{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:08:20Z","timestamp":1791432500741,"version":"4.3.3"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001273","name":"CHILDREN with CANCER UK","doi-asserted-by":"publisher","award":["2012\/139"],"award-info":[{"award-number":["2012\/139"]}],"id":[{"id":"10.13039\/501100001273","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009756","name":"Sarcoma UK","doi-asserted-by":"publisher","award":["007.2012"],"award-info":[{"award-number":["007.2012"]}],"id":[{"id":"10.13039\/100009756","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nPhysical limitations are frequent and debilitating after sarcoma treatment. Markerless motion capture (MMC) could measure these limitations. Historically expensive cumbersome systems have posed barriers to clinical translation.<\/jats:p>\n<\/jats:sec>\n\nResearch question<\/jats:title>\nCan inexpensive MMC [using Microsoft KinectTM<\/jats:sup>] assess functional outcomes after sarcoma surgery, discriminate between tumour sub-groups and agree with existing assessments?<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWalking, unilateral stance and kneeling were measured in a cross-sectional study of patients with lower extremity sarcomas using MMC and standard video. Summary measures of temporal, balance, gait and movement velocity were derived. Feasibility and early indicators of validity of MMC were explored by comparing MMC measures i) between tumour sub-groups; ii) against video and iii) with established sarcoma tools [Toronto Extremity Salvage Score (TESS)), Musculoskeletal Tumour Rating System (MSTS), Quality of life-cancer survivors (QoL-CS)]. Statistical analysis was conducted using SPSS v19. Tumour sub-groups were compared using Mann-Whitney U tests, MMC was compared to existing sarcoma measures using correlations and with video using Intraclass correlation coefficient agreement.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThirty-four adults of mean age 43 (minimum value\u2014maximum value 19\u201389) years with musculoskeletal tumours in the femur (19), pelvis\/hip (3), tibia (9), or ankle\/foot (3) participated; 27 had limb sparing surgery and 7 amputation. MMC was well-tolerated and feasible to deliver. MMC discriminated between surgery groups for balance (p<0.05*), agreed with video for kneeling times [ICC = 0.742; p = 0.001*] and showed moderate relationships between MSTS and gait (p = 0.022*, r = -0.416); TESS and temporal outcomes (p = 0.016* and r = -0.0557*), movement velocity (p = 0.021*, r = -0.541); QoL-CS and balance (p = 0.027*, r = 0.441) [* = statistical significance]. As MMC uncovered important relationships between outcomes, it gave an insight into how functional impairments, balance, gait, disabilities and quality of life (QoL) are associated with each other. This gives an insight into mechanisms of poor outcomes, producing clinically useful data i.e. data which can inform clinical practice and guide the delivery of targeted rehabilitation. For example, patients presenting with poor balance in various activities can be prescribed with balance rehabilitation and those with difficulty in movements or activity transitions can be managed with exercises and training to improve the quality and efficiency of the movement.<\/jats:p>\n<\/jats:sec>\n\nSignificance<\/jats:title>\nIn this first study world-wide, investigating the use of MMC after sarcoma surgery, MMC was found to be acceptable and feasible to assess functional outcomes in this cancer population. MMC demonstrated early indicators of validity and also provided new knowledge that functional impairments are related to balance during unilateral stance and kneeling, gait and movement velocity during kneeling and these outcomes in turn are related to disabilities and QoL. This highlighted important relationships between different functional outcomes and QoL, providing valuable information for delivering personalised rehabilitation. After completing future validation work in a larger study, this approach can offer promise in clinical settings. Low-cost MMC shows promise in assessing patient\u2019s impairments in the hospitals or their homes and guiding clinical management and targeted rehabilitation based on novel MMC outcomes affected, therefore providing an opportunity for delivering personalised exercise programmes and physiotherapy care delivery for this rare cancer.