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Chow R, Drkulec H, Im JHB, Tsai J, Nafees A, Kumar S, Hou T, Fazelzad R, Leighl NB, Krzyzanowska M, Wong P, Raman S. The Use of Wearable Devices in Oncology Patients: A Systematic Review. Oncologist 2024; 29:e419-e430. [PMID: 37971410 PMCID: PMC10994271 DOI: 10.1093/oncolo/oyad305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The aim of this systematic review was to summarize the current literature on wearable technologies in oncology patients for the purpose of prognostication, treatment monitoring, and rehabilitation planning. METHODS A search was conducted in Medline ALL, Cochrane Central Register of Controlled Trials, Embase, Emcare, CINAHL, Scopus, and Web of Science, up until February 2022. Articles were included if they reported on consumer grade and/or non-commercial wearable devices in the setting of either prognostication, treatment monitoring or rehabilitation. RESULTS We found 199 studies reporting on 18 513 patients suitable for inclusion. One hundred and eleven studies used wearable device data primarily for the purposes of rehabilitation, 68 for treatment monitoring, and 20 for prognostication. The most commonly-reported brands of wearable devices were ActiGraph (71 studies; 36%), Fitbit (37 studies; 19%), Garmin (13 studies; 7%), and ActivPAL (11 studies; 6%). Daily minutes of physical activity were measured in 121 studies (61%), and daily step counts were measured in 93 studies (47%). Adherence was reported in 86 studies, and ranged from 40% to 100%; of these, 63 (74%) reported adherence in excess of 80%. CONCLUSION Wearable devices may provide valuable data for the purposes of treatment monitoring, prognostication, and rehabilitation. Future studies should investigate live-time monitoring of collected data, which may facilitate directed interventions.
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Affiliation(s)
- Ronald Chow
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, ON, Canada
| | - Hannah Drkulec
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - James H B Im
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Jane Tsai
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abdulwadud Nafees
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Swetlana Kumar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tristan Hou
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monika Krzyzanowska
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Philip Wong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Srinivas Raman
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Furtado S, Godfrey A, Del Din S, Rochester L, Gerrand C. 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? Disabil Rehabil 2022:1-10. [PMID: 35710327 DOI: 10.1080/09638288.2022.2083701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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 rehabilitationRoutine 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.
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Affiliation(s)
- Sherron Furtado
- The London Sarcoma Service, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Craig Gerrand
- The London Sarcoma Service, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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Mellema M, Gjøvaag T. Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:2243. [PMID: 35336412 PMCID: PMC8955603 DOI: 10.3390/s22062243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/02/2022]
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.
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Affiliation(s)
- Mirjam Mellema
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
| | - Terje Gjøvaag
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
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Maximal Walking Distance in Persons with a Lower Limb Amputation. SENSORS 2020; 20:s20236770. [PMID: 33256247 PMCID: PMC7729984 DOI: 10.3390/s20236770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022]
Abstract
The distance one can walk at a time could be considered an important functional outcome in people with a lower limb amputation. In clinical practice, walking distance in daily life is based on self-report (SIGAM mobility grade (Special Interest Group in Amputee Medicine)), which is known to overestimate physical activity. The aim of this study was to assess the number of consecutive steps and walking bouts in persons with a lower limb amputation, using an accelerometer sensor. The number of consecutive steps was related to their SIGAM mobility grade and to the consecutive steps of age-matched controls in daily life. Twenty subjects with a lower limb amputation and ten age-matched controls participated in the experiment for two consecutive days, in their own environment. Maximal number of consecutive steps and walking bouts were obtained by two accelerometers in the left and right trouser pocket, and one accelerometer on the sternum. In addition, the SIGAM mobility grade was determined and the 10 m walking test (10 MWT) was performed. The maximal number of consecutive steps and walking bouts were significantly smaller in persons with a lower limb amputation, compared to the control group (p < 0.001). Only 4 of the 20 persons with a lower limb amputation had a maximal number of consecutive steps in the range of the control group. Although the maximal covered distance was moderately correlated with the SIGAM mobility grade in participants with an amputation (r = 0.61), for 6 of them, the SIGAM mobility grade did not match with the maximal covered distance. The current study indicated that mobility was highly affected in most persons with an amputation and that the SIGAM mobility grade did not reflect what persons with a lower limb amputation actually do in daily life. Therefore, objective assessment of the maximal number of consecutive steps of maximal covered distance is recommended for clinical treatment.
