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      Current clinical utilisation of wearable motion sensors for the assessment of outcome following knee arthroplasty: a scoping review

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          Abstract

          Objectives

          Wearable motion sensors are used with increasing frequency in the evaluation of gait, function and physical activity within orthopaedics and sports medicine. The integration of wearable technology into the clinical pathway offers the ability to improve post-operative patient assessment beyond the scope of current, questionnaire-based patient-reported outcome measures. This scoping review assesses the current methodology and clinical application of accelerometers and inertial measurement units for the evaluation of patient activity and functional recovery following knee arthroplasty.

          Design

          This is a systematically conducted scoping review following Joanna Briggs Institute methodology for scoping reviews and reported consulting the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews. A protocol for this review is registered with the Open Science Framework ( https://osf.io/rzg9q).

          Data sources

          CINAHL, EMBASE, MEDLINE and Web of Science databases were searched for manuscripts published between 2008 and 2019.

          Eligibility criteria

          We included clinical studies reporting the use of any combination of accelerometers, pedometers or inertial measurement units for patient assessment at any time point following knee arthroplasty.

          Data extraction and synthesis

          Data extracted from manuscripts included patient demographics, sensor technology, testing protocol and sensor-based outcome variables.

          Results

          45 studies were identified, including 2076 knee arthroplasty patients, 620 patients with end-stage osteoarthritis and 449 healthy controls. Primary aims of the identified studies included functional assessment, physical activity monitoring and evaluation of knee instability. Methodology varied widely between studies, with inconsistency in reported sensor configuration, testing protocol and output variables.

          Conclusions

          The use of wearable sensors in evaluation of knee arthroplasty procedures is becoming increasingly common and offers the potential to improve clinical understanding of recovery and rehabilitation. While current studies lack consistency, significant opportunity exists for the development of standardised measures and protocols for function and physical activity evaluation.

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          Most cited references67

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          Optimal Placement of Accelerometers for the Detection of Everyday Activities

          This article describes an investigation to determine the optimal placement of accelerometers for the purpose of detecting a range of everyday activities. The paper investigates the effect of combining data from accelerometers placed at various bodily locations on the accuracy of activity detection. Eight healthy males participated within the study. Data were collected from six wireless tri-axial accelerometers placed at the chest, wrist, lower back, hip, thigh and foot. Activities included walking, running on a motorized treadmill, sitting, lying, standing and walking up and down stairs. The Support Vector Machine provided the most accurate detection of activities of all the machine learning algorithms investigated. Although data from all locations provided similar levels of accuracy, the hip was the best single location to record data for activity detection using a Support Vector Machine, providing small but significantly better accuracy than the other investigated locations. Increasing the number of sensing locations from one to two or more statistically increased the accuracy of classification. There was no significant difference in accuracy when using two or more sensors. It was noted, however, that the difference in activity detection using single or multiple accelerometers may be more pronounced when trying to detect finer grain activities. Future work shall therefore investigate the effects of accelerometer placement on a larger range of these activities.
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            Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes.

            The purpose was to explore the responsiveness of both patient-report and performance-based outcome measures to determine functional changes during the acute and long-term postoperative recovery after total knee arthroplasty (TKA). One hundred patients scheduled for unilateral TKA underwent testing preoperatively and at 1 and 12 months postoperatively using the Delaware Osteoarthritis Profile. All physical performance measures decreased initially after surgery then increased in the long term; however, the perceived function did not follow the same trend, and some showed an increase immediately after surgery. Patient-report measures were variable, with no to small response early, but had excellent long-term responsiveness that was twice as large as performance measures. Patient perception fails to capture the acute functional declines after TKA and may overstate the long-term functional improvement with surgery. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty

              Objectives To identify patient-reported outcome measures (PROMs) that have been developed and/or used with patients undergoing hip or knee replacement surgery and to provide a shortlist of the most promising generic and condition-specific instruments. Methods A systematic review of the literature was performed to identify measures used in patients undergoing hip and knee replacement and extract and evaluate information on their methodological quality. Results Thirty-two shortlisted measures were reviewed for the quality of their measurement properties. On the basis of the review criteria, the measures with most complete evidence to date are the Oxford Hip Score (OHS) (for patients undergoing hip replacement surgery) and the Oxford Knee Score (OKS), with OKS-Activity and Participation Questionnaire (for patients undergoing knee replacement surgery). Conclusion A large number of these instruments lack essential evidence of their measurement properties (eg, validity, reliability, and responsiveness) in specific populations of patients. Further research is required on almost all of the identified measures. The best-performing condition-specific PROMs were the OKS, OHS, and Western Ontario and McMaster Universities Osteoarthritis Index. The best-performing generic measure was the Short Form 12. Researchers can use the information presented in this review to inform further psychometric studies of the reviewed measures.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                29 December 2019
                : 9
                : 12
                : e033832
                Affiliations
                [1 ] departmentNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford, Oxfordshire, UK
                [2 ] Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust , Oxford, UK
                [3 ] departmentCentre for Statistics in Medicine , University of Oxford , Oxford, UK
                Author notes
                [Correspondence to ] Scott R Small; scott.small@ 123456ndorms.ox.ac.uk
                Author information
                http://orcid.org/0000-0003-3603-8062
                http://orcid.org/0000-0002-4258-5866
                Article
                bmjopen-2019-033832
                10.1136/bmjopen-2019-033832
                6936993
                31888943
                d6ee71c4-fa44-4ac9-8e56-06aee8b28bca
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 23 August 2019
                : 18 November 2019
                : 20 November 2019
                Categories
                Rehabilitation Medicine
                Original Research
                1506
                1727
                Custom metadata
                unlocked

                Medicine
                accelerometry,gait analysis,systematic review,knee arthroplasty,physical activity
                Medicine
                accelerometry, gait analysis, systematic review, knee arthroplasty, physical activity

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