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Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes.
Gerontology. 2019; 65(2):186-197.G

Abstract

BACKGROUND

The physical frailty assessment tools that are currently available are often time consuming to use with limited feasibility.

OBJECTIVE

To address these limitations, an instrumented trail-making task (iTMT) platform was developed using wearable technology to automate quantification of frailty phenotypes without the need of a frailty walking test.

METHODS

Sixty-one older adults (age = 72.8 ± 9.9 years, body mass index [BMI] = 27.4 ± 4.9 kg/m2) were recruited. According to the Fried Frailty Criteria, 39% of participants were determined as robust and 61% as non-robust (pre-frail or frail). In addition, 17 young subjects (age = 29.0 ± 7.2 years, BMI = 26.2 ± 4.6 kg/m2) were recruited to determine the healthy benchmark. The iTMT included reaching 5 indexed circles (including numbers 1-to-3 and letters A&B placed in random orders), which virtually appeared on a computer-screen, by rotating one's ankle-joint while standing. By using an ankle-worn inertial sensor, 3D ankle-rotation was estimated and mapped into navigation of a computer-cursor in real-time (100 Hz), allowing subjects to navigate the computer-cursor to perform the iTMT. The ankle-sensor was also used for quantifying ankle-rotation velocity (representing slowness), its decline during the test (representing exhaustion), and ankle-velocity variability (representing movement inefficiency), as well as the power (representing weakness) generated during the test. Comparative assessments included Fried frailty phenotypes and gait assessment.

RESULTS

All subjects were able to complete the iTMT, with an average completion time of 125 ± 85 s. The iTMT-derived parameters were able to identify the presence and absence of slowness, exhaustion, weakness, and inactivity phenotypes (Cohen's d effect size = 0.90-1.40). The iTMT Velocity was significantly different between groups (d = 0.62-1.47). Significant correlation was observed between the iTMT Velocity and gait speed (r = 0.684 p < 0.001). The iTMT-derived parameters and age together enabled significant distinguishing of non-robust cases with area under curve of 0.834, sensitivity of 83%, and specificity of 67%.

CONCLUSION

This study demonstrated a non-gait-based wearable platform to objectively quantify frailty phenotypes and determine physical frailty, using a quick and practical test. This platform may address the hurdles of conventional physical frailty phenotypes methods by replacing the conventional frailty walking test with an automated and objective process that reduces the time of assessment and is more practical for those with mobility limitations.

Authors+Show Affiliations

Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. College of Natural Sciences and Mathematics, University of Houston, Houston, Texas, USA.VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA.VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA. VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA.Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USAnajafi.bijan@gmail.com.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30359976

Citation

Zhou, He, et al. "Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes." Gerontology, vol. 65, no. 2, 2019, pp. 186-197.
Zhou H, Razjouyan J, Halder D, et al. Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes. Gerontology. 2019;65(2):186-197.
Zhou, H., Razjouyan, J., Halder, D., Naik, A. D., Kunik, M. E., & Najafi, B. (2019). Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes. Gerontology, 65(2), 186-197. https://doi.org/10.1159/000493263
Zhou H, et al. Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes. Gerontology. 2019;65(2):186-197. PubMed PMID: 30359976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes. AU - Zhou,He, AU - Razjouyan,Javad, AU - Halder,Debopriyo, AU - Naik,Anand D, AU - Kunik,Mark E, AU - Najafi,Bijan, Y1 - 2018/10/25/ PY - 2018/05/22/received PY - 2018/08/27/accepted PY - 2018/10/26/pubmed PY - 2019/8/15/medline PY - 2018/10/26/entrez KW - Cognitive-motor test KW - Frailty KW - Frailty phenotype KW - Gait KW - Instrumented trail-making task KW - Virtual-reality KW - Wearable SP - 186 EP - 197 JF - Gerontology JO - Gerontology VL - 65 IS - 2 N2 - BACKGROUND: The physical frailty assessment tools that are currently available are often time consuming to use with limited feasibility. OBJECTIVE: To address these limitations, an instrumented trail-making task (iTMT) platform was developed using wearable technology to automate quantification of frailty phenotypes without the need of a frailty walking test. METHODS: Sixty-one older adults (age = 72.8 ± 9.9 years, body mass index [BMI] = 27.4 ± 4.9 kg/m2) were recruited. According to the Fried Frailty Criteria, 39% of participants were determined as robust and 61% as non-robust (pre-frail or frail). In addition, 17 young subjects (age = 29.0 ± 7.2 years, BMI = 26.2 ± 4.6 kg/m2) were recruited to determine the healthy benchmark. The iTMT included reaching 5 indexed circles (including numbers 1-to-3 and letters A&B placed in random orders), which virtually appeared on a computer-screen, by rotating one's ankle-joint while standing. By using an ankle-worn inertial sensor, 3D ankle-rotation was estimated and mapped into navigation of a computer-cursor in real-time (100 Hz), allowing subjects to navigate the computer-cursor to perform the iTMT. The ankle-sensor was also used for quantifying ankle-rotation velocity (representing slowness), its decline during the test (representing exhaustion), and ankle-velocity variability (representing movement inefficiency), as well as the power (representing weakness) generated during the test. Comparative assessments included Fried frailty phenotypes and gait assessment. RESULTS: All subjects were able to complete the iTMT, with an average completion time of 125 ± 85 s. The iTMT-derived parameters were able to identify the presence and absence of slowness, exhaustion, weakness, and inactivity phenotypes (Cohen's d effect size = 0.90-1.40). The iTMT Velocity was significantly different between groups (d = 0.62-1.47). Significant correlation was observed between the iTMT Velocity and gait speed (r = 0.684 p < 0.001). The iTMT-derived parameters and age together enabled significant distinguishing of non-robust cases with area under curve of 0.834, sensitivity of 83%, and specificity of 67%. CONCLUSION: This study demonstrated a non-gait-based wearable platform to objectively quantify frailty phenotypes and determine physical frailty, using a quick and practical test. This platform may address the hurdles of conventional physical frailty phenotypes methods by replacing the conventional frailty walking test with an automated and objective process that reduces the time of assessment and is more practical for those with mobility limitations. SN - 1423-0003 UR - https://www.unboundmedicine.com/medline/citation/30359976/Instrumented_Trail_Making_Task:_Application_of_Wearable_Sensor_to_Determine_Physical_Frailty_Phenotypes_ L2 - https://www.karger.com?DOI=10.1159/000493263 DB - PRIME DP - Unbound Medicine ER -