Correlation between objective and subjective measures to achieve functional limb salvage.

Abstract

Functional ambulation is a key component of limb salvage in the chronic lower extremity (LE) wound population. Function can be measured subjectively using patient-reported outcome measures (PROMs) and objectively using wearable gait sensors. The purpose of this study was to evaluate the relationship between gait parameters and PROMs to identify patients at risk of adverse outcomes. Between June 2021 and February 2024, adult patients aged ≥18 years without open wounds who could safely ambulate without assistance or pain were included. Patients completed the lower extremity function scale (LEFS), a walk test, and a Romberg sway test with sensors. Two patients groups were created for analysis: Moderate-high function (LEFS ≥ 41) and mild-minimal function patients (LEFS < 41). Overall, 104 patients participated in testing, with 76.9% classified as moderate-high function and 23.1% as mild-minimal function. There were no significant differences in comorbidities between the groups. Patients with moderate-high function had significantly faster gait speeds (p<0.001), shorter step duration (p<0.001), faster cadence (p<0.001), longer strides (p<0.001), greater single limb support (p<0.001), and greater stability (p<0.001) than those with mild-minimal function. Multivariate analysis demonstrated that high levels of function independently predicted improved gait for most studied parameters. Patients with lower LEFS scores demonstrated pathologic gait. The significant correlation between lower LEFS scores and gait speed, step duration, cadence, single limb support, and step length suggests the potential for the LEFS to be implemented in clinical practice. To our knowledge, this is the first study that has correlated objective analysis using gait sensors with PROMs to understand and correlate ambulatory status.