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

Mirjam Mellema,Terje Gjøvaag

doi:10.3390/s22062243

Mirjam Mellema, Terje Gjøvaag

Open Access

https://doi.org/10.3390/s22062243

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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.

Highlights

The use of wearable technology to monitor real-world ambulatory activity in people with a Lower Limb Amputation (LLA) has grown rapidly in the past decade
The overall purpose of this scoping review was to survey the scientific literature to evaluate the use of wearable activity monitors in reporting real-world ambulation and prosthetic use in people with LLA
This review demonstrated a poor diversity of reporting outcome measures, in particular studies using commercial devices rather than custom-developed devices were limited to reporting step count or the intensity of activity

Summary

Introduction

The use of wearable technology to monitor real-world ambulatory activity in people with a Lower Limb Amputation (LLA) has grown rapidly in the past decade. Activity monitors have the potential to provide objective information about peoples’ ambulatory behavior and participation in the community, an important domain of the International. Monitoring ambulatory behavior of people with LLA in a free-living setting gives valuable information that can be used to develop 4.0/). The prosthetic user themselves informs the clinician about their ambulatory behavior and physical activity level. Studies report that self-reported prosthetic use and activity level are both overestimated as well as underestimated by the user, indicating that a subjective assessment is unreliable [4]. Standardized performance-based tests can be used to objectively assess a person’s physical functioning and to monitor changes over time. Comprehensive testing is required to obtain a comprehensive picture of a person’s functioning, since single tests such as the 6 Meter

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