title: Comparison between Mother, ActiGraph wGT3X-BT, and a hand tally for measuring steps at various walking speeds under controlled conditions.
abstract: BACKGROUND
  Walking is endorsed as health enhancing and is the most common type of physical activity among older adults. Accelerometers are superior to self-reports when measuring steps, however, if they are to be used by clinicians the validity is of great importance. The aim of this study was to investigate the criterion validity of Mother and ActiGraph wGT3X-BT in measuring steps by comparing the devices to a hand tally under controlled conditions in healthy participants.
  
  
  METHODS
  Thirty healthy participants were fitted with a belt containing the sensor of Mother (Motion Cookie) and ActiGraph. Participants walked on a treadmill for two minutes at each of the following speeds; 3.2, 4.8, and 6.4 km/h. The treadmill walking was video recorded and actual steps were subsequently determined by using a hand tally. Wilcoxon's signed ranks test was used to determine whether Mother and ActiGraph measured an identical number of steps compared to the hand tally. Intraclass correlation coefficients were calculated to determine the relationship and Root Mean Square error was calculated to investigate the average error between the devices and the hand tally. Percent differences (PD) were calculated for between-instrument agreement (Mother vs. the hand tally and ActiGraph vs. the hand tally) and PDs below 3% were interpreted as acceptable and clinically irrelevant.
  
  
  RESULTS
  Mother and ActiGraph under-counted steps significantly compared to the hand tally at all walking speeds (p< 0.001). Mother had a median of total differences of 9.5 steps (IQR = 10) and ActiGraph 59 steps (IQR = 77). Mother had smaller PDs at all speeds especially at 3.2 km/h (2.5% compared to 26.7%). Mother showed excellent ICC values ≥0.88 (0.51-0.96) at all speeds whilst ActiGraph had poor and fair to good ICC values ranging from 0.03 (-0.09-0.21) at a speed of 3.2 km/h to 0.64 (0.16-0.84) at a speed of 6.4 km/h.
  
  
  CONCLUSIONS
  Mother provides valid measures of steps at walking speeds of 3.2, 4.8, and 6.4 km/h with clinically irrelevant deviations compared to a hand tally while ActiGraph only provides valid measurements at 6.4 km/h based on the 3% criterion. These results have significant potential for valid objective measurements of low walking speeds. However, further research should investigate the validity of Mother in patients at even slower walking speeds and in free-living conditions.
authors.affiliation: Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Riel
authors.affiliation: Department of Health Science and Technology, Aalborg University , Aalborg , Denmark.
authors.forename: Camilla Rams
authors.initials: CR
authors.lastname: Rathleff
authors.affiliation: Department of Health Science and Technology, Aalborg University , Aalborg , Denmark.
authors.forename: Pernille Møller
authors.initials: PM
authors.lastname: Kalstrup
authors.affiliation: Department of Health Science and Technology, Aalborg University , Aalborg , Denmark.
authors.forename: Niels Kragh
authors.initials: NK
authors.lastname: Madsen
authors.affiliation: Department of Health Science and Technology, Aalborg University , Aalborg , Denmark.
authors.forename: Elena Selmar
authors.initials: ES
authors.lastname: Pedersen
authors.affiliation: Department of Health Science and Technology, Aalborg University , Aalborg , Denmark.
authors.forename: Louise Bilenberg
authors.initials: LB
authors.lastname: Pape-Haugaard
authors.affiliation: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Villumsen
keywords: Accelerometer; Adults; Pedometer; Physical activity; Validity