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Kask G, Barner-Rasmussen I, Repo JP, Kjäldman M, Kilk K, Blomqvist C, Tukiainen EJ. Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review. Ann Surg Oncol 2019; 26:4707-4722. [PMID: 31407171 PMCID: PMC6863783 DOI: 10.1245/s10434-019-07698-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 12/16/2022]
Abstract
Background The importance of functional outcome (FO) in the treatment of patients with extremity soft tissue sarcoma (STS) has been increasingly recognized in the last three decades. This systematic review aimed to investigate how FO is measured in surgically treated lower-extremity STS patients. Methods A systematic search of PubMed, Web of Science, and Scopus was performed based on the PRISMA guidelines. The methodologic quality of the publications was measured using the MINORS tool. The results from the included studies examining measurement types, measures, and time of FO measurement were compiled. The FO pooled mean and standard deviation were calculated as a weighted average for the groups. The validity of the applied measures is reported. Results The literature search found 3461 publications, 37 of which met the inclusion criteria. The measurement types used were clinician-reported outcomes (n = 27), patient-reported outcomes (n = 20), and observer-reported outcomes (n = 2). The most frequently used measures were the Toronto Extremity Salvage Score (TESS) (n = 16) and the Musculoskeletal Tumor Society (MSTS) score 1993 (n = 12). The postoperative FO was relatively good. The pooled mean TESS and MSTS 1993 scores were respectively 83.3 and 86.2 (out of 100). Of the 10 previously reported measures, 3 provide validated FO scores. The methodologic quality of publications was generally low. Conclusions Based on this systematic review, several different methods exist for assessing FO in patients with lower-extremity sarcoma. The most frequently used measure is a validated TESS. The postoperative FO of patients with lower-extremity STS seems to increase to the preoperative baseline level during long-term follow-up evaluation.
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Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland. .,Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland.
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Jussi Petteri Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Magnus Kjäldman
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Kaarel Kilk
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Carl Blomqvist
- Helsinki University Hospital Comprehensive Cancer Center, HUS, Helsinki, Finland
| | - Erkki Juhani Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
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FIUZA-LUCES CARMEN, PADILLA JULIOR, SOARES-MIRANDA LUISA, SANTANA-SOSA ELENA, QUIROGA JAIMEV, SANTOS-LOZANO ALEJANDRO, PAREJA-GALEANO HELIOS, SANCHIS-GOMAR FABIÁN, LORENZO-GONZÁLEZ ROSALÍA, VERDE ZORAIDA, LÓPEZ-MOJARES LUISM, LASSALETTA ALVARO, FLECK STEVENJ, PÉREZ MARGARITA, PÉREZ-MARTÍNEZ ANTONIO, LUCIA ALEJANDRO. Exercise Intervention in Pediatric Patients with Solid Tumors. Med Sci Sports Exerc 2017; 49:223-230. [DOI: 10.1249/mss.0000000000001094] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bekkering WP, Vliet Vlieland TP, Koopman HM, Schaap GR, Bart Schreuder H, Beishuizen A, Jutte PC, Hoogerbrugge PM, Anninga JK, Nelissen RG, Taminiau AH. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol 2010; 103:276-82. [DOI: 10.1002/jso.21828] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 11/16/2010] [Indexed: 11/07/2022]
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Ambulation of people with lower-limb amputations: relationship between capacity and performance measures. Arch Phys Med Rehabil 2010; 91:543-9. [PMID: 20382285 DOI: 10.1016/j.apmr.2009.12.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 12/03/2009] [Accepted: 12/03/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the relationship between measures of ambulation capacity obtained in a clinical setting and measures of ambulation performance in the community, and to explore what demographic and clinical variables influence ambulation performance in people with lower-limb amputations. DESIGN A cross-sectional, correlational and descriptive study. SETTING Rehabilitation center and participants' homes and community environments. PARTICIPANTS Community-dwelling people (N=52) with lower-limb amputations at the unilateral transfemoral (n=16), unilateral transtibial (n=30), and bilateral transtibial (n=6) levels. All had been fit with prostheses for over 1 year. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measures of ambulation capacity were the Locomotor Capabilities Index version 5, the 2-Minute Walk Test (2MWT), and the Timed Up and Go Test. Measures of ambulation performance included a commercially available step activity monitor (SAM; steps per day, minutes active per day, peak activity index) and self-reported performance with the Activity Restriction subscales of the Trinity Amputation and Prosthesis Experience Scales (TAPES). RESULTS Most relationships among capacity and performance measures were in the moderate to high range (Spearman correlation coefficients, rho=.41-.78, P<.05). The highest correlation coefficient was between the 2MWT and SAM peak activity index (rho=.78, P=.000). A multivariate analysis found the 2MWT was significantly related to increased performance as measured by SAM mean steps per day (P=.026) and TAPES (P=.016). Depressive symptoms were also a significant predictor (P=.003) of decreased performance (TAPES). CONCLUSIONS The 2MWT, a measure of ambulation capacity, correlates well with most SAM measures of ambulation performance. Exploratory regression analysis indicated that the 2MWT is related to ambulation performance, while depression is only related to self-reported performance.
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Rosenbaum D, Brandes M, Hardes J, Gosheger G, Rödl R. Physical activity levels after limb salvage surgery are not related to clinical scores-objective activity assessment in 22 patients after malignant bone tumor treatment with modular prostheses. J Surg Oncol 2008; 98:97-100. [DOI: 10.1002/jso.21091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer 2004; 91:1012-4. [PMID: 15292924 PMCID: PMC2747710 DOI: 10.1038/sj.bjc.6602104] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study investigated quality of life (QoL) and function of 124 patients with lower extremity sarcoma who underwent either amputation or limb-salvage surgery (LSS) in order to assess potential differences in subjective treatment outcome. The results reflect similar QoL in both treatment groups. However, in contrast to patients with LSS, who described QoL in terms of a high physical performance status with sports and recreational activities, amputees' QoL was strongly associated with their social acceptability. High QoL in amputees brings into question the expectations held with time-consuming advanced technical skills for LSS by physicians.
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