Evaluating the Usability of Inertial Measurement Units for Measuring and Monitoring Activity Post-Stroke: A Scoping Review
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Search Strategy
2.3. Study Selection
2.4. Data Extraction
2.5. Data Synthesis
3. Results
3.1. Search Results
3.2. Aim 1: Participant and Clinical Characteristics of Usability Studies
3.3. Study Contexts, Activities Monitored, and Wearable Sensor Configurations
3.4. Methods of Usability Assessment and Usability Findings
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
6MWT | Six-Minute Walk Test |
ADL | Activities of Daily Living |
FAC | Functional Ambulatory Category |
FMI | Fugl-Meyer Assessment |
Hem | Hemorrhagic Stroke |
IMU | Inertial Measurement Unit |
Isch | Ischemic Stroke |
ISNCSCI | International Standard for Neurological Classification of Spinal Cord Injury |
ISO | International Organization of Standardization |
MMSE | Mini Mental State Examination |
MoCA | Montreal Cognitive Assessment |
mRS | Modified Rankin Scale |
QUEST | Quebec User Evaluation of Satisfaction with Assistive Technology |
SUS | System Usability Scale |
TIA | Transient Ischemic Attack |
Appendix A. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist
Section | Item | PRISMA-ScR Checklist Item | Reported on Page Number |
Title | |||
Title | 1 | Identify the report as a scoping review. | 1 |
Abstract | |||
Structured summary | 2 | Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives. | 1 |
Introduction | |||
Rationale | 3 | Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach. | 1–2 |
Objectives | 4 | Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives. | 2–3 |
Methods | |||
Protocol and registration | 5 | Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number. | 3 |
Eligibility criteria | 6 | Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale. | 3 |
Information sources * | 7 | Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed. | 3 |
Search | 8 | Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated. | Appendix B |
Selection of sources of evidence † | 9 | State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review. | 3 |
Data charting process ‡ | 10 | Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators. | 4 |
Data items | 11 | List and define all variables for which data were sought and any assumptions and simplifications made. | 4 |
Critical appraisal of individual sources of evidence § | 12 | If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate). | N/A |
Synthesis of results | 13 | Describe the methods of handling and summarizing the data that were charted. | 4 |
Results | |||
Selection of sources of evidence | 14 | Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram. | 4–5 |
Characteristics of sources of evidence | 15 | For each source of evidence, present characteristics for which data were charted and provide the citations. | 7,8,11–19 |
Critical appraisal within sources of evidence | 16 | If done, present data on critical appraisal of included sources of evidence (see item 12). | N/A |
Results of individual sources of evidence | 17 | For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives. | 7,8,11–19 |
Synthesis of results | 18 | Summarize and/or present the charting results as they relate to the review questions and objectives. | 5–6,9–10 |
Discussion | |||
Summary of evidence | 19 | Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups. | 20–22 |
Limitations | 20 | Discuss the limitations of the scoping review process. | 22 |
Conclusions | 21 | Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps. | 22 |
Funding | |||
Funding | 22 | Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review. | 22 |
* Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O’Malley (6) and Levac and colleagues (7) and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of “risk of bias” (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document). |
Appendix B. Database Search Terms
- Embase
- Wearable Technology Terms
- 1.
- wearable computer/
- 2.
- (wearable electronic device* OR wearable sensor* OR inertial measurement unit*)
- 3.
- 1 OR 2
- Stroke Terms
- 4.
- exp cerebrovascular accident/
- 5.
- (stroke* OR cerebrovascular accident* OR cerebral vascular accident* OR CVA*).
- 6.
- 4 OR 5
- Final Search Combination
- 7.
- 3 AND 6
- Medline
- Stroke Terms
- 1.
- exp Stroke/
- 2.
- Stroke Rehabilitation/
- 3.
- (stroke* OR cerebrovascular accident* OR cerebral vascular accident* OR CVA*)
- 4.
- 1 OR 2 OR 3
- Wearable Technology Terms
- 5.
