Objective clinical measurement of physical functioning after treatment for lower extremity sarcoma - A systematic review

Abstract

Background: Physical impairments and activity restrictions cause significant morbidity after surgery for sarcoma. Yet objective assessment of key components of balance, gait and physical activity (PA), using valid and reliable outcome measures, is lacking in routine clinical practice.

Purpose of review: We therefore performed a systematic review to identify studies quantifying balance, gait and PA in clinically useful ways, after treatment for lower extremity sarcoma.

Patients and methods: Relevant articles quantifying balance, gait and PA in patients who underwent surgery for lower extremity bone or soft tissue sarcoma were identified from Medline, Embase, Scopus, and Web of Science up to February 2016. Results were compiled by principal research findings, objective measures used, their ability to detect differences between important clinical groups, change over time and reliability.

Results: Eighteen articles were included. Surgery had a significant impact on outcomes (p < 0.05). A wide range of measures and concerns about accuracy of measurement were noted, as gait and PA measures did not discriminate between distinct clinical groups such as limb sparing surgery and amputation, and did not detect changes over time. Few studies investigated reliability (n = 1) and sensitivity to change (n = 4).

Conclusion: There is a deficit of studies quantifying balance, gait and PA in patients with lower extremity sarcoma. Studies did not use consistent, valid and reliable instruments. There is an urgent need to develop novel objective measures of physical functioning in this patient group to encourage evidence-based clinical care.

Keywords: Activity restrictions; Balance; Functional outcomes; Gait; Musculoskeletal cancer; Physical activity.