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Supplemental material, sj-docx-1-dhj-10.1177_20552076221150745 for Acceptability of wearable devices for measuring mobility remotely: Observations from the Mobilise-D technical validation study by Alison Keogh, Lisa Alcock, Philip Brown, Ellen Buckley, Marina Brozgol, Eran Gazit, Clint Hansen, Kirsty Scott, Lars Schwickert, Clemens Becker, Jeffrey M. Hausdorff, Walter Maetzler, Lynn Rochester, Basil Sharrack, Ioannis Vogiatzis, Alison Yarnall, Claudia Mazzà and Brian Caulfield in Digital Health

Gait alterations in those with mild unilateral knee pain during walking may provide clues to modifiable alterations that affect progression of knee pain and osteoarthritis (OA). To examine this, we applied machine learning (ML) approaches to gait data from wearable sensors in a large observational knee OA cohort, the Multicenter Osteoarthritis (MOST) study. Participants completed a 20-m walk test wearing sensors on their trunk and ankles. Parameters describing spatiotemporal features of gait and symmetry, variability and complexity were extracted. We used an ensemble ML technique ("super learning") to identify gait variables in our cross-sectional data associated with the presence/absence of unilateral knee pain. We then used logistic regression to determine the association of selected gait variables with odds of mild knee pain. Of 2066 participants (mean age 63.6 [SD: 10.4] years, 56% female), 21.3% had mild unilateral pain while walking. Gait parameters selected in the ML process as influential included step regularity, sample entropy, gait speed, and amplitude dominant frequency, among others. In adjusted cross-sectional analyses, lower levels of step regularity (i.e., greater gait variability) and lower sample entropy(i.e., lower gait complexity) were associated with increased likelihood of unilateral mild pain while walking [aOR 0.80 (0.64-1.00) and aOR 0.79 (0.66-0.95), respectively].

Remote monitoring of motor functions is a powerful approach for health assessment, especially among the elderly population or among subjects affected by pathologies that negatively impact their walking capabilities. This is further supported by the continuous development of wearable sensor devices, which are getting progressively smaller, cheaper, and more energy efficient. The external environment and mobility context have an impact on walking performance, hence one of the biggest challenges when remotely analysing gait episodes is the ability to detect the context within which those episodes occurred. The primary goal of this paper is the investigation of context detection for remote monitoring of daily motor functions. We aim to understand whether inertial signals sampled with wearable accelerometers, provide reliable information to classify gait-related activities as either indoor or outdoor. We explore two different approaches to this task: (1) using gait descriptors and features extracted from the input inertial signals sampled during walking episodes, together with classic machine learning algorithms, and (2) treating the input inertial signals as time series data and leveraging end-to-end state-of-the-art time series classifiers. We directly compare the two approaches through a set of experiments based on data collected from 9 healthy individuals. Our results indicate that the indoor/outdoor context can be successfully derived from inertial data streams. We also observe that time series classification models achieve better accuracy than any other feature-based models, while preserving efficiency and ease of use.

Walking activity and gait parameters are considered among the most relevant mobility-related parameters. Currently, gait assessments have been mainly analyzed in laboratory or hospital settings, which only partially reflect usual performance (i.e., real world behavior). In this study, we aim to validate a robust walking detection algorithm using a single foot- worn inertial measurement unit (IMU) in real-life settings. We used a challenging dataset including 18 individuals performing free-living activities. A multi-sensor wearable system including pressure insoles, multiple IMUs, and infrared distance sensors (INDIP) was used as reference. Accurate walking detection was obtained, with sensitivity and specificity of 98 and 91% respectively. As robust walking detection is needed for ambulatory monitoring to complete the processing pipeline from raw recorded data to walking/mobility outcomes, a validated algorithm would pave the way for assessing patient performance and gait quality in real-world conditions.