Watch

The final two approaches to identify sleep and wake times used data from the Actigraph watch. The participants wore the Actigraph watch for 3 days. The approach based upon actigraphy considered the motion data captured only on the day the participants also wore the ABPM for identification of sleep. The manual approach identified the longest consecutive period of inactive data to identify sleep.
To identify the longest consecutive period of inactive data, we used sliding windows of 30 minute readings with 15 minute overlaps from prior windows. These windows provided a moving average filter on the motion across the vector magnitude of the Actigraphy data. If this activity level fell in the bottom tertile of each participant’s total activity across periods of wake or sleep (bottom 33% of activity values), it was considered sedentary; the longest sequence of sedentary behavior was considered sleep.

To examine daily physical activity, the participants wear an ActiGraph watch for the duration of their study participation (baseline phase and across treatment). The ActiLife software (ActiGraph, LLC) will be used to extract data and calculate the mean and peak daily activity. Physical activity (mean and peak) is modeled at 2 time points, and the rate of change in physical activity from baseline to discharge will also be examined.

Once eligibility is confirmed, the baseline assessment is completed in 2 parts. First, adolescents and caregivers complete consent and baseline self-report questionnaires. Adolescents and caregivers are oriented to the mobile diaries, which adolescents complete daily and caregivers complete weekly while enrolled in treatment. Following the baseline study visit, adolescents and caregivers undergo a pretreatment data collection period for the number of days between consent and their subsequent PT appointment. During this time, adolescents complete daily diaries, and caregivers complete weekly health cost diaries. The second part of the baseline assessment takes place at the adolescent’s next PT session, during which a research coordinator completes a baseline physical assessment via ViFive (ViFive, Inc) [43 ], a motion capture app, consisting of the 6-minute Walk Test, Single Leg Balance Test, and Closed Kinetic Chain Upper Extremity test, and the adolescent receives an ActiGraph watch (ActiGraph, LLC) that monitors sleep and activity level throughout the trial.