- wearable electronic devices/OR fitness trackers/
- 6.
- (wearable electronic device* OR inertial measurement unit* OR wearable sensor*)
- 7.
- 5 OR 6
- Final Search Combination
- 8.
- 4 AND 7
- CINAHL
- Wearable Technology Terms
- S1.
- (MH “Wearable Sensors”) OR (MH “Accelerometers”)
- S2.
- Wearable device* or wearable sensor* or inertial measurement unit*
- S3.
- S1 or S2
- Stroke Terms
- S4.
- (MH “Stroke+”)
- S5.
- (MH “Stroke Patients”)
- S6.
- Stroke or cerebrovascular accident* or cva or cerebral vascular event*
- S7.
- S4 OR S5 or S6
- Final Search Combination
- S8.
- S3 and S7
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Inclusion Criteria |
|
Exclusion Criteria |
|
Study | Type of Stroke | Stroke Chronicity | Mobility | Impairment Mean (SD) | Time Since Stroke (Months) Mean (SD) | Number of Stroke Participants (Sex or Gender) | Age of Participants Mean (SD) |
---|---|---|---|---|---|---|---|
[45] | Not Provided | Chronic | Walking independently w/or w/o gait aid | Physical: Not Provided Cognitive: Not Provided * | Not Provided | 20 (10 male/10 female) | 72 (7.1) |
[40] | 4 Hem; 6 Isch | Chronic | Walking independently w/or w/o gait aid | Physical: Not Provided Cognitive: Not Provided | 42 (25) | 10 (3 male/7 female) | 70 (8) |
[41] | 2 Hem; 8 Isch; 1 unresolved | Chronic | Able to walk w/or w/o gait aid for 20 min and ≥100 m for 6MWT 6MWT (meters): 356.6 (91.9) | Physical: ISNCSCI- Muscle Test: 21.8 (4.4) Cognitive: Not Provided * | 65.9 (74.1) | 11 (7 male/4 female) | 56.8 (7.7) |
[39] | Not Provided | Chronic | Not provided | Physical: FM-UE (/66) 37 (8) Cognitive: Not Provided | 55.2 (66) | 17 (not provided) | 54.4 (10.1) |
[46] | 5 Hem; 21 Isch | Sub-acute | Walking independently w/or w/o supervision FAC 0–3 (13) FAC 4–5 (13) | Physical: FM-UE (/66) Median: 35 Q1–Q3: 15–50 Cognitive: Not Provided | 1.87 (0.8) | 26 (16 male/10 female) | 55.4 (11) |
[35] | Not Provided | Not Provided | FAC ≥ 2 | Physical: Not Provided Cognitive: Not Provided * | Not Provided | 13 (not provided) | Not provided |
[42] | 22 Isch | Chronic | Walking independently indoors w/o aid or with aid and supervision | Physical: FMA (/226) 110.4 (29.41) Cognitive: MMSE(/30) 26 (1.8) * | 11.5 (2.4) | 22 (15 male/7 female) | 55.3 (8.6) |
[48] | 5 Hem; 29 Isch and 10 TIA | Not provided | Not provided | Physical: Not Provided Cognitive: Not Provided * | Not Provided | 44 (22 male/22 female) | 64 IQR (24–92) |
[47] | 12 Hem; 28 Isch | Sub-acute | Walking independently w/or w/o gait aid | Physical: Not Provided Cognitive: Not Provided | 69.4 (38.9) | 40 (23 male/17 female) | 52.8 (7.38) |
[43] | Not Provided | Chronic | Not provided | Physical: FM-UE (/66) 51 (11.2) Cognitive: Not Provided * | 89.7 (52.5) | 4 (2 male/2 female) | 69.5 (5.9) |
[44] | Not Provided | Chronic | Community dwelling w/or w/o walking aid; gait speed < 1 m/s | Physical: Not Provided Cognitive: MoCA 24.5 (4.2) | Range: 17–172 | 17 (13 male/4 female) | 61.9 (18.8) |
[37] | 7 Hem; 21 Isch; 2 not reported | Chronic | Walking independently on 10 m walk test: Self-paced: 0.75 m/s (0.4) | Physical: FM-UE 41.2 (18) Cognitive: MoCA(/30) 24.7 (3.4) * | 91.2 (54) | 30 (18 men/11 women/1 non-binary) | 58.6 (13.1) |
[36] | Not Provided | Chronic | FAC ≥ 3 Gait speed: 0.64 m/s (0.39) | Physical: FM-UE (/66) 37.3 (17.6) Cognitive: MoCA(/30) 24.9 (3.8) * | 78.7 (48.8) | 30 (19 men/10 women/1 non-binary) | 57 (10) |
