Validity and Reliability of DT-Walk for Assessment and Biofeedback of Asymmetries in Limb Loading and Plantar Pressure in Knee Osteoarthritis
Keywords:
wearable, limb load, plantar pressure, knee osteoarthritis, asymmetryAbstract
Background: Biomechanical alterations are the primary changes that result in development, progression, or increased risk of injury/disease. The use of wearable has gained significant importance in clinical research for early diagnosis and prediction of injury/disease, thereby providing rehabilitation based on the information received from such devices.
Objective: This study aims to develop a wearable device for real-time assessment and feedback of limb load asymmetry (LLA) and dynamic plantar pressure asymmetry (PPA).
Method: A focus group discussion was conducted with an experienced group of physiotherapists to identify the needs of the clinicians for the assessment and rehabilitation of patients with gait and balance disorders in knee osteoarthritis. The prototype device (DT-walk) was fabricated in a pair of insole-based devices, using two inertial measurement unit (IMU) sensors, ten force-sensitive resistors (FSR), and a pair of insoles-shaped custom-made pressure-sensitive matrix made of 16×8 using velostat and copper tape. A set of five FSRs are used in each insole that lies underneath the custom pressure sensitive matrix. Each controller unit incorporates one microcontroller, wireless communication module, storage, and power unit. The data was sent to a mobile computing device for real-time analysis and visualization.
Results: DT-walk showed excellent intra-rater and inter-rater reliability and good to excellent validity against the WinTrack platform for static LLA and dynamic PPA in KOA. The reliability had ICC>0.9, SEM=0.002-0.00668, MDC= 0.00556-0.01852 and CV=5.43-13.15%. Validity had ICC>0.9, SEM=0.00234-0.98608, MDC= 0.00648-2.73327 and CV=2.31-82.68%.
Conclusion: The DT-walk, a wearable device, was equally effective in assessing asymmetries in limb loading and plantar pressure compared to the platform-based device. Future studies should evaluate the validity of this device in healthy and diseased conditions.
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S. Shahid, A. Nandy, S. Mondal, M. Ahamad, P. Chakraborty, and G. C. Nandi, “A study on human gait analysis,” no. May 2014, pp. 358–364, 2012, doi: 10.1145/2393216.2393277.
A. Nandy and P. Chakraborty, “A new paradigm of human gait analysis with Kinect,” 2015 8th International Conference on Contemporary Computing, IC3 2015, pp. 443–448, 2015, doi: 10.1109/IC3.2015.7346722.
H. j. Chiel, L. H. Ting, O. Ekeberg, and M. J. Z. Hartmann, “Confocal imaging-guided laser ablation of basal cell carcinomas: An ex vivo study,” Journal of Neuroscience, vol. 29, no. 41, pp. 12807–12814, 2009,
doi:10.1523/JNEUROSCI.3338-09.2009.
C. L. Lewis, N. M. Laudicina, A. Khuu, and K. L. Loverro, “The Human Pelvis: Variation in Structure and Function During Gait,” Anatomical Record, vol. 300, no. 4, pp. 633–642, 2017, doi: 10.1002/ar.23552.
H. K. V. Kevin R. Vincent, Bryan P. Conrad, Benjamin J. Fregly, “Perspective on the Knee Joint,” vol. 4, no. 5 0, pp. 1–11, 2013, doi: 10.1016/j.pmrj.2012.01.020.The.
D. Coggon, P. Croft, S. Kellingray, D. Barrett, M. McLaren, and C. Cooper, “Occupational Physical Activities and the Knee,” Arthritis Rheum, vol. 43, no. 7, pp. 1443–9, 2000, doi: 10.1002/1529- 0131(200007)43:7<1443::AID-ANR5>3.0.CO;2-1.
J. B. Arnold, S. F. Mackintosh, S. Jones, and D. Thewlis, “Asymmetry of lower limb joint loading in advanced knee osteoarthritis,” Gait Posture, vol. 40, no. 2014, p. S11, 2014, doi: 10.1016/j.gaitpost.2014.05.033.
