Prosthetists’ Perceptions of Information Obtained From a Lower-Limb Prosthesis Monitoring System: A Pilot Study

Abstract

Introduction-Prosthetists have limited knowledge of their patients' use of a prosthesis outside of the clinical environment. Prosthesis-mounted monitors can be used to directly measure patients' prosthesis use and activity. Prosthetists' opinions regarding potential clinical applications for sensor-based information may inform further development of this technology. A pilot study was conducted to assess prosthetists' perceptions of prosthesis use and activity information obtained by a monitoring system. Materials and methods-Three local prosthetists were recruited to participate in the study. One patient with transtibial amputation from each prosthetist volunteered to wear limb presence and activity monitors for two weeks. Collected data were used to determine prosthesis use and activity. Each prosthetist completed a survey, examined clinical reports of their patient's prosthesis use and activity, and participated in a semi-structured interview. Survey results and interview transcripts were analyzed to identify and compare prosthetists' perceptions. Results-Prosthesis use and activity varied among patients. Prosthetists over-and underestimated patient activity, relative to measurements recorded by the monitors. All three prosthetists selected multiple clinical applications for the prosthesis use and activity information in the survey, and several additional applications were suggested during the interviews. When presented with multiple report formats, prosthetists found features of each to be clinically useful. Conclusions-Prosthesis-mounted monitors may provide prosthetists with a better understanding of their patients' prosthesis use and activity. Information provided by the monitoring system may inform clinical decisions and promote evidence-based practices.

Technology for monitoring everyday prosthesis use: a systematic review

“…Activity level, measured outside the clinic, may lend support for K-level classifications. Balkman (2019) [ 45 ] Prosthetists’ perceptions of information obtained from a lower limb prosthesis monitoring system: a pilot study. 3 participants (All AK) WAFER (P. In socket, distal end) 2x ActiGraph GT3X+ (L. proximal to patella, P. lateral side of ankle) Donning and doffing, sitting, standing, walking (2 weeks) Compare prosthetist-estimated patient activity with the prosthesis use and activity recorded by the sensors.…”

“…The majority of lower-limb studies used body-worn accelerometers. However, 5 used in-socket sensors [ 35 – 37 , 39 , 45 ], 4 used GPS in addition to accelerometers [ 38 , 49 , 94 , 95 ], and 2 used phone-based accelerometers [ 40 , 43 ]. The most commonly used actimeter in the lower-limb studies was the StepWatch, which counts steps but does not classify the type of activity.…”

Technology for monitoring everyday prosthesis use: a systematic review

“…[104][105][106] The majority of lower-limb studies used body-worn accelerometers. However, 5 used in-socket sensors, [35][36][37]39,45 4 used the global positioning system (GPS) in addition to accelerometers, 38,49,94,95 and 2 used phone-based accelerometers. 40,43 The most commonly used actimeter in the lower-limb studies was the StepWatch, which counts steps but does not classify the type of activity.…”

“…112 The ability to detect donning and doffing is also useful for understanding whether a prosthesis is meeting the user's needs and may give more specific indications, such as physical and/or thermal comfort. 39,45,113 Changes in daily prosthesis wear time or the types of activity undertaken over time might provide an early warning of changes in socket fit and tissue health.…”

“…Studies have used these activity classification methods in a laboratory setting, 13,107,108 but only a couple have used these methods to monitor activity in the community. 45,90 These activity classification algorithms have mostly been designed for use with sensors worn on the thigh (ActivPAL), the wrist and the waist (studies have used the Actigraph at varying locations but the wrist and waist have the most validation). For long-term monitoring of prosthesis use, the authors suggest that embedding a sensor in the cosmesis of the prosthesis may enable longer monitoring periods, as it would remove the discomfort of having a sensor taped or strapped to the skin and the user would not need to remember to wear it, improving wear compliance.…”