Assessing Functional Mobility in Survivors of LowerExtremity Sarcoma:

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• Assessing Functional Mobility in Survivors of
  Lower-Extremity Sarcoma
• Reliability and Validity of a New Tool
• Victoria Marchese, PhD, PT
• June 9, 2006
• Niagara-on-the-Lake, Ontario, Canada

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Background Rational

• Increasing numbers of survivors
• Greater focus on functional outcomes and QOL
• Commonly used Outcome Measures
• Musculoskeletal Tumor Society (MSTS)
• Toronto Extremity Salvage Score (TESS)
• Short Form 36 (SF-36)

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Aim

• Examine the reliability validity of a new tool,
  the Functional Mobility Assessment (FMA)

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Procedures

• 3 physical therapists
• Multi-site
• St. Jude Childrens Research Hospital
• The Childrens Hospital of Philadelphia
• Reliability Testing
• Validity Testing
• Longitudinal Component

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Inclusion Criteria

• Lower-extremity sarcoma
• Undergone amputation, limb-sparing, or
  rotationplasty at lease one year prior
• At least 13 years of age or in the 6th grade

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Participants

• 114 participants
• 20 healthy volunteers
• 94 patients with lower-extremity sarcoma
• 23 participants in reliability testing
• 7 patients (6, 12, 18 months)

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Patients with Lower-Extremity Sarcoma

• 94 patients
• Type of sarcoma
• 15 Ewings (14 bone sarcoma, 1 soft tissue)
• 77 Osteosarcoma (all bone sarcoma)
• 2 Synovial (all soft-tissue)
• Type of surgery
• 22 Amputation
• 68 Limb sparing
• 4 Rotation plasty
• Median age 19 years at enrollment (range, 10-42
  years)

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Outcome Measures

• Functional Mobility Assessment
• Musculoskeletal Tumor Society
• Toronto Extremity Salvage Score
• Short Form-36 version 2

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Pain
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Functional Mobility
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Subjective
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Endurance
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Results

• Intra- and inter-rater Reliability (ICCgt0.97)
• Concurrent Validity
• FMA MSTS (r0.68, Plt0.001)
• FMA TESS (r0.63, Plt0.001)
• FMA SF-36v2 physical (r0.64, Plt0.001)

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Construct Validity

• 
  

Plt0.001
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AKA and Limb-Sparing Femur
(Plt0.01)

• No significant differences were identified with
  the MSTS, TESS or SF-36v2

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BKA and Limb-Sparing Tibia
(Plt0.10)
(Plt0.05)

• No significant differences were identified with
  the MSTS or TESS

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AKA and Rotationplasty
(P0.05)
(P0.01)

• No significant differences were identified with
  the TESS or SF-36v2

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Limb-Sparing Femur and Rotationplasty
(P0.01)
(P0.04)

• No differences were identified with the FMA or
  SF-36v2

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Longitudinal

• Positive trend
• 9-minute run-walk 6, 12, 18 months (P0.04)
• SF-36v2 6, 12, 18 months (P0.02)
• No trends with the MSTS TESS

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FMA Quality of Life

• FMA is a significant predictor of health related
  quality of life as measured with the SF-36v2

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Conclusion

• The FMA is a reliable and valid measure of
  functional mobility in patients with
  lower-extremity sarcoma.
• The FMA can discriminate between patients with
  varying functional abilities.
• There is a need to include measures of objective
  functional mobility in the examination of
  patients with lower-extremity sarcoma.