Validity of Wearable Inertial Sensors for Gait Analysis: A Systematic Review

Background/Objectives: Gait analysis, traditionally performed with lab-based optical motion capture systems, offers high accuracy but is costly and impractical for real-world use. Wearable technologies, especially inertial measurement units (IMUs), enable portable and accessible assessments outside the lab, though challenges with sensor placement, signal selection, and algorithm design can affect accuracy. This systematic review aims to bridge the benchmarking gap between IMU-based and traditional systems, validating the use of wearable inertial systems for gait analysis. Methods: This review examined English studies between 2012 and 2023, retrieved from the Scopus database, comparing wearable sensors to optical motion capture systems, focusing on IMU body placement, gait parameters, and validation metrics. Exclusion criteria for the search included conference papers, reviews, unavailable papers, studies without wearable inertial sensors for gait analysis, and those not involving agreement studies or optical motion capture systems. Results: From an initial pool of 479 articles, 32 were selected for full-text screening. Among them, the lower body resulted in the most common site for single IMU placement (in 22 studies), while the most frequently used multi-sensor configuration involved IMU positioning on the lower back, shanks, feet, and thighs (10 studies). Regarding gait parameters, 11 studies out of the 32 included studies focused on spatial-temporal parameters, 12 on joint kinematics, 2 on gait events, and the remainder on a combination of parameters. In terms of validation metrics, 24 studies employed correlation coefficients as the primary measure, while 7 studies used a combination of error metrics, correlation coefficients, and Bland-Altman analysis. Validation metrics revealed that IMUs exhibited good to moderate agreement with optical motion capture systems for kinematic measures. In contrast, spatiotemporal parameters demonstrated greater variability, with agreement ranging from moderate to poor. Conclusions: This review highlighted the transformative potential of wearable IMUs in advancing gait analysis beyond the constraints of traditional laboratory-based systems.