Exploring Motio Functional Report Metrics - Daily Activity Highlights
Building upon one of our previous blog posts, the Motio Functional Report contains distinct sections, including daily activity highlights, an overall activity summary, blind outcome evaluations, and detailed activity graphs.
During the long-term acquisition, the Motio StepWatch™ system gathers step-related information and integrates it with in-clinic patient outcome results to create a deeper understanding of each prosthetic user's mobility potential. The different metrics and visuals that are presented on the Motio Functional Report allow the clinician to comprehend what prosthetic users are usually accomplishing in their daily lives. Then, they can use this information as a benchmark when evaluating their potential and deciding which K-level recommendation would be more appropriate to each case before getting the Motio Functional Level. The Motio Functional Level, suggested by the Motio StepWatch, will then take into account the clinician's decision, along with the remaining report context.
To help you understand the Daily Activity Highlights section, in this blog post, we will present the importance of each of the specific categories presented.
The significance and how to understand the Daily Activity Highlights
The Motio StepWatch System collects step data, which is then used to categorize Daily Activity Highlights into four distinctive groups throughout the patient's acquisition process. This data is provided to the clinician in two different contexts:
Firstly, the average data recorded per day offers an overview of the patient's typical activity level. It provides valuable information for the clinician to understand the patient's regular accomplishments.
Secondly, the system presents the best result for each Daily Activity Highlight, which represents the patient's highest activity level recorded on their "best day." This data enables the clinician to gain insights into the patient's peak performance and evaluate their potential.
Figure 1: Example of Daily Activity Highlights in the Motio Functional Report
By considering both the average data and the best results, the clinician can make a well-informed Clinician Recommendation, prior to obtaining the Motio Functional Level result. This comprehensive approach ensures that the patient's activity and potential are thoroughly assessed and considered during the evaluation process.
Steps (steps): A Measure of Transformation
When it comes to prosthetic rehabilitation and the well-being of lower-limb prosthetic users, the simple act of walking holds transformative power. In a previous blog post, we highlighted the significance of evaluating Daily Steps.
Step counts provide valuable insights into the functional capabilities of prosthetic users. As lower-limb prosthetic users adapt to their prosthetic limbs, tracking their daily step count provides valuable insights into their mobility improvements over time. Steps are recorded on the prosthetic side and doubled to correlate to the contralateral leg.
Daily average: average daily step count.
Best step count: highest step count recorded in a single day.
A review of 21 research studies was undertaken in 2021 by Wong et al.[1] focusing on the acquisition of daily step counts to assess physical activity among individuals with lower-limb loss (PLL). According to their findings, the individuals with lower-limb loss were observed to take an average of around 5,000 steps per day. This count falls notably short of the recommended daily step targets of 9000 to 11000 steps for maintaining overall health among able-bodied individuals, as proposed by Tudor-Locke et al.[2] in 2004. They also state that recommended steps per day for PLL could consider the increased energy expenditure used by them compared with able-bodied controls, which averaged approximately 3% to 28% higher for transtibial amputees and 31% to 45% higher for transfemoral amputees, depending on walking speed (with considerable individual variation). For instance, if transtibial amputees require 20% more energy and transfemoral amputees require 40% more energy, the recommended equivalent of 10,000 steps per day would be 8333 for the first and 7143 for the latter [1].
Top Speed (mph): Assessing Functional Capacity
Measuring top speed helps assess the overall functional capacity and mobility of someone using a lower limb prosthesis. It provides information about their ability to move quickly, efficiently, and safely in various environments. For individuals undergoing prosthetic rehabilitation, tracking their top speed over time can be a valuable indicator of their progress. It can serve as a concrete measure of improvements in strength, balance, and prosthetic control.
Average top speed: average top daily speed during the acquisition period.
Best speed: fastest speed recorded during the acquisition period.
Top Cadence (steps/min): Optimizing Gait Function
Measuring top cadence, also known as the maximum step rate, refers to the maximum number of steps taken per minute. Walking is defined as ≥ 1 step per minute. An increase in cadence indicates that the patient is walking at faster speeds and/or walking longer in continuous bouts[3].
Understanding a prosthetic user’s top cadence helps ensure that the prosthetic device is appropriately designed and fitted and track their progress over time. This information aids in selecting components and settings that can accommodate the user's preferred cadence and stride length but also allows for evaluation of any improvements in strength, coordination, and overall gait function.
This may emphasize the significance of cadence in the function of people with lower-limb prosthetics, particularly the ability to reach a greater peak cadence, which suggests a higher level of cadence variability.
Average top cadence: average maximum steps per minute in a day during the acquisition period.
Best top cadence: the highest number of steps per minute recorded during the acquisition period.
Maximum Continuous Walking Distance (ft): Endurance and Community Engagement
Defined as the longest period of continuous walking for a certain period or distance, this measure is seen as a relevant clinical outcome, hence the usage of six-minute walk tests and similar outcome measures. Analyzing the maximum continuous walking distance provides valuable information about the ability of the person to endure continuous walking, reflecting their aerobic capacity and the patient’s possibility of engagement in their community.
Average gait bout: average longest continuously walked distance in a day during the acquisition period.
Best gait bout: longest continuously walked distance throughout the whole acquisition period.
Researchers have previously determined that ≈984 feet (300 meters) is the minimum distance for community ambulation [4] – [6].
A Complete Approach to Prosthetic Rehabilitation
The Motio Functional Report, driven by the Motio StepWatch System, empowers rehabilitation teams to make well-informed decisions. By comprehensively analyzing the different sections, clinicians gain a vivid picture of each individual's daily activities and potential. This not only aids in setting realistic goals for rehabilitation but also contributes to the overall enhancement of the quality of life for prosthetic users. In the absence of specific activity recommendations for lower limb prosthetic users in current guidelines, the Motio Functional Report emerges as a valuable tool for personalized and effective prosthetic rehabilitation.
References
[1] C. K. Wong, M. S. Rissland, D. M. Madagan, and K. N. Jones, “A Scoping Review of Physical Activity in People With Lower-Limb Loss: 10,000 Steps Per Day?,” Phys Ther, vol. 101, no. 8, Aug. 2021, doi: 10.1093/ptj/pzab115.
[2] C. Tudor-Locke and D. R. Bassett, “How Many Steps/Day Are Enough? Preliminary Pedometer Indices for Public Health,” Sports Medicine, vol. 34, no. 1, pp. 1–8, Dec. 2004, doi: 10.2165/00007256-200434010-00001/METRICS.
[3] B. Godfrey, C. Duncan, and T. Rosenbaum-Chou, “Comparison of Self-Reported vs Objective Measures of Long-Term Community Ambulation in Lower Limb Prosthesis Users,” Arch Rehabil Res Clin Transl, vol. 4, no. 3, p. 100220, Sep. 2022, doi: 10.1016/j.arrct.2022.100220.
[4] M. Ayabe, H. Kumahara, K. Morimura, and H. Tanaka, “Epoch length and the physical activity bout analysis: An accelerometry research issue,” 2013, doi: 10.1186/1756-0500-6-20.
[5] “Physical activity.” Accessed: Nov. 02, 2023. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/physical-activity
[6] B. Godfrey, C. Duncan, and T. Rosenbaum-Chou, “Comparison of Self-Reported vs Objective Measures of Long-Term Community Ambulation in Lower Limb Prosthesis Users,” Arch Rehabil Res Clin Transl, vol. 4, no. 3, p. 100220, Sep. 2022, doi: 10.1016/J.ARRCT.2022.100220.
