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


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


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).


CONCLUSIONS
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.
North of England Bone and Soft Tissue Tumour Service, Department of Orthopaedics, Freeman Hospital, Newcastle Upon Tyne, NE77DN, UK. Electronic address: sherron.furtado@newcastle.ac.uk.
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Furtado
Faculty of Medical Sciences, Newcastle Library, Newcastle University, NE2 4HH, UK. Electronic address: linda.errington@newcastle.ac.uk.
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Errington
Institute of Neuroscience, Clinical Aging Research Unit, Newcastle University, NE4 5PL, UK. Electronic address: alan.godfrey@newcastle.ac.uk.
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Godfrey
Institute of Neuroscience, Clinical Aging Research Unit, Newcastle University, NE4 5PL, UK. Electronic address: lynn.rochester@newcastle.ac.uk.
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Rochester
North of England Bone and Soft Tissue Tumour Service, Department of Orthopaedics, Freeman Hospital, Newcastle Upon Tyne, NE77DN, UK. Electronic address: craig.gerrand@nuth.nhs.uk.
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Gerrand
D000203:Activities of Daily Living; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000503:physiopathology / Q000628:therapy*; D015444:Exercise; D005684:Gait; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology / Q000601:surgery*; D059351:Organ Sparing Treatments; D017063:Outcome Assessment, Health Care; D004856:Postural Balance; D015203:Reproducibility of Results; D012509:Sarcoma / Q000503:physiopathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000503:physiopathology / Q000628:therapy*
Activity restrictions; Balance; Functional outcomes; Gait; Musculoskeletal cancer; Physical activity