Free-living monitoring of ambulatory activity after treatments for lower extremity musculoskeletal cancers using an accelerometer-based wearable – a new paradigm to outcome assessment in musculoskeletal oncology?

Abstract

Purpose

Ambulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: (A) it was feasible to conduct ambulatory activity assessments in patient’s homes using an accelerometer-based wearable (AX3, Axivity). (B) AX3 assessments produced clinically useful data, distinguished tumour sub-groups and related to existing measures.

Methods

In a prospective cross-sectional pilot, 34 patients with musculoskeletal tumours in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) participated. Twenty-seven had limb-sparing surgery and seven amputation. Patients were assessed using a thigh-worn monitor. Summary measures of volume (total steps/day, total ambulatory bouts/day, mean bout length), pattern (alpha), and variability (S₂) of ambulatory activity were derived.

Results

AX3 was well-tolerated and feasible to use. Outcomes compared to literature but did not distinguish tumour sub-groups. Alpha negatively correlated with disability (walking outside (r=–418, p = 0.042*), social life (r=–0.512, p = 0.010*)). Disability negatively predicted alpha (unstandardised co-efficient= −0.001, R²=0.186, p = 0.039*).

Conclusions

A wearable can assess novel attributes of walking; volume, pattern, and variability after sarcoma surgery. Such outcomes provide valuable information about people’s physical performance in their homes, which can guide rehabilitation.

Implications for rehabilitation

• Routine capture of ambulatory activity by sarcoma services in peoples’ homes can provide important information about individuals “actual” physical activity levels and limitations after sarcoma surgery to inform personalised rehabilitation and care needs, including timely referral for support.

• Routine remote ambulatory monitoring about out of hospital activity can support personalised care for patients, including identifying high risk patients who need rapid intervention and care closer to home.

• Use of routine remote ambulatory monitoring could enhance delivery of evidence-based care closer to peoples’ homes without disrupting their daily routine and therefore reducing patient and carer burden.

• Collection of data close to home using questionnaires and objective community assessment could be more cost effective and comprehensive than in-hospital assessment and could reduce the need for hospital attendance, which is of importance to vulnerable patients, particularly during the Covid-19 pandemic.

Keywords:

• Functional outcomes
• sarcoma
• cancer
• quality of life
• rehabilitation
• ambulatory activity
• ambulation
• mobility

Acknowledgements

Thanks to the staff of the North of England Bone and Soft Tissue Tumour Service for their assistance in patient screening and recruitment, in clinics, staff from the Orthopaedic Research Unit for their support in data collection and staff from Clinical Ageing Research Unit in Newcastle University for their technical and engineering input during data processing and analysis. Thanks to the Royal National Orthopaedic Hospital NHS Trust for support with resources for data analysis and write-up of this valuable piece of work.

Level of evidence: level III, diagnostic study.

Disclosure statement

The institution of one or more of the authors (AG, LR) has received, during the study period, funding from the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre and Unit based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The institution of one or more of the authors (AG, SDD, and LR) has received, during the study period, funding from the NIHR Newcastle Clinical Research Faculty infrastructure funding. The institution of one or more of the authors (CG, SF) has received, during the study period, funding from the Children with Cancer UK Charity, Sarcoma UK Charity, and Shear’s Foundation and Research and Capability (RCF). All ICMJE Conflict of Interest Forms for authors and Disability and Rehabilitation Journal editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at the major clinic sites and Human Movement Room at the North of England Bone and Soft Tissue Tumor Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK. Data analysis and write-up of this manuscript has been conducted in Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle University and the Royal National Orthopaedic Hospital NHS Trust.

Additional information

Funding

Thanks to our funders Children with Cancer UK Charity, Sarcoma UK Charity, and Shear’s Foundation and Research and Capability (RCF), for supporting this work.