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0300351","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T18:15:10Z","timestamp":1711649710000},"page":"e0300351","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Feasibility of using low-cost markerless motion capture for assessing functional outcomes after lower extremity musculoskeletal cancer surgery"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9635-1571","authenticated-orcid":true,"given":"Sherron","family":"Furtado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brook","family":"Galna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Godfrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Rochester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Gerrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"issue":"1","key":"pone.0300351.ref001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13569-016-0047-1","article-title":"UK guidelines for the management of bone sarcomas","volume":"6","author":"C Gerrand","year":"2016","journal-title":"Clinical Sarcoma Research"},{"key":"pone.0300351.ref002","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13569-016-0060-4","article-title":"UK guidelines for the management of soft tissue sarcomas.","volume":"6","author":"A Dangoor","year":"2016","journal-title":"Clin Sarcoma Res"},{"issue":"2","key":"pone.0300351.ref003","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/13577149977677","article-title":"Symptoms and their Relationship to Disability Following Treatment for Lower Extremity Tumours.","volume":"3","author":"AM Davis","year":"1999","journal-title":"Sarcoma."},{"issue":"5","key":"pone.0300351.ref004","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1007\/BF00540024","article-title":"Development of a measure of physical function for patients with bone and soft tissue sarcoma","volume":"5","author":"AM Davis","year":"1996","journal-title":"Qual Life Res"},{"issue":"6","key":"pone.0300351.ref005","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.ejso.2016.10.002","article-title":"Objective clinical measurement of physical functioning after treatment for lower extremity sarcoma; 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Modification of the system for functional evaluation in the surgical management of musculoskeletal tumors"},{"issue":"286","key":"pone.0300351.ref009","first-page":"241","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","author":"WF Enneking","year":"1993","journal-title":"Clinical orthopaedics and related research"},{"issue":"3","key":"pone.0300351.ref010","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/CORR.0000000000000883","article-title":"Are Accelerometer-based Functional Outcome Assessments Feasible and Valid After Treatment for Lower Extremity Sarcomas?","volume":"478","author":"S Furtado","year":"2020","journal-title":"Clinical orthopaedics and related research"},{"issue":"11","key":"pone.0300351.ref011","doi-asserted-by":"crossref","first-page":"2424","DOI":"10.1016\/j.clinph.2008.07.220","article-title":"The clinical utility of posturography.","volume":"119","author":"JE Visser","year":"2008","journal-title":"Clin Neurophysiol"},{"issue":"5","key":"pone.0300351.ref012","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2522\/ptj.20070205","article-title":"Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review","volume":"88","author":"L Blum","year":"2008","journal-title":"Phys Ther"},{"issue":"6","key":"pone.0300351.ref013","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1016\/j.ridd.2011.07.038","article-title":"Three-dimensional upper limb movement characteristics in children with hemiplegic cerebral palsy and typically developing children.","volume":"32","author":"E Jaspers","year":"2011","journal-title":"Res Dev Disabil"},{"issue":"7","key":"pone.0300351.ref014","doi-asserted-by":"crossref","first-page":"161018","DOI":"10.1098\/rsos.161018","article-title":"Balance control strategies during perturbed and unperturbed balance in standing and handstand.","volume":"4","author":"GM Blenkinsop","year":"2017","journal-title":"R Soc Open Sci"},{"issue":"4","key":"pone.0300351.ref015","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.gaitpost.2014.01.008","article-title":"Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson\u2019s disease.","volume":"39","author":"B Galna","year":"2014","journal-title":"Gait Posture."},{"issue":"4","key":"pone.0300351.ref016","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.apergo.2011.09.011","article-title":"Evaluation of the Kinect sensor for 3-D kinematic measurement in the workplace","volume":"43","author":"T. Dutta","year":"2012","journal-title":"Appl Ergon."