Validity and Reliability of a Smartphone-Based Gait Assessment in Measuring Temporal Gait Parameters: Challenges and Recommendations.

Smartphone-embedded inertia sensors are widely available nowadays. We have developed a smartphone application that could assess temporal gait characteristics using the built-in inertia measurement unit with the aim of enabling mass screening for gait abnormality. This study aimed to examine the test-retest reliability and concurrent validity of the smartphone-based gait assessment in assessing temporal gait parameters in level-ground walking. Twenty-six healthy young adults (mean age: 20.8 ± 0.7) were recruited. Participants walked at their comfortable pace on a 10 m pathway repetitively in two walking sessions. Gait data were simultaneously collected by the smartphone application and a VICON system during the walk. Gait events of heel strike and toes off were detected from the sensors signal by a peak detection algorithm. Further gait parameters were calculated and compared between the two systems. Pearson Product-Moment Correlation was used to evaluate the concurrent validity of both systems. Test-retest reliability was examined by the intraclass correlation coefficients (ICCs) between measurements from two sessions scheduled one to four weeks apart. The validity of smartphone-based gait assessment was moderate to excellent for parameters involving only heel strike detection (r = 0.628-0.977), poor to moderate for parameters involving detection of both heel strike and toes off (r = 0.098-0.704), and poor for the proportion of gait phases within a gait cycle. Reliability was good to fair for heel strike-related parameters (ICC = 0.845-0.388), good to moderate for heel strike and toes-off-related parameters (ICC = 0.827-0.582), and moderate to fair for proportional parameters. Validity was adversely affected when toe off was involved in the calculation, when there was an insufficient number of effective steps taken, or when calculating sub-phases with short duration. The use of smartphone-based gait assessment is recommended in calculating step time and stride time, and we suggest collecting no less than 100 steps per leg during clinical application for better validity and reliability.