Criterion validity of device-based motion sensors for monitoring free-living physical activity in community-dwelling manual wheelchair users: A systematic review

Community-dwelling manual wheelchair users (MWU) accumulate less physical activity (PA) and are more sedentary than their ambulatory peers. To promote PA and evaluate interventions, accurate PA monitoring methods in free-living circumstances are needed. Recent advances in device-based motion sensor (DBMS) technology and data analytics have raised the possibility that DBMS might be used – either individually or in combination – to provide accurate estimates of free-living PA in MWU. This study reviewed the evidence for existing DBMS for estimating energy expenditure (EE); self-propulsion (SP); activities other than SP; and wheelchair kinematics (WK) including time, distance and speed in MWU. Forty studies evaluating thirty-four devices were identified, analysed, and synthesized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) Statement and COSMIN Methodology for Systematic Reviews of Patient‐Reported Outcome Measure. Sixteen devices (47%) were custom made and eighteen (53%) were commercially available devices. Of those commercially available, thirteen (72%) were research-based devices, and five (28%) were consumer-based devices. According to the assessment using COSMIN, twenty-six devices (76%) provided accurate estimates of the target outcome. The level of evidence was ‘moderate’ to ‘high’ for sixteen (47%) devices, ‘very low’ for eleven (32%), ‘low’ (24%) for eight, and ‘low to high’ for one (3%). Seventeen DBMS were body-worn and of those, tri-axial accelerometers secured to the upper-arm or wrist provided the most accurate estimate of EE and for differentiating SP from other daily activities. Fourteen DBMS were wheelchair mounted and of those, tri-axial accelerometers and inertial measurement units (IMU) provided accurate estimates of wheelchair movement time, distance, and speed. Devices with gyroscope sensor/s, also provided an accurate estimate of SP, upper body movement when doing activities such using an arm ergometer or playing wheelchair basketball, and distance travelled by the wheelchair. DBMS have the potential to monitor free-living PA in MWU. However, future research should be of higher methodological quality and aim to enhance accuracy and acceptability of DBMS through population specific algorithms and improved wearability.