},{"key":"pone.0300351.ref017","first-page":"3","article-title":"The evolution of methods for the capture of human movement leading to markerless motion capture for biomechanical applications","author":"L M\u00fcndermann","year":"2006","journal-title":"J Neuroeng Rehabil"},{"issue":"8","key":"pone.0300351.ref018","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1109\/TBME.2013.2250286","article-title":"Markerless Motion Capture and Measurement of Hand Kinematics: Validation and Application to Home-Based Upper Limb Rehabilitation","volume":"60","author":"CD Metcalf","year":"2013","journal-title":"IEEE Transactions on Biomedical Engineering"},{"issue":"2","key":"pone.0300351.ref019","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.3390\/s120201437","article-title":"Accuracy and resolution of Kinect depth data for indoor mapping applications.","volume":"12","author":"K Khoshelham","year":"2012","journal-title":"Sensors (Basel)."},{"key":"pone.0300351.ref020","author":"A Bleiweiss","year":"2009","journal-title":"Markerless motion capture using a single depth sensor"},{"issue":"3","key":"pone.0300351.ref021","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.gaitpost.2012.03.033","article-title":"Validity of the Microsoft Kinect for assessment of postural control.","volume":"36","author":"RA Clark","year":"2012","journal-title":"Gait & Posture."},{"key":"pone.0300351.ref022","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/978-3-642-28661-2_5","volume-title":"Machine Learning for Computer Vision.","author":"J Shotton","year":"2013"},{"issue":"5","key":"pone.0300351.ref023","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3109\/03091902.2014.909540","article-title":"Comparative abilities of Microsoft Kinect and Vicon 3D motion capture for gait analysis","volume":"38","author":"A Pfister","year":"2014","journal-title":"J Med Eng Technol"},{"issue":"10","key":"pone.0300351.ref024","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1016\/j.jbiomech.2015.05.021","article-title":"Gait assessment using the Microsoft Xbox One Kinect: Concurrent validity and inter-day reliability of spatiotemporal and kinematic variables","volume":"48","author":"BF Mentiplay","year":"2015","journal-title":"J Biomech"},{"issue":"4","key":"pone.0300351.ref025","doi-asserted-by":"crossref","first-page":"e0175813","DOI":"10.1371\/journal.pone.0175813","article-title":"Validation of enhanced kinect sensor based motion capturing for gait assessment.","volume":"12","author":"B M\u00fcller","year":"2017","journal-title":"PLOS ONE."},{"key":"pone.0300351.ref026","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.medengphy.2018.07.011","article-title":"Validity of the Microsoft Kinect() in assessing spatiotemporal and lower extremity kinematics during stair ascent and descent in healthy young individuals.","volume":"60","author":"J Oh","year":"2018","journal-title":"Med Eng Phys."},{"key":"pone.0300351.ref027","doi-asserted-by":"crossref","DOI":"10.1109\/SIU.2017.7960561","article-title":"Gait analysis using kinect: Towards in-home gait analysis.","volume":"15","author":"N Pehlivan","year":"2017","journal-title":"2017 25th Signal Processing and Communications Applications Conference (SIU);"},{"issue":"5","key":"pone.0300351.ref028","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.amepre.2009.02.002","article-title":"How we design feasibility studies.","volume":"36","author":"DJ Bowen","year":"2009","journal-title":"Am J Prev Med"},{"issue":"23","key":"pone.0300351.ref029","doi-asserted-by":"crossref","first-page":"3237","DOI":"10.1111\/j.1365-2702.2009.02939.x","article-title":"Reliability and validity in a nutshell","volume":"18","author":"K Bannigan","year":"2009","journal-title":"Journal of Clinical Nursing"},{"key":"pone.0300351.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.clinpsy.032408.153639","article-title":"Construct validity: advances in theory and methodology.","volume":"5","author":"ME Strauss","year":"2009","journal-title":"Annu Rev Clin Psychol"},{"key":"pone.0300351.ref031","author":"The SAGE Encyclopedia of Educational Research","year":"2018","journal-title":"Measurement, and Evaluation"},{"key":"pone.0300351.ref032","first-page":"1","article-title":"Free-living monitoring of ambulatory activity after treatments for lower extremity musculoskeletal cancers using an accelerometer-based wearable\u2014a new paradigm to outcome assessment in musculoskeletal oncology?","author":"S Furtado","year":"2022","journal-title":"Disabil Rehabil."