BACKGROUND: Ambulatory children with Spina Bifida (SB) often show a decline in physical activity leading to deconditioning and functional decline. Therefore, assessment and promotion of physical activity is important. Because energy expenditure during activities is higher in these children, the use of existing pediatric equations to predict physical activity energy expenditure (PAEE) may not be valid. AIMS: (1) To evaluate criterion validity of existing predictions converting accelerocounts into PAEE in ambulatory children with SB and (2) to establish new disease-specific equations for PAEE. METHODS: Simultaneous measurements using the Actical, the Actiheart, and indirect calorimetry took place to determine PAEE in 26 ambulatory children with SB. DATA ANALYSIS: Paired T-tests, Intra-class correlations limits of agreement (LoA), and explained variance (R2) were used to analyze validity of the prediction equations using true PAEE as criterion. New equations were derived using regression techniques. RESULTS: While T-tests showed no significant differences for some models, the predictions developed in healthy children showed moderate ICC’s and large LoA with true PAEE. The best regression models to predict PAEE were: PAEE = 174.049 + 3.861 × HRAR – 60.285 × ambulatory status (R2 = 0.720) and PAEE = 220.484 + 0.67 × Actical counts – 60.717 × ambulatory status (R2 = 0.681). CONCLUSIONS: Existing equations to predict PAEE are not valid for use in children with SB for the individual evaluation of PAEE. The best regression model was based on HRAR in combination with ambulatory status, followed by a new model for the Actical monitor. A benefit of HRAR is that it does not require the use of expensive accelerometry equipment. Further cross-validation of these models is still needed.
BackgroundEarly structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect.MethodsAll patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July–December 2018) or after (July–December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences.Results Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007–0.059, p ConclusionsA substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery.
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