Exploring the Motio Report: A Quick Guide to Understanding its Insights
Patients with lower limb prostheses face unique challenges in their rehabilitation journey. The steps taken to evaluate a prosthetic user’s functional level vary between practitioners. Most frequently, it combines the patient's information with the clinician's own in-office evaluation, both of which can be fairly subjective. To assess their progress and determine the effectiveness of interventions, outcome measures are essential tools clinicians use. These measures provide valuable data that guide treatment decisions, enhance communication among healthcare providers, and improve patient outcomes, but most of them only really represent how a patient acts within the walls of an O&P Clinic or Rehabilitation Center.
With the Motio StepWatch™ system developed by Adapttech, the Rehabilitation Team surrounding a patient’s care has the ability to make more informed decisions on each individual’s prosthetic rehabilitation by obtaining real-world information on what’s occurring in their day-to-day.
The system tracks a lower limb prosthetic user's activity over a minimum period of 7 days, generating a report that contains different metrics. These metrics include energy consumption, cadence, distance, speed, and more, allowing clinicians to accurately classify their patient's activity level.
Extracting meaningful insights from the objective data provided by Motio StepWatch is crucial for understanding a patient's mobility. However, without the necessary context, comprehending the significance of these findings can pose a challenge. In order to overcome this, let us embark on a deeper exploration of the Motio Report, examining its diverse sections and discovering valuable insights along the way.
Section 1: Patient Information
To ensure patient-centered care, it is essential to integrate data sources and track progress, combining data-driven metrics with historical patient information.
In this section, a clear identification of the patient and the circumstances of the test(s) performed are presented. The Motio Stepwatch provides objective data that should be contextualized with patient information, such as demographics, comorbidities, height and weight, and prosthetic components, in order to gain a comprehensive understanding of the patient's overall health status.
Section 2: Clinical Evaluation – Clinician Recommendation
This section emphasizes the clinician's suggested K-Level for the patient, which can be justified through a comprehensive evaluation of in-clinic patient-reported outcome measures, performance outcome measures, and/or the Daily Highlights presented in Section 5.
This K-Level recommendation will be used in the calculation of the Motio Functional Level.
Section 3: Motio Functional Level
Once the data has been collected, the Motio Stepwatch system uses specific proprietary algorithms to calculate scores related to ambulation energy, cadence variability, and the user’s peak performance. These scores are represented as numerical values and are then averaged with the clinician's recommended K-Level from Section 2, providing the Motio Functional Level.
The inclusion of a decimal value in the Motio Functional Level score allows for more precise quantification of a patient's functional level and potential.
While two patients may have the same K-level classification, they can still have distinct needs and capabilities. By incorporating an additional numerical detail in the score, the system can better capture these nuances and provide a more accurate representation of the patient's functional status, ensuring that their specific requirements are appropriately addressed.
Table 1 - Motio Functional Level vs MCFL K-Level
Section 4: In-Clinic Tests
This section is dedicated to presenting the results of optional Gold Standard Outcome Measures conducted in-clinic. While these tests are not mandatory, they offer valuable insights that, when combined with the Motio Functional Level, contribute to obtaining a more comprehensive understanding of the patient's functional level.
The suggested in-clinic tests include the following:
Performance-based measures: AMPPRO® and TUG
The AMPPRO® evaluates functional levels beyond locomotion, encompassing aspects such as balance, gait characteristics, and obstacle overcoming. These are crucial elements that cannot be fully assessed by Motio Stepwatch alone.
The TUG test provides additional information about static and dynamic balance, enriching the evaluation of mobility.
Patient-reported measure: PLUS-M™
The PLUS-M™ is a widely validated tool that incorporates the patient's perspective into their evaluation. It provides various mobility-related factors from the patient's point of view, offering valuable insights into their considerations and experiences.
By including these optional Gold Standard Outcome Measures in the assessment, a more holistic picture of the patient's functional level can be obtained, encompassing a broader range of factors and perspectives beyond the data provided by the Motio Stepwatch.
Section 5: Daily Highlights
The Motio StepWatch utilizes and collects step data, which is then used to categorize Daily Highlights into five distinct groups throughout the patient's acquisition process. This data is provided to the clinician in two different contexts in Section 5:
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 and serves as a benchmark for evaluating their potential.
Secondly, the system presents the best result for each Daily 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 capabilities.
By considering both the average data and the best results, the clinician can make a well-informed K-Level recommendation (Section 2), 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.
Section 6: Activity Scores
In this section, step data obtained during data collection is presented by three different scores:
Ambulation Energy: This score is derived from the energy expended during ambulation, taking into account the daily steps and the intensity of continuous walking bouts. It reflects the overall energy expenditure of the patient throughout the acquisition period. By considering weight and walking intensity, this score provides insights into the patient's overall energy usage during walking activities.
The score provided ranges from 1.5 to 4.9.
A higher score indicates a greater amount of energy expended by the prosthetic user over the course of the acquisition period. This means that individuals with higher scores demonstrate a higher level of energy usage during their ambulation activities.
