Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review

Abstract

Background: The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. Methods: The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. Results and conclusions: 98 articles met the inclusion criteria. According to the included studies’ main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.

Beyond step counts: Including wear time in prosthesis use assessment for lower-limb amputation

“…Improvements in activity monitoring technology are advancing the characterization of prosthesis use in people with lower-limb amputation, allowing researchers to extend beyond the traditional measurements of step count and cadence to more fully characterize prosthesis users' clinical outcomes. 2 Activities such as working at a counter or moving items around while sitting at a desk may soon be detectable, for example. Providing body support to enable these actions is a key function of the prosthesis from the user’s perspective, but one that is rarely measured using traditional step counting technologies.…”

“…Several researchers have pursued this type of investigation, most of them delineating sitting, standing, lying, and stepping. 2 Others extended from these types of activities to delineate the time-of-day steps were taken, 16 durations of activities, 17 or the direction of movement. 3,9 In the present study, we sought to extend from those efforts by developing a sensor capable of measuring weight shifts.…”

“…1 Processing strategies are executed to calculate various activity-related metrics, including steps/day, cadence, fitness and intensity of activity, type of activity and body posture, commercial scores, and gait quality. 2 Data may be communicated to users via a personal device, such as a watch or phone, to help them achieve activity targets. More recently, inertial measurement units (IMUs) that add a 3-axis gyroscope and magnetometer to the accelerometer have been introduced.…”

Sensors for Human Physical Behaviour Monitoring

“…Mellema and Gjøvaag [1] conducted a scoping review to evaluate the purpose and reported outcome measures of wearable activity monitors in people with a lower limb amputation (LLA) in real-world situations. The review found that step count was the most frequently reported outcome measure, but caution is needed in choosing reliable outcome measures.…”

A Scientometric Analysis and Visualization of Prosthetic Foot Research Work: 2000 to 2022

“…However, since walking is an essential part of daily life, those with an LEA suffer from significant loss of mobility, which is inconvenient and causes hardship [4,6]. Prosthesis use can disguise the partial or complete loss of a lower limb in appearance, while assisting those with an LEA to walk or participate in daily activities and enjoy a certain amount of physical movement and ability to self-care [7][8][9]. In recent years, there has been growing research interest on prosthetic feet.…”