Exploring Motio Functional Report Metrics - Daily Steps
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.
Building upon one of our previous blog posts, the Motio Functional Report contains distinct sections, including daily highlights, an overall activity summary, structured blind tests, and detailed activity graphs. In this post, our focus will center on the significance of one specific metric highlighted in the daily highlights section and a graphical representation found within the detailed activity section – Daily Steps.
The Significance of Daily Steps in Prosthetic Rehabilitation
When it comes to prosthetic rehabilitation and the well-being of lower-limb prosthetic users, the simple act of walking holds transformative power. Daily steps, often taken for granted, play a pivotal role in enhancing the quality of life for individuals who have undergone lower limb amputation and are adapting to life with a prosthetic limb.
The daily step number serves as an objective measure of progress in prosthetic rehabilitation to assess mobility, optimize prosthetic functionality, and promote overall health. As lower-limb prosthetic users adapt to their prosthetic limbs, tracking their daily step count provides valuable insights into their mobility improvements over time. It allows both the individual and their healthcare team to set achievable goals, gradually increasing step counts and distances as their comfort and abilities improve.
Functional Assessment
Step counts provide valuable insights into the functional capabilities of prosthetic users. By analyzing step counts, healthcare professionals can assess the user's ability to perform activities of daily living, such as walking, climbing stairs, or traversing uneven surfaces.
Prosthetic Optimization
Step counts serve as a quantifiable indicator of the prosthetic limb's fit, alignment, and overall functionality. If step counts are consistently low or uneven, it may indicate issues with the prosthesis, such as improper alignment, socket discomfort, or mechanical limitations. By closely monitoring step counts, prosthetists can identify areas for improvement and make necessary adjustments to enhance the user's mobility and comfort.
Physical and Mental Health Benefits
Regular physical activity is essential for maintaining overall health and well-being. For lower limb prosthetic users, step counts are an outcome measure to track the impact of physical activity on a user's quality of life and functional independence and can help ensure an appropriate level of activity and prevent sedentary behaviour. Achieving and maintaining a target step count promotes cardiovascular health, muscular strength, and psychological well-being. Additionally, the positive impact on mental well-being cannot be overlooked. Walking outdoors, engaging with nature, and being able to participate in social activities can significantly boost one's mood, reduce stress, and foster a sense of belonging within the community.
Setting Daily Step Goals: Recommended Step Counts for Lower Limb Prosthetic Users – do they exist?
The recommended daily number of steps for lower limb prosthetic users can vary based on several factors, including an individual's overall health status, physical condition, level of amputation, and rehabilitation progress. It's important to note that there is no one-size-fits-all answer, as each person's circumstances are unique.
How can these factors influence the step count?
Level of Amputation: The level of amputation (e.g., above knee, below knee) can influence the individual's biomechanics and energy expenditure while walking. If one has to spend more energy to walk the same distance as someone else with a lower level of amputation (for example, above knee in comparison to below knee amputees), their walks will be shorter, or their speed and number of breaks will have to be adjusted for the distance goal to be achieved.
Physical Fitness: An individual's overall physical fitness, strength, and cardiovascular health play a role in determining the appropriate number of steps. Those with better physical conditioning may be able to achieve higher step counts.
Rehabilitation Progress: The stage of prosthetic rehabilitation is a crucial factor. Early on, the focus may be on building strength, and balance and adapting to the prosthetic limb. As rehabilitation progresses, the goal could shift toward increasing daily steps.
Functional Goals: The patient's personal goals and lifestyle preferences are important considerations. If someone has specific goals, such as returning to work, participating in sports, or engaging in outdoor activities, their step count goals may be adjusted accordingly.
Health Status: Any existing health conditions or medical considerations need to be taken into account when determining a suitable daily step count goal.
A review of 21 research studies was undertaken in 2021 by Wong et al1, 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 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% more for transtibial amputees and 31% to 45% more 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 to 10,000 steps per day would be 8333 for the first and 7143 for the latter.
In the same article, the authors analyzed a study where stroke survivors (based on normative data) were categorized based on their daily step counts. Those surpassing 7500 steps per day were classified as unlimited community walkers, while those who took 5000 to 7499 steps per day were classified as limited community ambulators. Participants taking 2500 to 4999 steps per day were classified as the most limited community walkers and those who took 100 to 2499 steps per day were classified as household walkers. Although stroke survivors and PLLs face distinctly different and perhaps incomparable challenges, they can live in community settings that demand the same walking distances and speed requirements.
Daily Steps in the Motio Functional Report: Presentation and Interpretation
In the Motio Functional Report, daily steps are presented in two different sections: Daily Highlights and Detailed Activity.
In the Daily Highlights section, daily steps are presented on:
Average steps are recorded per day, offering an overview of the patient's typical activity level, and providing valuable information for the clinician to understand the patient's regular accomplishments.
Best step day, representing the patient's highest step count recorded on their "best day." This value enables the clinician to gain insights into the patient's peak performance and evaluate their potential.
In the Detailed Activity section, daily steps are presented with a visual representation of the daily number of steps taken by the patient during the acquisition period. This visual allows clinicians to observe the variation in step count on a day-to-day basis, providing insights into the highest, lowest, and most common values throughout the acquisition period. This can be used to gather insights about a patient’s consistency from day to day.
To date, specific daily step recommendations for lower limb prosthetic users remain missing from guidelines and literature. Getting up on our feet and walking every day may seem like a small action, but its impact is profound, serving not only as a journey towards independence and an enhanced quality of life for the individuals themselves but also as a crucial aspect for the rehabilitation team. By utilizing the Motio service and analyzing the Motio Functional Report, the rehabilitation team can make more informed decisions on each individual’s prosthetic rehabilitation by gathering data that shows a vivid picture of each individual's daily activities and potential.
References
1. Wong CK, Rissland MS, Madagan DM, Jones KN. A Scoping Review of Physical Activity in People with Lower-Limb Loss: 10,000 Steps per Day? Phys Ther. 2021;101(8). doi:10.1093/ptj/pzab115
2. Tudor-Locke C, Bassett DR. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004;34(1):1-8. doi:10.2165/00007256-200434010-00001