[38] | Not Provided | Chronic | Walking independently | Physical: FM-UE Median: 46.0 Range = 18–66 Cognitive: MoCA(/30) Median: 26 * | Median: 87.8 Range: (54–129) | 30 (18 men/11 women/1 transgender man) | Median: 61.5 Range: 48.5–64.9 |
Study | Year | Setting | Activity of Interest | Device | Number of Sensors and Wear Location | Wear Adherence | |
---|---|---|---|---|---|---|---|
Directed by Study Methodology | Reported Wear Time Mean (SD) | ||||||
[45] | 2008 | Free-living | Physical Activity: Mean vector magnitude | System: RT3; 3-axis Sensors used: accelerometer | One sensor attached to a waist belt in a central back position | 7 days (hours/day not specified) | 11 h/day |
[40] | 2016 | Free-living | Postural Transitions: Duration in seconds, and # of unsuccessful attempts Gait: Steps, speed, and duration | System: PAMSys (Biosensics LLC, MA, USA); 3-axis Sensors used: accelerometer | One on mid-sternal pocket located in a comfortable t-shirt | 2 days (hours/day not specified) | 2 days |
[41] | 2018 | Lab | Gait: Stride length, stance or swing duration, or foot-to-ground angle | System: RehaGait; 9-axis Sensors used: accelerometer and gyroscope | Two sensors: One on each shoe, mounted to users’ shoes (lateral, just below ankle joint) | Three training sessions: Minimum of 22.5 min for each session | 37.5 min (7.4 min) |
[39] | 2018 | Lab | Upper Limb: Goal-directed and non-goal-directed movements | System: Shimmer; 6-axis Sensors used: accelerometer only for ADLs, gyroscope and accelerometer for rehabilitation exercises | Two sensors: One on each wrist | Worn during completion of motor tasks, ADL tasks, and rehabilitation exercises. | Not applicable |
[46] | 2019 | Free-living | Upper and Lower Limb: Signal Magnitude Area (SMA) ratio for arms and legs, duration of arm and leg use | System: Shimmer®3; 3-axis Sensors used: accelerometer | Five sensors: One on each wrist, one on each ankle, and one on trunk | Two separate 48 h sessions on weekdays and over a weekend | Missing data for all five sensors (<20 h): 11 participants on weekdays; 19 participants on weekends |
[35] | 2020 | In-patient setting | Gait: Speed, step count, and stride length | System: Shimmer®3; 3-axis Sensors used: accelerometer | Three sensors: Two on ankle and one under the mattress of participant at level of thorax | 5–7 days (hours/day not specified—only worn during daytime, taken off prior to bedtime and when showering) | Median: 6 days 11.1 ± 2.0 h/day |
[42] | 2020 | Free-living | Lower Limb: Abduction and adduction of the hip, knee and hip ROM (flexion-extension) Upper Limb: Flexion–extension of wrist, elbow, and shoulder Balance: Lateral trunk flexion and torsion of trunk | System: WeReha device; 9-axis Sensors used: specific sensors not specified | One sensor which could be placed on either trunk, leg, foot, or wrist depending on the exercise they are performing | During exercises proposed by WeReha (15–30 min) Note: Exact wear time not specified | Not provided |
[48] | 2020 | In-patient setting | General Activity | System: Apple Watch Series 3; 9-axis Sensors used: accelerometer and gyroscope | Four sensors: One on each wrist, one on each ankle | 24 h/day, 1 day | Range: 1.5–24 h |
[47] | 2022 | Free-living | Physical Activity | System: activPAL; 3-axis Sensors used: accelerometer | One on anterior unaffected thigh | 7 days (hours/day not specified) | 7 days |
[43] | 2022 | Free-living | Upper Limb: Duration and ratio of bilateral limb use | System: name not provided; 3-axis Sensors used: accelerometer | Two sensors: One on each index finger | 8 h/day, 2 days | Not provided |