M. Favero, R. Ramonda, M. B. Goldring, S. R. Goldring, and L. Punzi, “Early knee osteoarthritis,” RMD Open, vol. 1, no. Suppl 1, pp. 1–7, 2015, doi: 10.1136/rmdopen-2015-000062.
V. Silverwood, M. Blagojevic-Bucknall, C. Jinks, J. L. Jordan, J. Protheroe, and K. P. Jordan, “Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis,” Osteoarthritis Cartilage, vol. 23, no. 4, pp. 507–515, 2015, doi: 10.1016/j.joca.2014.11.019.
B. J. F. Dong Zhao, Scott A. Banks, Kim H. Mitchell, Darryl D. D’Lima, Clifford W. Colwell Jr., “Correlation between the Knee Adduction Torque and Medial Contact Force for a Variety of Gait Patterns,” Journal of Orthopaedic Research, vol. 25, no. June, pp. 789–797, 2007, doi: 10.1002/jor.
T. Bhosale, H. Kudale, V. Kumthekar, S. Garude, and P. Dhumal, “Gait Analysis Using Wearable Sensors,” in International Conference on Energy Systems and Applications (ICESA 2015), 2015, pp. 267–269. doi: 10.3390/s120202255.
A. H. Abdul Razak, A. Zayegh, R. K. Begg, and Y. Wahab, “Foot plantar pressure measurement system: A review,” Sensors (Switzerland), vol. 12, no. 7, pp. 9884–9912, 2012,
doi: 10.3390/s120709884.
A. R. Anwary, H. Yu, and M. Vassallo, “Optimal Foot Location for Placing Wearable IMU Sensors and Automatic Feature Extraction for Gait Analysis,” IEEE Sens J, vol. 18, no. 6, pp. 2555–2567, 2018,
doi: 10.1109/JSEN.2017.2786587.
M. J. Wylde, M. B.C. Lee, L. Chee Yong, and A. J. Callaway, “Reliability and validity of GPS-embedded accelerometers forthe measurement of badminton specific player load,” Journal of Trainology, vol. 7, no. 2, pp. 34–37, 2018, doi: 10.17338/trainology.7.2_34.
L. A. Kimmel, J. E. Elliott, J. M. Sayer, and A. E. Holland, “Assessing the Reliability and Validity of a Physical Therapy Functional Measurement Tool--the Modified Iowa Level of Assistance Scale--in Acute Hospital Inpatients,” Phys Ther, vol. 96, no. 2, pp. 176–182, 2016, doi: 10.2522/ptj.20140248.
C. Bond, Pharmacy Practice, Second Edition. Routledge, 2015. doi: 10.1201/b19093.
D. Bishop, “Standard Error of Measurement ( SEm ),” Tallahassee, FL 32301, 1996.
P. E. Shrout and J. L. Fleiss, “Intraclass correlations: Uses in assessing rater reliability,” Psychol Bull, vol. 86, no. 2, pp. 420–428, 1979, doi: 10.1037/0033-2909.86.2.420.
F. Arafsha, C. Hanna, A. Aboualmagd, S. Fraser, and A. El Saddik, “Instrumented wireless smartinsole system for mobile gait analysis: A validation pilot study with Tekscan Strideway,” Journal of Sensor and Actuator Networks, vol. 7, no. 3, 2018, doi: 10.3390/jsan7030036.
A. Martínez-Nova, J. C. Cuevas-García, J. Pascual-Huerta, and R. Sánchez-Rodríguez, “BioFoot® in-shoe system: Normal values and assessment of the reliability and repeatability,” Foot, vol. 17, no. 4, pp. 190–196, Dec. 2007, doi: 10.1016/j.foot.2007.04.002.
