Validity Analysis of WalkerViewTM Instrumented Treadmill for Measuring Spatiotemporal and Kinematic Gait Parameters

Test-Retest Reliability and Validity of TecnoBody D-Wall to Assess the Range of Motion During Overhead Squat in Healthy Individuals

This study evaluated the validity and reliability of the TecnoBody D-Wall system in assessing joint range of motion (ROM) during overhead squat movements in healthy individuals, using Kinovea as a reference tool for data comparison. A total of 29 participants (16 males, 13 females) with a mean age of 28.41 ± 6.66 years were included. Measurements were conducted for hip and knee joint angles in the sagittal plane, with three repetitions per participant analyzed using both systems. The D-Wall system employed a 3D Kinect V2 camera and force platform, while Kinovea used 2D video-based motion analysis. The results demonstrated excellent agreement between the two systems, with intra-class correlation coefficients (ICC) ranging from 0.79 to 0.99. For the knee joint, the test-retest ICC values were 0.99 (95% CI: 0.97-0.99) for Kinovea and 0.98 (95% CI: 0.95-0.99) for the D-Wall on the right side, and 0.98 (95% CI: 0.97-0.99) for Kinovea and 0.88 (95% CI: 0.79-0.94) for the D-Wall on the left side. For the hip joint, test-retest ICC values were 0.99 (95% CI: 0.97-0.99) for Kinovea and 0.94 (95% CI: 0.88-0.97) for the D-Wall on the right side, and 0.98 (95% CI: 0.97-0.99) for Kinovea and 0.93 (95% CI: 0.87-0.97) for the D-Wall on the left side. Bland-Altman plots confirmed good agreement, with no significant systematic bias observed. Both systems showed statistically insignificant differences (p > 0.05) between measurements, and correlation values ranged from 0.83 to 0.99, indicating strong associations. These findings highlight the high validity and reliability of both TecnoBody D-Wall and Kinovea systems in measuring joint angles during dynamic movements. The comparable accuracy between systems suggests that either system can be effectively utilized in clinical or research settings, depending on specific needs and resource availability.

The Restoration of the Prearthritic Joint Line Does Not Guarantee the Natural Knee Kinematics: A Gait Analysis Evaluation Following Primary Total Knee Arthroplasty

Background

Unrestricted kinematic alignment (uKA) in total knee arthroplasty (TKA) has the theoretical advantage of reproducing patients' constitutional alignment and restoring the pre-arthritic joint line position and obliquity. However, modifications of the original uKA technique have been proposed due to the potential risk of mechanical failure and instability. Given the significant variability in soft tissue behavior within the same bony morphology group, uKA pure knee resurfacing could be occasionally detrimental. This study aimed to kinematically compare the outcomes of uKA TKA with those of a robotic-assisted KA TKA technique based on specific soft-tissue boundaries.

Methods

In this retrospective gait analysis study, 24 TKA patients and 12 healthy controls were recruited. Inclusion criteria were a 9-month minimum follow-up from successfully, primary medial-pivot or medially-congruent TKA performed for isolated degenerative joint disease. Preoperatively, patients were randomly assigned to two surgical groups: A) uKA (#12) and B) robot-assisted (#12), KA (hybrid-kinematic) with boundaries (±3° from hip-knee-ankle neutral axis) and a slight intercompartmental gap asymmetry (max 2 mm lateral-opening). The gait analysis was performed using instrumented treadmills equipped with 3D cameras.

Results

Sagittal knee kinematic data: during the early-stance phase of gait, the uKA group showed a less consistent weight-acceptance phase and a less efficient transition between the first knee-flexion peak and mid-stance-extension plateau with respect to the hybrid-kinematic alignment group. Spatiotemporal and overall gait quality data: no significant differences were found between the two TKA groups regarding walking speed (P = .51) and step length (P = .8534). Control group patients walked more efficiently compared to TKA groups, showing inferior trunk flexion and inferior variation in step length (P < .0001).

Conclusions

This study showed that restoring the pre-arthritic joint line, as advocated by surgeons following the uKA philosophy, does not guarantee a closer-to-normal knee kinematics.

Self-selected speed provides more accurate human gait kinematics and spatiotemporal parameters than overground simulated speed on a treadmill: a cross-sectional study

BACKGROUND

Walking speed, a key element of gait analysis, is essential for evaluating the biomechanics of the musculoskeletal system and is typically assessed on flat surfaces, such as walkways or treadmills. While many authors have compared the differences and similarities between treadmill and overground walking, no studies have yet investigated the differences between treadmill gait analysis at self-selected speed (SS) and overground simulated speed (OS). The hypothesis is that accurate kinematic measurements depend on selecting the correct gait speed; however, a mismatch between the perceived comfortable treadmill speed and actual overground speed may affect the accuracy of treadmill gait analyses. This study aimed to assess treadmill gait in healthy young adults by comparing the SS with the OS. The objectives were to determine whether participants could match SS with OS on a treadmill, examine sex differences in gait kinematics and spatiotemporal parameters (KSP) at different speeds, and identify which speed better reflects natural gait kinematics.

