How is physical activity monitored in people following stroke?

Purpose: To describe how physical activity is monitored following stroke; to summarise methods and devices used across the stroke pathway and document their psychometric properties. Methods: Searches of five databases identified studies that included stroke survivors whose physical activity was quantitatively measured. Two reviewers independently determined inclusion. A descriptive synthesis was undertaken and reliability data for specific methods of monitoring physical activity were pooled where possible. Results: Ninety-one papers (60 using devices and 31 using observational methods) met inclusion criteria, with 3479 participants aged 21-96 years. Twenty-nine devices (72% accelerometers) were identified. Devices were typically used to measure ambulant participants more than 6 months following stroke. Direct observation of physical activity was commonly used for inpatients. No outcome measurements were common to all methods/devices. Test-retest reliability was not reported for 23 devices; for the remaining six it ranged from r=0.44 to r=0.99. Inter-rater reliability of observational methods ranged from 0.51 to 1.0. Validity was infrequently reported. Conclusions: Physical activity outcomes were variable. Devices allow for unobtrusive, sustained monitoring in free-living environments. Observational methods suit inpatient settings but are time and labour intensive. No single approach appears superior but standardisation of outcomes would improve the field.