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Validation of accelerometer cut points in toddlers with and without cerebral palsy
Stina Oftedal1, Kristie L Bell, Peter S W Davies
11Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, AUSTRALIA; 2Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, AUSTRALIA; 3Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, AUSTRALIA; and 4School of Population Health, The University of Queensland, Brisbane, AUSTRALIA.
Insights
Triaxial accelerometers accurately measure sedentary time in toddlers with cerebral palsy (CP) and typically developing children (TDC). Uniaxial cut points are not recommended due to inaccurate sedentary time estimations.
Area of Science:
- Pediatrics
- Biomedical Engineering
- Physical Therapy
Background:
- Sedentary time is a crucial health indicator in children.
- Accurate measurement of sedentary behavior is vital for understanding health outcomes in children with cerebral palsy (CP).
- ActiGraph devices are commonly used to assess physical activity, but their accuracy in specific populations requires validation.
Purpose of the Study:
- To validate uni- and triaxial ActiGraph cut points for sedentary time measurement.
- To compare the accuracy of different ActiGraph accelerometer axes in toddlers with CP and typically developing children (TDC).
- To assess the predictive validity of ActiGraph cut points across varying functional abilities in children with CP.
Main Methods:
- 103 toddlers (aged 1.5-3 years) were divided into calibration and validation groups.
- Participants included typically developing children (TDC) and children with cerebral palsy (CP) categorized by ambulatory status (GMFCS I-V).
- ActiGraph accelerometers were worn during a videotaped assessment, with behavior coded as sedentary or nonsedentary; data analyzed using ROC and Bland-Altman methods.
Main Results:
- Triaxial ActiGraph cut points demonstrated good classification accuracy for sedentary time in all groups (CP and TDC).
- Uniaxial cut points showed fair accuracy in ambulatory CP and TDC groups but poor accuracy in nonambulatory CP groups.
- Uniaxial cut points significantly overestimated sedentary time in ambulatory CP and TDC groups, while triaxial cut points provided accurate group-level measures.
Conclusions:
- Triaxial accelerometers are recommended for accurate group-level assessment of sedentary time in children with CP and TDC.
- Uniaxial cut points are not suitable for measuring sedentary time in this population due to significant overestimation.
- Findings support the use of triaxial data for objective sedentary behavior assessment across the spectrum of functional abilities in children.
Aim:
The purpose of this study was to validate uni- and triaxial ActiGraph cut points for sedentary time in toddlers with cerebral palsy (CP) and typically developing children (TDC).
Methods:
Children (n = 103, 61 boys, mean age = 2 yr, SD = 6 months, range = 1 yr 6 months-3 yr) were divided into calibration (n = 65) and validation (n = 38) samples with separate analyses for TDC (n = 28) and ambulant (Gross Motor Function Classification System I-III, n = 51) and nonambulant (Gross Motor Function Classification System IV-V, n = 25) children with CP. An ActiGraph was worn during a videotaped assessment. Behavior was coded as sedentary or nonsedentary. Receiver operating characteristic-area under the curve analysis determined the classification accuracy of accelerometer data. Predictive validity was determined using the Bland-Altman analysis.
Results:
Classification accuracy for uniaxial data was fair for the ambulatory CP and TDC group but poor for the nonambulatory CP group. Triaxial data showed good classification accuracy for all groups. The uniaxial ambulatory CP and TDC cut points significantly overestimated sedentary time (bias = -10.5%, 95% limits of agreement [LoA] = -30.2% to 9.1%; bias = -17.3%, 95% LoA = -44.3% to 8.3%). The triaxial ambulatory and nonambulatory CP and TDC cut points provided accurate group-level measures of sedentary time (bias = -1.5%, 95% LoA = -20% to 16.8%; bias = 2.1%, 95% LoA = -17.3% to 21.5%; bias = -5.1%, 95% LoA = -27.5% to 16.1%).
Conclusion:
Triaxial accelerometers provide useful group-level measures of sedentary time in children with CP across the spectrum of functional abilities and TDC. Uniaxial cut points are not recommended.
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