Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review

Abstract

Background The number of wearable technological devices or sensors that are commercially available for gait training is increasing. These devices can fill a gap by extending therapy outside the clinical setting. This was shown to be important during the COVID-19 pandemic when people could not access one-on-one treatment. These devices vary widely in terms of mechanisms of therapeutic effect, as well as targeted gait parameters, availability, and strength of the evidence supporting the claims. Objective This study aimed to create an inventory of devices targeting improvement in gait pattern and walking behavior and identify the strength of the evidence underlying the claims of effectiveness for devices that are commercially available to the public. Methods As there is no systematic or reproducible way to identify gait training technologies available to the public, we used a pragmatic, iterative approach using both the gray and published literature. Four approaches were used: simple words, including some suggested by laypersons; devices endorsed by condition-specific organizations or charities; impairment-specific search terms; and systematic reviews. A findable list of technological devices targeting walking was extracted separately by 3 authors. For each device identified, the evidence for efficacy was extracted from material displayed on the websites, and full-text articles were obtained from the scientific databases PubMed, Ovid MEDLINE, Scopus, or Google Scholar. Additional information on the target population, mechanism of feedback, evidence for efficacy or effectiveness, and commercial availability was obtained from the published material or websites. A level of evidence was assigned to each study involving the device using the Oxford Centre for Evidence-Based Medicine classification. We also proposed reporting guidelines for the clinical appraisal of devices targeting movement and mobility. Results The search strategy for this consumer-centered review yielded 17 biofeedback devices that claim to target gait quality improvement through various sensory feedback mechanisms. Of these 17 devices, 11 (65%) are commercially available, and 6 (35%) are at various stages of research and development. Of the 11 commercially available devices, 4 (36%) had findable evidence for efficacy potential supporting the claims. Most of these devices were targeted to people living with Parkinson disease. The reporting of key information about the devices was inconsistent; in addition, there was no summary of research findings in layperson’s language. Conclusions The amount of information that is currently available to the general public to help them make an informed choice is insufficient, and, at times, the information presented is misleading. The evidence supporting the effectiveness does not cover all aspects of technology uptake. Commercially available technologies help to provide continuity of therapy outside the clinical setting, but there is a need to demonstrate effectiveness to support claims made by the technologies.

Assisted technology in Parkinson's disease gait: what's up?

“…20 Other studies monitoring gait parameters in PD used wearable sensors or wearable devices based on different types of sensors. [31][32][33][34][35][36][37][38][39] Figure 1 Flow diagram of literature search strategy.…”

“…20 Other studies monitoring gait parameters in PD used wearable sensors or wearable devices based on different types of sensors. 31 32 33 34 35 36 37 38 39…”

“…Of the 11 commercially available devices, only 4 (36%) had findable evidence for efficacy potential supporting the claims. 34 Although there are promising results with SWD for gait assessment, many challenges need to be overcome. To cite some, gait requires complex algorithms for its analysis, and most of the available portable devices do not avoid noise contamination or provide precise data synchronization and collection of real-time spatiotemporal, kinematic, and kinetic parameters.…”

“…74 RAGT may also benefit PD patients' gait endurance. 24 Therefore, assistant robotic device training can improve gait parameters with reduced motor workload in PD patients, 34 but more studies should be done to confirm these findings.…”

Real-time Auditory Feedback for Improving Gait and Walking in People with Parkinson’s Disease: A Pilot and Feasibility Trial

“…There is support from the literature for the effectiveness of biofeedback in improving gait patterns in healthy and clinical populations including people with PD[45, 46] but few feedback devices are available to the general public. [47]…”