) effects of drugs, hormonal, radiation and surgical procedures, (2) studies with children, (3) non-breast cancers, lower extremity oedema, (4) impact on fatigue only, diets or sexually transmitted diseases, (5) cost-analysis only and (6) non-carcinogenic syndromes or (7) prevention of breast cancer. After scoring the methodological quality of the selected studies, data concerning volume reduction of the oedema swelling were extracted. Thirty-two studies were included in this systematic review. Nine studies were selected for the RCT-based studies and 19 studies were included in the pre–post studies-based random-effects meta-analyses. All conclusions should be taken with precautions because of the insufficient quality of the selected papers. Exercise seems beneficial in reducing oedema volume in BCRL. IPC seems beneficial in helping to reduce the oedema volume in the acute phase of treatment. Compression sleeves do not aid in the volume reduction in the acute phase; however, they do prevent additional swelling.

Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke

ObjectiveThis study investigated the clinical predictive value of the Fugl-Meyer Assessment (FMA) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke. DesignThe prospective cohort (n = 129) was recruited from a general hospital; activity variables and FMA score at intake were related to the FMA, the modified Rankin Scale, and rehabilitation status after 3 mos of follow-up. The prediction model was based on binary logistic regression. ResultsAlthough the FMA score at intake has the best overall predictive value for all three outcome measures (FMA3, 87.6%; modified Rankin Scale, 85.3%; RS, 73.6%), the activity of the impaired arm as assessed by the accelerometer has the best predictive value to determine patients who are at risk for continued disability (modified Rankin Scale score 1, 95.1%). The most difficult outcome measure for prediction is the rehabilitation status; specifically, the patients who went home are predicted imprecisely. The ratio variable is the least accurate predictor of all tested variables. ConclusionsThe FMA arm score at intake is the best predictor for arm recovery and general disability. The activity of the impaired arm is an excellent predictor for prolonged disability and is an alternative to the FMA score when it is impossible to score the FMA in the acute phase of stroke.

Clinical feasibility of Axillary Reverse Mapping and its influence on breast cancer related lymphedema: a systematic review.

Breast cancer is the most common malignancy in women worldwide. Fortunately, the overall survival is good. Therefore it is important to focus on the morbidities related to breast cancer treatment. One of the most dreaded morbidities is lymphedema. In 2007 the Axillary Reverse Mapping (ARM) was introduced to limit the invasiveness in the axilla during breast cancer surgery. It is hypothesized that ARM is able to limit the incidence of breast cancer related lymphedema (BCRL) considerably. This systematic review aims to answer the following research questions: (1) which approaches for ARM are described? (2) Is ARM surgical feasible and oncological safe? (3) Does ARM decrease the incidence of lymphedema after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND)? In total 27 papers were retrieved using four electronic databases (PubMed, Web of Science, Medline and Cochrane clinical trials; assessed until May 13, 2015. The level of evidence of these studies was low (mostly level 3). Therefore the conclusions are that the ARM procedure is feasible although ARM-node rates have a broad range. Additionally, from a theoretical point there is a clear benefit from ARM in terms of lymphedema prevention. From a practical point there is little scientific data to support this due to the lack of studies; and especially because of the different methods and definitions for lymphedema used in the different studies.

IS ACTIVITy LoSS PREDICTIVE FoR DEVELoPMENT oF uPPER LIMb oEDEMA AFTER STRokE

OBJECTIVE To investigate the disuse hypothesis as an explanation for upper limb oedema in patients with stroke. DESIGN Longitudinal observational study. PATIENTS Patients with acute hemiparetic stroke were recruited from 2006 to 2009 (n=139). METHODS Patients wore 2 uni-axial accelerometers, 1 on each wrist, for 2 periods of 48 h with a 1-week interval. Activity performed by the patients with acute stroke was measured by determining total activity, measured as a total sum of raw counts, and calculating the ratio variable. The National Institute of Health Stroke Scale (NIHSS), Fügl-Meyer Assessment and modified Rankin Scale were used. During a 3-month follow-up, patients underwent 3 assessments of upper limb oedema. RESULTS The incidence of upper limb oedema range for the objective evaluation was 7.7-14.7%, while the incidence for the subjective evaluation ranged from 11.5% to 18.1%. No significant differences were found between patients with and without oedema concerning the activity variables; therefore no prognostic value could be determined. CONCLUSION No difference in upper limb activity was found between patients with and without oedema after stroke. It is doubtful that loss of activity of the paretic limb is solely responsible for the development of upper limb oedema after stroke.

Incidence of upper limb oedema in patients with acute hemiparetic stroke

Purpose. Assessment of the incidence of upper limb oedema in an acute care setting by means of clinical and volumetric evaluation. Methods. Patients with acute hemiparetic stroke were recruited from 2006 until 2009 (n  ==  125). Baseline measurements consisted of the National Institute of Health Stroke Scale, Fugl-Meyer Assessment Arm Section and demographic characteristics. Oedema assessment was performed at 7 days after inclusion and at 1 month and 3 months follow-up. A standardised water displacement method (objective measurement) was used to define oedema and was compared to data from visual inspection and palpation (subjective measurement). Results. In literature, the incidence of upper limb oedema ranges from 16–83%%, defined by a variety of definitions. Oedema incidence in this study was defined by strict criteria using water displacement and ranged from 9–13.9%%, while the incidence of oedema defined by visual inspection and palpation ranged from 6–18.5%% during the different stages of follow-up. The agreement (Kappa) between both measurements ranged from 0.23–0.38, which is not more than ‘moderate’ but comparable to the agreement of 0.34 found in literature. Conclusion. An objective and subjective assessment of oedema was used; the agreement between both methods was only moderate. The incidence of oedema found in this study is lower than the incidences found in literature.