},{"issue":"6","key":"pone.0300351.ref033","doi-asserted-by":"crossref","first-page":"601","DOI":"10.4097\/kjae.2017.70.6.601","article-title":"Introduction of a pilot study","volume":"70","author":"J. In","year":"2017","journal-title":"Korean J Anesthesiol."},{"key":"pone.0300351.ref034","first-page":"147","article-title":"Real-time classification of dance gestures from skeleton animation.","author":"M Raptis","year":"2011","journal-title":"Vancouver, British Columbia, Canada: Association for Computing Machinery"},{"issue":"6","key":"pone.0300351.ref035","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/BF00634747","article-title":"Measurement of the quality of life in cancer survivors","volume":"4","author":"BR Ferrell","year":"1995","journal-title":"Qual Life Res"},{"key":"pone.0300351.ref036","doi-asserted-by":"crossref","first-page":"75","DOI":"10.2147\/JMDH.S40020","article-title":"A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision.","volume":"6","author":"CC Bornbaum","year":"2013","journal-title":"Journal of multidisciplinary healthcare"},{"issue":"3","key":"pone.0300351.ref037","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3109\/17518421003620525","article-title":"The ICF model of functioning and disability: incorporating quality of life and human development.","volume":"13","author":"J McDougall","year":"2010","journal-title":"Developmental neurorehabilitation"},{"issue":"5","key":"pone.0300351.ref038","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/S0003-9993(00)90039-X","article-title":"Unipedal stance testing as an indicator of fall risk among older outpatients.","volume":"81","author":"EA Hurvitz","year":"2000","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"pone.0300351.ref039","doi-asserted-by":"crossref","first-page":"817906","DOI":"10.1155\/2015\/817906","article-title":"The Impact of an Intact Infrapatellar Fat Pad on Outcomes after Total Knee Arthroplasty","volume":"2015","author":"L White","year":"2015","journal-title":"Advances in Orthopedic Surgery"},{"issue":"3","key":"pone.0300351.ref040","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1179\/1743288X15Y.0000000005","article-title":"Movement analysis of sit-to-stand\u2013research informing clinical practice.","volume":"20","author":"GE Frykberg","year":"2015","journal-title":"Physical Therapy Reviews"},{"issue":"2","key":"pone.0300351.ref041","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.gaitpost.2013.07.006","article-title":"Balance control in lower extremity amputees during quiet standing: a systematic review.","volume":"39","author":"PX Ku","year":"2014","journal-title":"Gait Posture"},{"issue":"6","key":"pone.0300351.ref042","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1302\/0301-620X.90B6.19805","article-title":"Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients","volume":"90","author":"LH Aksnes","year":"2008","journal-title":"The Journal of bone and joint surgery British volume"},{"issue":"4","key":"pone.0300351.ref043","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/(SICI)1096-9098(200004)73:4<206::AID-JSO4>3.0.CO;2-5","article-title":"Predictors of functional outcomes following limb salvage surgery for lower-extremity soft tissue sarcoma","volume":"73","author":"AM Davis","year":"2000","journal-title":"Journal of surgical oncology"},{"issue":"Suppl 1","key":"pone.0300351.ref044","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1093\/geront\/gnv044","article-title":"Automated In-Home Fall Risk Assessment and Detection Sensor System for Elders.","volume":"551","author":"M Rantz","year":"2015","journal-title":"Gerontologist"},{"key":"pone.0300351.ref045","article-title":"Digital healthcare: The only solution for better healthcare during COVID-19 pandemic?","author":"A Kapoor","year":"2020","journal-title":"Indian Heart Journal"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0300351","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T18:15:41Z","timestamp":1711649741000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0300351"}},"subtitle":[],"editor":[{"given":"Roberto","family":"Di Marco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,3,28]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0300351","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,28]]}}}