Technology for monitoring everyday prosthesis use: a systematic review

Abstract

BackgroundUnderstanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring.MethodsA systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis-users during daily-living.Results60 lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm.ConclusionsActivity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.

Technology for monitoring everyday prosthesis use: a systematic review

“…Small sample-size is a common issue in the field of prosthetics, as it is difficult to recruit large participant cohorts from the small limb-absent population [ 117 ]. One way to help address this issue is to develop a commonly-agreed framework for reporting participant characteristics, clinical outcomes and the engineering characteristics of the components tested, so that comparisons can be made across studies and the foundations laid for big data approaches [ 118 ]. Strengthening the partnerships and collaborations between academic institutions, the prosthetics industry, clinics, hospitals and societies of people with limb absence is important for ensuring research is informed by an understanding of the users’ needs, and that the research outputs inform changes in clinical practice.…”

Loading characteristics data applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art components during daily activities

“… The loading profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art prosthetic components presented here were characterized by several datasets including the confounders as well as the loading patterns, loading boundaries and loading local extrema of the forces and moments applied during straight-level walking, ascending and descending ramp and stairs [2] , [3] , [4] , [5] . These datasets are essential for promoters of prosthetic care innovations (e.g., users, clinicians, engineers, scientists, administrators) because they provide valuable insights supporting the prescription of advanced prosthetic components to the growing population of individuals suffering from lower limb loss choosing bionics solutions [6] , [7] , [8] , [9] , [10] , [11] .…”

“…The loading profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art prosthetic components presented here were characterized by several datasets including the confounders as well as the loading patterns, loading boundaries and loading local extrema of the forces and moments applied during straight-level walking, ascending and descending ramp and stairs [2] , [3] , [4] , [5] .…”

Co-creation and User Perspectives for Upper Limb Prosthetics

“…For example, developing experimental protocols that take ethical considerations, such as privacy, into account whilst researching within user home environments (Jones et al). In-home trials for upper limb prosthetics have been documented (Brinton et al, 2020;Chadwell et al, 2020;Garske et al, 2021;Wu et al, 2021), however there are challenges when conducting such studies with users. Acquiring ethical approval for user involvement within such studies, may present new scenarios for review committees to consider (Goodyear-Smith et al, 2015).…”