[44] | 2023 | Free-Living | Gait: Speed, step length, and step height | System: (54 × 33 × 14 mm, 22 g, EXEL s.r.l, Bologna, Italy), and an app (“Stappy”) was installed on an Android smartphone (Mortorola Moto G 3rd generation); 6-axis Sensors used: accelerometer and gyroscope | Two sensors: One sensor on each shoe connected via Bluetooth to smartphone | Use during walks for a two-week period | 4.5 days (3.9 days) |
[37] | 2023 | Free-living | Upper Limb: Active movement time Gait: Step count and stance time | System: MiGo activity watch (FlintRehab); 6-axis Sensors used: accelerometer and gyroscope (gait) | Four sensors: One on each wrist and one on each ankle | 12 h/day, 7 days | Not provided |
[36] | 2024 | Lab | Upper Limb: Active movement time and movement counts Gait: Step count and stance time | System: MiGo activity watch (FlintRehab); 6-axis Sensors used: accelerometer and gyroscope (gait) | Five sensors: One on each wrist, one on each ankle, and one on hip | Worn during completion of UL and mobility standardized assessments | Not applicable |
[38] | 2024 | Free-living for monitoring arm use and lab for assessment | Upper Limb: Time of active movement for each arm, arm use ratio | System: MiGo activity watch (FlintRehab); 6-axis Sensors used: accelerometer | Two sensors: One on each wrist | 12 h/day, 7 days | 12.6 (0.2) h/day |
Study | Participants | Study Aim | Usability Assessment Methods | Usability Findings |
---|---|---|---|---|
Quantitative | ||||
[40] | 10 with stroke | Determine the acceptability of wearing the PAMSys equipment (i.e., t-shirt with Velcro pocket closure for sensor) for 48 consecutive hours | Method: Phone call interview with study-generated questionnaire * Response Type: Yes/No ISO Usability: 1,2,3 |
|
[41] | 11 with stroke | Evaluate user satisfaction of the RehaGait real-time feedback system | Method: Modified Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) * ISO Usability: 1,2,3 |
|
[39] | 17 with stroke 13 occupational therapists | Evaluate the appropriateness of the envisioned technological approach for stroke survivors and occupational therapists (OTs) | Method: Study-generated questionnaire Response Type: Yes/Neutral/No ISO Usability: 1,2 | Stroke
|
[46] | 26 with stroke | Feasibility of sensor measurement in terms of comfort, acceptance, and management in the clinical setting | Method: Study-generated questionnaire (close-ended) Response Type: 5-point Likert scale ISO Usability: 2,3 |
|
[35] | 13 with stroke | Assess user experience of a sensor-based platform which can continuously measure gait and sleep | Method: Study-generated questionnaire * Response Type: Yes/No and 0–10 scale ISO Usability: 1,2,3 |
Findings below are for the whole group; the study did not specify stroke-specific findings:
|
[42] | 22 with stroke | Satisfaction and acceptance of WeReha device by patients | Method: Technology Acceptance Model (TAM) * ISO Usability: 3 |
|
[47] | 40 with stroke | Acceptability of multimodal ambulatory monitoring system to assess daily activity and health-related symptoms among community-dwelling survivors of stroke | Method: Study-generated Likert scale questionnaire * Response Type: 3- and 5-point scale; Yes/Maybe/No ISO Usability: 3 |
|
[36] | 30 with stroke | Assess the acceptability of MiGo in terms of ease of use, ease of donning and doffing, and esthetics | Method: Study-generated questionnaire * Response Type: 5-point Likert scale ISO Usability: 1,2,3 |
