Actigraphy in the Critically Ill: Correlation With Activity, Agitation, and Sedation

ABSTRACT

By Mary Jo Grap, RN, PhD, ACNP, C. Todd Borchers, RN, MS, Cindy L. Munro, RN, PhD, ANP, R. K. Elswick, Jr, PhD, and Curtis N. Sessler, MD.

OBJECTIVES To determine the feasibility of continuous measurement of limb movement via wrist and ankle actigraphy (an activity measure) in critically ill patients and to compare actigraphy measurements with observed activity, subjective scores on sedation-agitation scales, and heart rate and blood pressure of patients.

METHODS In a prospective, descriptive, correlational study, all activity of 20 adult patients in medical and coronary care units in a university medical center were observed for 2 hours and documented. Wrist and ankle actigraphy, heart rate, and systolic and diastolic blood pressure data were collected every minute. The Comfort Scale and the Richmond Agitation-Sedation Scale were completed at the beginning of the observation period and 1 and 2 hours later.

RESULTS Wrist actigraphy data correlated with scores on the Richmond Agitation-Sedation Scale (r=0.58) and the Comfort Scale (r=0.62) and with observed stimulation and activity events of patients (r = 0.45). Correlations with systolic, diastolic, and mean arterial pressures were weaker. Wrist and ankle actigraphy data were significantly correlated (r = 0.69; P < .001); however, their mean values (wrist, 418; ankle, 147) were significantly different (t=5.77; P<.001).

CONCLUSIONS Actigraphy provides a continuous recording of patients’ limb movement. Actigraphy measurements correlate well with patients’ observed activity and with subjective scores on agitation and sedation scales. Actigraphy may become particularly important as a continuous measurement of activity for use in behavioral research and may enhance early recognition and management of the excessive activity that characterizes agitation. (American Journal of Critical Care. 2005;14:52-60)

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