METHODS

A total of 60 healthy men and 70 healthy women, aged 22-35 years, participated in this cross-sectional study to investigate the gait kinematics and spatiotemporal differences between the SS and OS. Student's t-test, Bonferroni adjustment, Cohen's effect size, and quadratic regression were employed to analyse differences across walking speeds and groups.

RESULTS

A discrepancy between OS and SS was observed in 66.4% of the participants. Our findings revealed that the adjusted R² values for KSP at SS were consistently greater than those at OS, suggesting that SS offers a more robust and accurate representation of gait kinematics, whereas OS is less reliable.

CONCLUSIONS

These findings underscore the importance of individualized speed selection in gait analysis, as it significantly impacts the accuracy of kinematic and spatiotemporal measurements. This insight is pivotal for clinicians and researchers to develop more effective rehabilitation strategies and comprehensively understand gait dynamics.

The Reliability and Validity of the OneStep Smartphone Application for Gait Analysis among Patients Undergoing Rehabilitation for Unilateral Lower Limb Disability

An easy-to-use and reliable tool is essential for gait assessment of people with gait pathologies. This study aimed to assess the reliability and validity of the OneStep smartphone application compared to the C-Mill-VR+ treadmill (Motek, Nederlands), among patients undergoing rehabilitation for unilateral lower extremity disability. Spatiotemporal gait parameters were extracted from the treadmill and from two smartphones, one on each leg. Inter-device reliability was evaluated using Pearson correlation, intra-cluster correlation coefficient (ICC), and Cohen's d, comparing the application's readings from the two phones. Validity was assessed by comparing readings from each phone to the treadmill. Twenty-eight patients completed the study; the median age was 45.5 years, and 61% were males. The ICC between the phones showed a high correlation (r = 0.89-1) and good-to-excellent reliability (ICC range, 0.77-1) for all the gait parameters examined. The correlations between the phones and the treadmill were mostly above 0.8. The ICC between each phone and the treadmill demonstrated moderate-to-excellent validity for all the gait parameters (range, 0.58-1). Only 'step length of the impaired leg' showed poor-to-good validity (range, 0.37-0.84). Cohen's d effect size was small (d < 0.5) for all the parameters. The studied application demonstrated good reliability and validity for spatiotemporal gait assessment in patients with unilateral lower limb disability.

Instrumented treadmill for run biomechanics analysis: a comparative study

This study aims compare the spatiotemporal and kinematic running parameters obtained by the WalkerView (Tecnobody, Bergamo, Italy) with those recorded by a optoelectronic 3D motion capture system. Seventeen participants were simultaneously recorded by the WalkerView and a motion capture system during running tests on the WalkerView at two different speeds (i.e., 8 km/h and 10 km/h). Per each parameter and speed the Root Mean Square Error (RMSE), the intraclass correlation coefficient (ICC), and the mean of the difference (MOD) and limits of agreement (LOAs) indexes obtained from Bland-Altman analysis were used to compare the two systems. ICCs show an excellent agreement for the mean step time and the cadence at both testing speeds (ICC=0.993 at 8 km/h; ICC=0.998 at 10 km/h); a lower agreement was found for all the kinematic variables. Small differences for some spatio-temporal parameters and greater differences for the kinematic variables were found. Therefore, WalkerView could represent a practical, accessible, and less expensive tool for clinicians, researchers, and sports trainers to assess the characteristics spatio-temporal parameters of running in non-laboratory settings.

Conventional physical therapy combined with extracorporeal shock wave leads to positive effects on spasticity in stroke survivors: a prospective observational study

The study aimed to evaluate the effectiveness of radial extracorporeal shock wave therapy (rESWT) and conventional physical therapy (CPT) protocol on the gait pattern in stroke survivors through a new gait analysis technology. Fifteen (n=15) stroke survivors took part in this prospective, observational study and were assessed clinically and through an instrumented treadmill before and after rESWT and CPT. Spasticity grade 95% CI 0.93 (0.79 +/- 1.08), pain intensity 95% CI 1.60 (1.19 +/- 2.01), and clonus score decreased significantly 95% CI 1.13 (0.72 +/- 1.54). The sensorimotor function 95% CI -2.53 (-3.42 +/- 1.65), balance 95% CI -5.67 (-6.64 +/- - 4.69), and gait parameters were enhanced at the end of the program. Step length 95% CI -3.47 (-6.48 +/- 0.46) and step cycle were improved 95% CI -0.09 (-0.17 +/- -0.01), and hip 95% CI -3.90 (-6.92 +/- -0.88), knee 95% CI -2.08 (-3.84 +/- -0.32) and ankle flexion-extension 95% CI -2.08 (-6.64 +/- -4.69) were augmented. Adding the quantitative analysis to the clinical assessment, we gained easy access to track progress and obtained an individualized therapeutic approach for stroke survivors.