|
Qualitative | ||||
[43] | 4 with stroke 15 occupational therapists | Examine stroke survivors’ and therapists’ receptiveness towards arm performance data and how they use the data | Method: Interview * ISO Usability: 1,2,3 | Themes:
|
[44] | 17 with stroke | To assess attitudes towards “Stappy” in people after stroke practicing walking performance independently at home | Method: Interview * ISO Usability: 1,2,3 | Themes:
|
Mixed Methods | ||||
[45] | 20 with stroke | Investigate the utility of RT3 to measure physical activity in the free-living environment in adults with and without neurologic dysfunction | Method: Quantitative: Study-generated questionnaire * Response Type: 9-point scale Yes/Maybe/No Qualitative: Open-ended questionnaire * ISO Usability: 1,2 | Findings below are for the whole group; the study did not specify stroke-specific findings: Utility Questionnaire
|
[48] | 44 with stroke 15 healthcare professionals (therapists, doctors, and nurses) | Survey the attitudes of healthcare professionals (doctors, nurses, therapists) and in-patient stroke patients after continuous IMU use | Method: Quantitative: Study-generated questionnaire * Response Type: Close-ended questionnaire with 7- and 10-point scale options * Qualitative: Interview (open-ended and close-ended questions) * ISO Usability: 3 | Close-Ended Questions: Stroke:
Stroke:
|
[37] | 30 with stroke | Aim 1: Determine ease of understanding feedback from wearable sensor data (both arm/hand use and mobility) for chronic stroke survivors Aim 2: Identify stroke survivors’ preferences for feedback metrics (i.e., mode, content, frequency, and timing) that have the potential to drive health-supporting behavior change | Method: Quantitative: Study-generated questionnaire * Response Type: Likert scale Qualitative: Interviews * ISO Usability: 3 | Quantitative:
Qualitative Themes:
|
[38] | 30 with stroke | Establish short-term usability of wrist-worn wearable sensors to capture arm and hand movement behavior in the unsupervised home or community environment in people with chronic stroke | Method: Quantitative: System Usability Scale (SUS) * Qualitative: Interviews * ISO Usability: 1,2,3 | Quantitative:
|
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Shenoy, A.; Samra, M.S.; Van Ooteghem, K.; Beyer, K.B.; Thomson, S.; McIlroy, W.E.; Eng, J.J.; Pollock, C.L. Evaluating the Usability of Inertial Measurement Units for Measuring and Monitoring Activity Post-Stroke: A Scoping Review. Sensors 2025, 25, 3694. https://doi.org/10.3390/s25123694
Shenoy A, Samra MS, Van Ooteghem K, Beyer KB, Thomson S, McIlroy WE, Eng JJ, Pollock CL. Evaluating the Usability of Inertial Measurement Units for Measuring and Monitoring Activity Post-Stroke: A Scoping Review. Sensors. 2025; 25(12):3694. https://doi.org/10.3390/s25123694
Chicago/Turabian StyleShenoy, Aishwarya, Manvir Singh Samra, Karen Van Ooteghem, Kit B. Beyer, Sherri Thomson, William E. McIlroy, Janice J. Eng, and Courtney L. Pollock. 2025. "Evaluating the Usability of Inertial Measurement Units for Measuring and Monitoring Activity Post-Stroke: A Scoping Review" Sensors 25, no. 12: 3694. https://doi.org/10.3390/s25123694
APA StyleShenoy, A., Samra, M. S., Van Ooteghem, K., Beyer, K. B., Thomson, S., McIlroy, W. E., Eng, J. J., & Pollock, C. L. (2025). Evaluating the Usability of Inertial Measurement Units for Measuring and Monitoring Activity Post-Stroke: A Scoping Review. Sensors, 25(12), 3694. https://doi.org/10.3390/s25123694