2022

JMIR Medical Informatics

Prediction of Physical Frailty in Orthogeriatric Patients Using Sensor Insole–Based Gait Analysis and Machine Learning Algorithms: Cross-sectional Study

Moritz Kraus, Maximilian Michael Saller, Sebastian Felix Baumbach, Carl Neuerburg, Ulla Cordula Stumpf, Wolfgang Böcker Alexander Martin Keppler

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, Ludwig-Maximilians Universität Munich, Munich, Germany

Keywords

wearables, insole sensors, orthogeriatric, artificial intelligence, prediction models, machine learning, gait analysis, digital sensors, digital health, aging, prediction algorithms, geriatric, mobile health, mobile insoles

Abstract

Background: Assessment of the physical frailty of older patients is of great importance in many medical disciplines to be able to implement individualized therapies. For physical tests, time is usually used as the only objective measure. To record other objective factors, modern wearables offer great potential for generating valid data and integrating the data into medical decision-making. Objective: The aim of this study was to compare the predictive value of insole data, which were collected during the Timed-Up-and-Go (TUG) test, to the benchmark standard questionnaire for sarcopenia (SARC-F: strength, assistance with walking, rising from a chair, climbing stairs, and falls) and physical assessment (TUG test) for evaluating physical frailty, defined by the Short Physical Performance Battery (SPPB), using machine learning algorithms. Methods: This cross-sectional study included patients aged >60 years with independent ambulation and no mental or neurological impairment. A comprehensive set of parameters associated with physical frailty were assessed, including body composition, questionnaires (European Quality of Life 5-dimension [EQ 5D 5L], SARC-F), and physical performance tests (SPPB, TUG), along with digital sensor insole gait parameters collected during the TUG test. Physical frailty was defined as an SPPB score≤8. Advanced statistics, including random forest (RF) feature selection and machine learning algorithms (K-nearest neighbor [KNN] and RF) were used to compare the diagnostic value of these parameters to identify patients with physical frailty. Results: Classified by the SPPB, 23 of the 57 eligible patients were defined as having physical frailty. Several gait parameters were significantly different between the two groups (with and without physical frailty). The area under the receiver operating characteristic curve (AUROC) of the TUG test was superior to that of the SARC-F (0.862 vs 0.639). The recursive feature elimination algorithm identified 9 parameters, 8 of which were digital insole gait parameters. Both the KNN and RF algorithms trained with these parameters resulted in excellent results (AUROC of 0.801 and 0.919, respectively). Conclusions: A gait analysis based on machine learning algorithms using sensor soles is superior to the SARC-F and the TUG test to identify physical frailty in orthogeriatric patients.

Moticon's Summary

This study evaluated different means for assessing physical frailty in elderly. For this purpose, the predictive value of three different assessment methods were compared, namely a the timed up and go test, sensor insole data collected during the timed up and go test as well as the short physical performance battery likewise applied to the timed up and go test. Moticon sensor insoles were used to obtain gait parameters. Subjects included for testing were older than 60 years. Parameters obtained from the different testing methods were compared using machine learning. Results showed that gait parameters obtained during the timed up and go test produced the highest predictive value for detecting frailty.

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