Validity of artificial intelligence-based markerless motion capture system for clinical gait analysis: Spatiotemporal results in healthy adults and adults with Parkinson's disease

Markerless motion capture methods are continuously in development to target limitations encountered in marker-, sensor-, or depth-based systems. Previous evaluation of the KinaTrax markerless system was limited by differences in model definitions, gait event methods, and a homogenous subject sample. The purpose of this work was to evaluate the accuracy of spatiotemporal parameters in the markerless system with an updated markerless model, coordinate- and velocity-based gait events, and subjects representing young adult, older adult, and Parkinson's disease groups. Fifty-seven subjects and 216 trials were included in this analysis. Interclass correlation coefficients showed excellent agreement between the markerless system and a marker-based reference system for all spatial parameters. Temporal variables were similar, except swing time which showed good agreement. Concordance correlation coefficients were similar with all but swing time showing moderate to almost perfect concordance. Bland-Altman bias and limits of agreement (LOA) were small and improved from previous evaluations. Parameters showed similar agreement across coordinate- and velocity-based gait methods with the latter showing generally smaller LOAs. Improvements in spatiotemporal parameters in the present evaluation was due to inclusion of keypoints at the calcanei in the markerless model. Consistency in the calcanei keypoints relative to heel marker placements may improve results further. Similar to previous work, LOAs are within boundaries to detect differences in clinical groups. Results support the use of the markerless system for estimation of spatiotemporal parameters across age and clinical groups, but caution should be taken when generalizing findings due to remaining error in kinematic gait event methods.

Supervised versus unsupervised rehabilitation following total knee arthroplasty: A systematic review and meta-analysis

BACKGROUND

Outcomes after total knee arthroplasty (TKA) are strongly influenced by the adequacy of rehabilitation and the consequent functional recovery. The economic impact of rehabilitation it is not negligible. Inpatient rehabilitation can be 5 to 26 times more expensive than the home-based rehabilitation. This topic is extremely relevant as the COVID-19 pandemic has highlighted the importance of unsupervised rehabilitation in orthopedic surgery. The aim of this review and meta-analysis is to investigate the scientific evidence regarding the comparison between supervised and unsupervised rehabilitation following TKA.

MATERIALS AND METHODS

Following PRISMA guideline, a comprehensive search of PubMed, Cochrane and Scopus databases using combinations of keywords and MeSH descriptors: "total "Knee replacement," "Arthroplasty", "Rehabilitation" was performed from inception to December 2021. All relevant articles were retrieved, and their bibliographies were searched for further relevant references. Only English written randomized controlled trials comparing supervised and unsupervised rehabilitation following TKA were included in this systematic review. The outcomes considered were long-term pain, physical function, knee flexion and extension ROM, 6 minute walking test (6MWT) and timed up and go test (TUG).

RESULTS

11 studies (2.181 patients in total) were included in this systematic review. The long-term pain outcome showed no significant differences (Std. Mean Difference [SMD] = 0.00, 95 % confidence interval [CI] -0.16, 0.017) between the supervised (n = 397) and unsupervised (n = 255). Physical function showed no significant differences among the two groups (mean difference [MD] = 0.84, 95 % CI = -1.82, 3.50). Non-significant differences were also found for knee ROM flexion (mean difference [MD] = -0.46, 95 % CI = -2.95, 2.04) and for knee extension (mean difference [MD] = 0.54, 95 % CI = -0.89, 1.97). At the 52-week follow-up, the unsupervised group showed significant better results in 6MWT (mean difference [MD] = -26.10, 95 % CI = -47.62, -4.59) and in Timed up and go test (mean difference [MD] = 1.33, 95 % CI = 0.50, 2.15).

CONCLUSION

This systematic review did not show a significant clinical difference in improving pain, function, and mobility outcomes after TKA between supervised PT and unsupervised PT. Therefore, it would appear that supervised rehabilitation did not had additional benefits compared to unsupervised rehabilitation.