A. Khandakar et al., “Design and Implementation of a Smart Insole System to Measure Plantar Pressure and Temperature,” Sensors, vol. 22, no. 19, Oct. 2022, doi: 10.3390/s22197599.
A. Alamäki1 et al., “Validation of the wearable sensor system - MoveSole® smart insoles,” 2021.
S. Crea, M. Donati, S. M. M. de Rossi, C. Maria Oddo, and N. Vitiello, “A wireless flexible sensorized insole for gait analysis,” Sensors (Switzerland), vol. 14, no. 1, pp. 1073–1093, Jan. 2014, doi: 10.3390/s140101073.
D. Parker, J. Andrews, and C. Price, “Validity and reliability of the XSENSOR in-shoe pressure measurement system,” PLoS One, vol. 18, no. 1, p. e0277971, 2023,
doi: 10.1371/journal.pone.0277971.
F. Lin, A. Wang, Y. Zhuang, M. R. Tomita, and W. Xu, “Smart Insole: A Wearable Sensor Device for Unobtrusive Gait Monitoring in Daily Life,” IEEE Trans Industr Inform, vol. 12, no. 6, pp. 2281–2291, Dec. 2016, doi: 10.1109/TII.2016.2585643.
L. A. Cramer, M. A. Wimmer, P. Malloy, J. A. O’keefe, C. B. Knowlton, and C. Ferrigno, “Validity and Reliability of the Insole3 Instrumented Shoe Insole for Ground Reaction Force Measurement during Walking and Running,” Sensors, vol. 22, no. 6, Mar. 2022, doi: 10.3390/s22062203.
D. C. Low and S. J. Dixon, “Footscan pressure insoles: Accuracy and reliability of force and pressure measurements in running,” Gait Posture, vol. 32, no. 4, pp. 664–666, Oct. 2010, doi: 10.1016/j.gaitpost.2010.08.002.
C. Price, D. Parker, and C. Nester, “Validity and repeatability of three in-shoe pressure measurement systems,” Gait Posture, vol. 46, pp. 69–74, May 2016,
doi: 10.1016/j.gaitpost.2016.01.026.
R. A. Lakho, Z. A. Abro, J. Chen, and R. Min, “Smart Insole Based on Flexi Force and Flex Sensor for Monitoring Different Body Postures,” Sensors, vol. 22, no. 15, Aug. 2022, doi: 10.3390/s22155469.
S. Zhao, R. Liu, C. Fei, A. W. Zia, and L. Jing, “Flexible sensor matrix film-based wearable plantar pressure force measurement and analysis system,” PLoS One, vol. 15, no. 8 August, Aug. 2020, doi: 10.1371/journal.pone.0237090.
M. P. D. Castro et al., “Accuracy and repeatability of the gait analysis by the walkinsense system,” Biomed Res Int, vol. 2014, 2014, doi: 10.1155/2014/348659.
M. Godi, A. M. Turcato, M. Schieppati, and A. Nardone, “Test-retest reliability of an insole plantar pressure system to assess gait along linear and curved trajectories,” J Neuroeng Rehabil, vol. 11, no. 1, Jun. 2014, doi: 10.1186/1743-0003-11-95.
G. K. Barratt, C. Bellenger, E. Y. Robertson, J. Lane, and R. G. Crowther, “Validation of plantar pressure and reaction force measured by moticon pressure sensor insoles on a concept2 rowing ergometer,” Sensors, vol. 21, no. 7, Apr. 2021, doi: 10.3390/s21072418.
A. T. Peebles, L. A. Maguire, K. E. Renner, and R. M. Queen, “Validity and Repeatability of Single-Sensor Loadsol Insoles during Landing,” Sensors, vol. 18, no. 12, Dec. 2018, doi: 10.3390/S18124082.
M. Ntagios and R. Dahiya, “3D Printed Soft and Flexible Insole with Intrinsic Pressure Sensing Capability,” IEEE Sens J, 2022,
doi: 10.1109/JSEN.2022.3179233.
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