title: Assessing functional mobility after lower limb reconstruction: a psychometric evaluation of a sensor-based mobility score.
abstract: OBJECTIVE
  To develop and validate a robust, objective mobility assessment tool, Hamlyn Mobility Score (HMS), using a wearable motion sensor.
  
  
  BACKGROUND
  Advances in reconstructive techniques allow more limbs to be salvaged. However, evidence demonstrating superior long-term outcomes compared with amputation is unavailable. Lack of access to quality regular functional mobility status may be preventing patients and health care staff from optimizing rehabilitation programs and evaluating the reconstructive services.
  
  
  METHODS
  In this prospective cohort study, 20 patients undergoing lower limb reconstruction and 10 age-matched controls were recruited. All subjects completed the HMS activity protocol twice under different instructors at 3 months postoperatively, and again at 6 months, while wearing an ear-worn accelerometer. Demographic and clinical data were also collected including a short-form health survey (SF-36). HMS parameters included standard test metrics and additional kinematic features extracted from accelerometer data. A psychometric evaluation was conducted to ascertain reliability and validity.
  
  
  RESULTS
  The HMS demonstrated excellent reliability (intraclass correlation coefficient >0.90, P < 0.001) and internal consistency (Cronbach α = 0.897). Concurrent validity was demonstrated by correlation between HMS and SF-36 scores (Spearman ρ = 0.666, P = 0.005). Significant HMS differences between healthy subjects and patients, stratified according to fracture severity, were shown (Kruskal-Wallis nonparametric 1-way analysis of variance, χ = 21.5, P < 0.001). The HMS was 50% more responsive to change than SF-36 (effect size: 1.49 vs 0.99).
  
  
  CONCLUSIONS
  The HMS shows satisfactory reliability and validity and may provide a platform to support adaptable, personalized rehabilitation and enhanced service evaluation to facilitate optimal patient outcomes.
authors.affiliation: *Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom; and †Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Kwasnicki
authors.forename: Shehan
authors.initials: S
authors.lastname: Hettiaratchy
authors.forename: Delaram
authors.initials: D
authors.lastname: Jarchi
authors.forename: Craig
authors.initials: C
authors.lastname: Nightingale
authors.forename: Matthew
authors.initials: M
authors.lastname: Wordsworth
authors.forename: Jon
authors.initials: J
authors.lastname: Simmons
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods*; D020127:Recovery of Function; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome