Reliability and Validity of IMU-Based Foot Progression Angle Measurement under Different Gait Retraining Strategies

Abstract

Load modifying gait retraining strategies, such as changing the foot progression angle (FPA) to toe-in and toe-out gait, are used for people with medial knee osteoarthritis. The FPA can be measured using a pressure sensitive walkway (PSW), but inertial measurement units (IMUs) are considered more suitable for clinical use. This study evaluated the reliability and validity of an IMU system, to measure FPA under different gait retraining strategies. Twenty healthy participants walked a 10-m-long path using different gait strategies (natural (2), toe-out gait (1), toe-in gait (1)) during four 90-s trials. FPA was measured simultaneously with IMUs and a PSW, the latter considered the reference standard. There was good and excellent reliability for the IMUs and PSW FPA measurements, respectively (ICC: IMU, 0.89; PSW, 0.97). Minimal detectable change (MDC) was 4.5° for the IMUs and 2.7° for the PSW. Repeated measures ANOVA indicated a significant effect of gait type on FPA (p < 0.001), but not the measurement instrument (p = 0.875). Bland–Altman plots demonstrated the good agreement of both systems for the baseline condition, though the IMUs seemed to consistently overestimate the FPA value compared to the PSW. In conclusion, IMUs are a reliable and valid measurement system for measuring FPA under different gait retraining strategies. The differences between the systems are significant for all gait strategies, so the systems should not be used interchangeably.

IMU-Based Kinematics Estimation Accuracy Affects Gait Retraining Using Vibrotactile Cues

“…Inertial measurement units, or IMUs, offer a portable and low-cost alternative to optical motion capture. By building on existing methods to track the foot progression angle using IMUs embedded in the shoe [18][19][20] or worn on top of the foot [21,22], inertial systems could enable patients to one day carry out their gait retraining therapy at home. However, when compared to motion capture, inertial estimates of the foot progression angle can vary in accuracy across subjects [20][21][22][23], even in cases where outlier data are removed in post-processing steps.…”

“…By building on existing methods to track the foot progression angle using IMUs embedded in the shoe [18][19][20] or worn on top of the foot [21,22], inertial systems could enable patients to one day carry out their gait retraining therapy at home. However, when compared to motion capture, inertial estimates of the foot progression angle can vary in accuracy across subjects [20][21][22][23], even in cases where outlier data are removed in post-processing steps. Because feedback is provided once per gait cycle, foot progression angle estimates must be accurate at the level of a single step, not averaged across several strides.…”