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?

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.