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uncertain if this renewed version still has the same validity as shown in the previous study by Wendel-Vos et al. (2003). The aim of this study therefore was to determine the concurrent validity of the adjusted SQUASH in physically disabled and chronically ill patients. Determining the validity of the adjusted SQUASH The validity of an instrument is the extent of which it truly assess the exposure of interest (Welk, 2002). Because physical activity is a multidimensional exposure it is difficult to find an absolute golden standard for it. Instead, in determining the validity of the adjusted SQUASH it has to be compared to objective data that resembles the individual physical activity pattern of patients. This is called concurrent validity. Multiple techniques can be used for obtaining objective information about physical activity behaviour. Gyroscopes, pedometers, diaries, accelerometers and heart rate monitors have been used in similar studies (Lamonte & Ainsworth, 2001; Montoye & Henry, 1996; Sirard & Pate, 2001). All devices have their own benefits and limitations. Accelerometers have been proven valid in detecting activity patterns (Wendel-Vos et al., 2003). However, these devises seem to be less accurate in detecting changes in more-energy consuming gait patterns which patients of our target population might have (Wezenberg et al., 2013). Heart rate monitors can distinguish between these differences because heart rate is a physiological variable directed related to oxygen uptake. Nonetheless, heart rate monitors as a single-measurement device are unreliable because changes in hart rate can be the cause of many other factors such as temperature, stress and dehydration (Crouter et al., 2008). A device that incorporates both acceleration and heart rate is the Actiheart (CamNtech™). It combines these two variables into a single unit activity score which resembles the total physical activity behaviour. The Actiheart has proven to be a valid instrument in monitoring physical activity in both healthy subjects (Brage et al., 2005) as in a variety of patients groups, for example free-living women with COPD (Farooqi et al., 2013) and children with Spina Bifida (de Groot et al., 2013). To establish the concurrent validity of the adjusted SQUASH, it will be compared to the physical activity monitor Actiheart in several ways.
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