Peak Performance: This score represents the average of the 30 fastest 1-minute walking spurts achieved by the person each day. It captures the best step and cadence metrics recorded during the periods when the prosthesis was in use. The Peak Performance score reflects the individual's highest level of performance during those moments, providing a measure of their maximum walking ability.
The score provided ranges from 0.5 to 4.9. Higher scores correlate with higher functional levels, as these individuals typically engage in activities requiring more endurance, coordination, and energy.
Additionally, if prosthetic users demonstrate the ability to walk quickly in 1-minute spurts, it indicates their potential to sustain that fast pace with further training or by utilizing different prosthetic components. This suggests that, with additional support such as training programs or adjustments to their prosthetic setup, they have the opportunity to further enhance their walking speed and potentially attain even higher functional levels.
Cadence Variability: This score relates to the proportion of time spent at different walking cadences, including high, moderate, and low cadences. It offers insight into how the individual varies their walking cadence throughout the day. Cadence variability can be a useful metric for assessing gait patterns and understanding how the patient adjusts their walking speed and rhythm.
The score provided ranges from 0.5 to 4.9. The higher the value, the greater the variance in cadence throughout the acquisition period.
Higher scores correlate with Higher Functional Levels. Individuals with higher functional levels often exhibit the ability to adjust their walking speed and cadence in order to successfully accomplish tasks within their community. By demonstrating a wider range of cadence variability, these individuals showcase their flexibility and adaptability in ambulation, which reflects their higher functional capacity.
Section 7: Overall Activity Description
Section 7 provides an overall activity description of the long-term acquisition. This section offers a calendar and a percentage of time for different intensity levels.
The calendar presents the number of evaluated days with the Motio Stepwatch during the total acquisition period. It specifically highlights the days on which step activity was captured by the device and subsequently analyzed for the report. This calendar serves as a visual representation of the data collection timeline, indicating the specific days during which the patient's step activity was monitored and considered in the generation of the report.
The percentage of time spent at different intensity levels of walking activity is shown by activity intensity. Measuring the duration of time spent at different intensity levels of walking activity is a valuable metric for assessing functional and relevant walking performance. This data provides insights into the "structure of daily walking activity." Activity intensity is classified into three categories: low (1–30 steps per minute), moderate (31–80 steps per minute), and high (more than 80 steps per minute) based on the number of steps taken per minute.
Section 8: Structured Blind Tests
The Motio Stepwatch can perform three blind tests that can be conducted during the acquisition period, whose results are presented in Section 8: the 2-Minute Walk Test, the 6-Minute Walk Test, and the 10-Meter Walk Test.
The Distance Walk Tests, which include the 2-Minute and 6-Minute Walk Tests, provide insights into a person's endurance when walking continuously for a specific duration. By measuring the accumulated distance during these tests, the clinician can gain an understanding of their cadence during moments of daily life that require sustained movement.
On the other hand, the Timed Walk Test serves as a measure of short-distance walking at the patient's usual pace. It provides valuable information about their walking speed over a defined distance.
The advantage of conducting blind tests is that they capture the most accurate and unbiased representation of a patient's functional level. By removing the awareness of being tested, the results are less influenced by external factors and provide a more objective assessment of the patient's capabilities.
Section 9: Detailed Activity
The final section of the Motio Report focuses on summarizing the activity observed throughout the acquisition period using two distinct visuals (bar graphs and histogram graphs) with three detailed values: the daily number of steps, daily activity intensity, and daily step activity.
Bar graphs
The first bar graph presents 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 view a patient’s consistency from day to day.
The second visual depicts the daily activity intensity, showcasing the distribution of time spent in low, moderate, and high-intensity activity throughout the acquisition period. By presenting this information visually, clinicians can easily identify the patterns and trends in the patient's activity intensity levels each day, gaining a deeper understanding of their activity profile.
Histogram graphs
The third visual depicts the detailed activity graphs in the form of histograms of steps per minute over a 24-hour period. Each day of the acquisition period is represented by a single histogram, starting at midnight and ending 24 hours later. In these graphs, the number of steps in each one-minute interval is depicted by a thin vertical line, with the length of the line representing the number of steps recorded during that specific minute. By visualizing the distribution of steps taken throughout the day, these graphs provide insights into cadence variability, the potential to ambulate, and energy level.
The presence of multiple varying peaks and valleys in the histograms indicates a higher potential for mobility. This visual representation signifies fluctuations in activity levels, with distinct peaks suggesting periods of increased movement and valleys indicating relatively less active moments.
By utilizing accurate and quantifiable information, healthcare professionals are empowered to make informed decisions and adapt treatment plans to each individual's needs. Objective data allows for a comprehensive understanding of a patient's progress, gait patterns, and functional abilities, enabling targeted interventions that maximize outcomes and enhance overall rehabilitation success. Moreover, objective data provides a basis for tracking improvements over time, setting realistic goals, and objectively evaluating the effectiveness of different interventions.
In conclusion, the implementation of this data-driven approach, as exemplified by the insights offered in the Motio Report, is invaluable in understanding the progress and overall performance of lower limb prosthetic users. This empowers healthcare professionals to implement targeted interventions and make necessary adjustments, ultimately optimizing the rehabilitation journey for these individuals.
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