Rehabilitation and physical functioning after treatment for lower extremity musculoskeletal tumours

Abstract

Physical deficits are common after treatment for musculoskeletal tumours. Good quality support services, and the use of valid and reliable physical assessments to guide rehabilitation could significantly reduce these deficits, but knowledge about this is lacking. This PhD thesis therefore, examines the national state of rehabilitation services and outcomes for patients who have an amputation for sarcoma (phase 1), systematically reviews the current state of objective clinical measurement of physical functioning (phase 2), and pilots the use of small accelerometer-based body worn monitors (BWMs) to assess physical functioning in patients treated for lower extremity musculoskeletal tumours (phase 3). Original contributions to knowledge are: - Phase 1: Patients have a variable experience of rehabilitation services in England, after amputation for sarcoma, with services falling short of recommended national standards. Patients also present with poor physical functioning, pain and quality of life. - Phase 2: Studies quantifying balance, gait and physical activity (PA) are lacking in patients with lower extremity sarcomas, with most not using valid and reliable instruments. - Phase 3: This study supports the feasibility, acceptability and general validity of using a low-cost accelerometer-based BWM for rapid physical assessments in the clinic and real world. BWM measures of ellipsis (area of postural sway), root mean square (magnitude of sway), jerk (smoothness of sway), step time, stance time, step length, step velocity, total time, instrumented timed up and go (iTUG) time, total steps/day and alpha (pattern of bouts) were most sensitive in characterising physical functioning. The major conclusions were that patient experience of rehabilitation services and outcomes are variable after amputation for sarcoma, with scope for improvements. There is a deficit of studies on balance, gait and PA assessments in patients with sarcoma and accelerometer-based BWMs, could be a solution as the thesis supports their feasibility, acceptability and validity.