The Use Of Real-world Physical Behaviour Information To Support Clinical Decision-making Process In Lower-limb Prosthetic Care

Patricks, Victoria

Abstract

A limited understanding of activity levels and functional status in people with lower limb amputation can adversely impact the healthcare delivery and the individual’s quality of life. Current methods to fit prosthetic limbs and evaluate their impact are limited to in-clinic evaluations, restricting the ability to monitor patient’s use and activity levels at home. This problem could be addressed by finding the right tools to understand how amputees use their prostheses in the real-world.
Wearable monitoring sensors have the capacity to complement the standard outcomes measures in current prosthetic care by providing clinicians with objective information about users’ physical behaviours and participation in the community. Sensor-based information is important to clinicians to inform both evidence-based component selection and goal setting during rehabilitation, including the justifications of clinical decisions.
Information from monitoring sensors can provide valuable evidence-based insights, enhancing clinicians’ evaluation capabilities. However, meaningful information from monitoring devices that are relevant to the needs of clinicians in prosthetic care is yet to be determined. To date, step count is almost the only reported information from real-world monitoring technologies used in people with lower-limb amputation. This information may not be reliable determinant for clinicians to make clinical decisions. There is therefore a need to involve healthcare professionals in understanding their views of information obtained from monitoring technologies used in prosthetic care.
AIM
The overall aims of the study were to obtain relevant physical behaviour information from wearable monitoring sensors to support clinical decision-making in lower-limb prosthetic care and test the feasibility of providing this information to clinicians.
METHODS
A three-phase sequential mixed methods design was employed. The first phase used a qualitative interview involving seven clinicians. This phase explored clinicians’ view on the need for monitoring sensors, identifying important clinical information from wearable monitoring sensors and discussing effective presentation methods to enhance clinical decisions and improve treatment for prosthesis users. The second phase involved a pilot study with ten lower-limb amputees to the feasibility of using the activPAL device for data collection in both transfemoral and transtibial populations to gather real-world physical behaviour data and validate shank-worn algorithm and non-wear time algorithm from the activPAL. Additionally, the collected data was triangulated with interview results to create visualisations that could provide valuable feedback to aid clinicians.
The third phase involved a trial to evaluate the feasibility and acceptance of providing physical behaviour information of prosthesis users to clinicians. This study presented visual graphs of physical behaviour data from seven lower-limb amputee to seven clinicians for feedback in their clinical process. A mixed method exploratory research approach used questionnaire and open-ended questions to evaluate the feasibility and acceptance of the visualisation system.
RESULTS
The results from study one indicated that clinicians found several key metrics from monitoring devices useful, including step count, cadence, wear and non-wear time, type of activity, sedentary time, time spent doing activity, distance travelled, Energy (MET) used in activity. This information can be effectively presented in a visual system to support routine prosthetic care
Study Two confirmed the feasibility of using the activPAL device to measure physical behavior outcomes in both transfemoral and transtibial prosthesis users. Twenty sets of data were collected from ten patients without any losses, demonstrating that thigh-worn sensor can produce outcomes in posture classifications, cadence, sit-to-stand, and stepping activities, while shank-worn sensor could produce outcomes in non-wear prosthesis time from both lower-limb populations for durations longer than 2 hours from both lower-limb populations. This highlights the clinical significance of wear and non-wear time and can be successfully measured using an activPAL sensor.
The final study evaluated the feasibility and acceptance of providing physical behavior data to clinicians, showing that visual graphs of physical activity from seven amputees could offer objective, detailed insights into amputees' physical behaviours, significantly beyond what is currently possible with traditional methods.
CONCLUSION
Wearable monitoring technologies can significantly enhance the understanding of lower-limb prosthesis usage in real-world environments. By providing clinicians with access to detailed, objective data, this approach supports more informed decision-making, potentially leading to personalised and effective prosthetic care. Future research, as proposed in the third phase, will further explore the clinical implications of integrating such technologies into routine prosthetic care.

• Thesis Type: Thesis
• Deposit Date: Nov 8, 2024
• Award Date: Nov 21, 2024