CORR Insights®: Are Accelerometer-based Functional Outcome Assessments Feasible and Valid After Treatment for Lower Extremity Sarcomas?

Where Are We Now?

Physicians often use performance-based clinical assessments like physical therapist evaluations or standardized scoring systems to assess function in our patients. Modern technology is impacting health care in many ways, but little is known about how we might use wearable technology to devise new clinical assessments of function for patients with sarcoma.

Traditional functional outcome measures in sarcoma care include the Musculoskeletal Tumor Society Functional Assessment Score [3] and the Toronto Extremity Salvage Score [2]. Generally, gait has been studied in a laboratory using force plates that include costly equipment not easily used by the general public [1]. But recently, we have seen tremendous growth in personal wearable technology, including a number of devices that give users a somewhat-accurate assessment of the distance, time, places, and types of activities that we participate in. Other wearable devices can measure heart rate, the number of steps we take, and the number of stairs we climb. It seems reasonable, therefore, for clinician-scientists to explore the breadth of disease processes that can be analyzed with wearable technology [5, 7].

In the current study, Furtado and colleagues [4] bring wearable technology into the clinical realm of sarcoma care. To my knowledge, they are the first to report accelerometer-based body-worn monitor assessments of balance, gait, and timed up-and-go tests to produce clinically useful data. Furtado and colleagues [4] demonstrate in a small subset of patients that wearable devices can be used to discriminate balance and gait differences between controls and limb salvage patients.

Where Do We Need To Go?

As physicians, we know that sometimes our patients travel long distances to receive care, which imposes burdens of cost, time, and stress on patients and their families. Therefore, we should not be surprised that when patients perceive they have recovered to a reasonable level, they may opt not to return, even when the surgeon would like additional in-person follow-up. Future studies should examine whether video technology as a part of surgical aftercare is a viable and affordable option for patients with sarcomas. Can wearable devices safely and privately transmit valuable real-time data to a physical therapist, for example, who then can both analyze a patient’s progress and guide his or her next steps in care? Can new models of care combining technology led by wearable devices improve patient satisfaction? Will the healthcare system support the implementation of such approaches? If wearable sensors are reliable, we can then confidently recommend their use for physical therapy and rehabilitation following limb salvage surgery. This technology is only gaining in popularity, and so physicians should embrace telemedicine for follow-up appointments, as patients will likely demand them anyway. Should these approaches be validated by robust clinical research, insurers then will need to adopt payment mechanisms that incent patients to purchase wearable technology, and physicians to employ technology to receive results from these devices, and to provide remote care facilitated by these devices.

How Do We Get There?

Collaborative research between physical therapists, engineers, and surgeons at high-volume sarcoma centers will be needed to lead the way in demonstrating that these devices capture the appropriate data to direct outcomes directed care for each type of limb salvage procedure. Once researchers document the utility of wearable technology, we must begin to change care teams and how they function. Physical therapists will need to be more closely integrated in the follow-up care of patients who underwent limb salvage surgery. The therapist should be able to use the data from wearable technology, discuss it with the physician, and provide care progression. This transition in care will be challenging for the healthcare system, but will become easier as bundled care encourages further integration within systems.

In my region, the patients who are most in need of receiving care closer to home lack the financial resources to gain access to the technology that can provide them with local care. But physical therapists may no longer need an individual gym in a facility. Instead, they may direct their patients to perform activities that do not require expensive equipment, or to utilize wearable technology so the therapist can monitor their progress via internet-driven video platforms. Recovery from major limb salvage surgery can range between months to even years. New paradigms that utilize wearable technology to decrease the number of physician and physical therapy visits will decrease cost. Once insurers realize these devices decrease costs, they will facilitate improved integration of care by providing wearable technology for their constituents. The cost savings will allow those with the least financial resources to gain access to local or specialty care that is otherwise not currently obtainable.