BACKGROUND
Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of
prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and
technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses
the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits
of monitoring daily living and the barriers to long-term monitoring.
METHODS
A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of
studies that monitored the activity of prosthesis-users during daily-living.
RESULTS
60 lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in
the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast,
the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb
studies focused on the development or validation of actimeters, algorithms and/or scores for activity
classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the
amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb
studies were fairly evenly spread between development of algorithms, comparison of everyday activity to
clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the
degree of symmetry in activity levels between the arm with the prosthesis and the intact arm.
CONCLUSIONS
Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant
insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited
battery-life and lack of availability in many countries mean that using sensors to understand the daily use of
prostheses and the types of activity being performed has not yet become a feasible standard clinical practice.
This review provides recommendations for the research and clinical communities to advance this area for the
benefit of prosthesis users