Accuracy of the fully integrated Insole3's estimates of spatiotemporal parameters during walking

This study investigated the accuracy of the Insole3 wireless shoe device in estimating several clinically useful spatiotemporal parameters (STPs). Eleven subjects walked at slow (0.8-1.0 m/s) and moderate-paced (1.2-1.4 m/s) speeds. Data were simultaneously recorded using the Insole3 and an industry-standard, three-dimensional motion capture (MOCAP) system. An error analysis compared the resulting STP data from the two systems. The mean bias error (MBE) was generally lower for temporal variables, and somewhat higher, but acceptable, for spatial variables. The MBE for temporally-related cadence and cycle time were the lowest (less than ±0.45%), with 100% (110/110) of slow-paced walking trial values and 99.1% (109/110) of moderate-paced walking trial values within 5% of the MOCAP estimates. The MBE was highest for speed (3.23-4.91%) and stride length (3.68-4.63%), with between 52.7 and 69.1% of trial values falling within the 5% error range. Stance time and swing time ranged between -0.98 and 4.38% error for both walking conditions. The results of this study suggest that the Insole3 is a potential alternative to MOCAP for estimating several STPs, namely cadence, stance time, and cycle time, particularly for use outside of the laboratory setting.

Running Footwear and Impact Peak Differences in Recreational Runners

Running is a physical activity and the investigation of its biomechanical aspects is crucial both to avoid injuries and enhance performance. Recreational runners may be liable to increased stress over the body, particularly to lower limb joints. This study investigates the different running patterns of recreational runners by analyzing characteristics of the footwear impact peak, spatiotemporal, and kinematic parameters among those that present with a peak impact and those that do not, with a 3D markerless system. Thirty recreational runners were divided into two groups: impact peak group (IP) (n = 16) and no impact peak group (n = 14) (n-IP). Kinematic and spatiotemporal parameters showed a large Cohen's d effect size between the groups. The mean hip flexion was IP 40.40° versus n-IP 32.30° (d = -0.82). Hip extension was IP 30.20° versus n-IP 27.70° (d = -0.58), and ankle dorsiflexion was IP 20.80°, versus n-IP 13.37° (d = -1.17). Stride length was IP 117.90 cm versus n-IP 105.50 cm (d = -0.84). Steps per minute was IP group 170 spm, versus n-IP 163 spm (d = -0.51). The heel-to-toe drop was mainly 10-12 mm for the IP group and 4-6 mm for the n-IP group. Recreational runners whose hip extension is around 40°, ankle dorsiflexion around 20°, and initial foot contact around 14°, may be predisposed to the presence of an impact peak.

Wearable Inertial Gait Algorithms: Impact of Wear Location and Environment in Healthy and Parkinson's Populations

Wearable inertial measurement units (IMUs) are used in gait analysis due to their discrete wearable attachment and long data recording possibilities within indoor and outdoor environments. Previously, lower back and shin/shank-based IMU algorithms detecting initial and final contact events (ICs-FCs) were developed and validated on a limited number of healthy young adults (YA), reporting that both IMU wear locations are suitable to use during indoor and outdoor gait analysis. However, the impact of age (e.g., older adults, OA), pathology (e.g., Parkinson's Disease, PD) and/or environment (e.g., indoor vs. outdoor) on algorithm accuracy have not been fully investigated. Here, we examined IMU gait data from 128 participants (72-YA, 20-OA, and 36-PD) to thoroughly investigate the suitability of ICs-FCs detection algorithms (1 × lower back and 1 × shin/shank-based) for quantifying temporal gait characteristics depending on IMU wear location and walking environment. The level of agreement between algorithms was investigated for different cohorts and walking environments. Although mean temporal characteristics from both algorithms were significantly correlated for all groups and environments, subtle but characteristically nuanced differences were observed between cohorts and environments. The lowest absolute agreement level was observed in PD (ICC_2,1 = 0.979, 0.806, 0.730, 0.980) whereas highest in YA (ICC_2,1 = 0.987, 0.936, 0.909, 0.989) for mean stride, stance, swing, and step times, respectively. Absolute agreement during treadmill walking (ICC_2,1 = 0.975, 0.914, 0.684, 0.945), indoor walking (ICC_2,1 = 0.987, 0.936, 0.909, 0.989) and outdoor walking (ICC_2,1 = 0.998, 0.940, 0.856, 0.998) was found for mean stride, stance, swing, and step times, respectively. Findings of this study suggest that agreements between algorithms are sensitive to the target cohort and environment. Therefore, researchers/clinicians should be cautious while interpreting temporal parameters that are extracted from inertial sensors-based algorithms especially for those with a neurological condition.