From Footprints to Forecast: Baropodometry for Fall Risk Identification and Mobility Classification Among Pilgrims

Background/Objectives: Hajj is a major annual mass gathering. It requires prolonged walking under conditions of fatigue, heat stress, and crowd density, which increases mobility difficulties and fall risk, particularly among older adults and individuals with chronic diseases. Therefore, rapid operational mobility screening is required to identify risk and plan mobility. To support an operational mobility-classification workflow in a pre-Hajj setting, this study evaluated whether Timed Up and Go (TUG)-based stratification, combined with spatiotemporal gait and plantar pressure measurements, differentiates fall-risk categories. Methods: We conducted a cross-sectional study at a seasonal medical center near Al-Haram in Madinah Al-Munawwarah (21 May-3 June 2025) within the "I Lean On It" screening initiative. Participants completed the TUG and dynamic baropodometric gait assessments. We stratified the risk of falling as low (≤10 s), moderate (10.1-13.5 s), and high (>13.5 s) according to the TUG performance. We performed between-group comparisons using the Kruskal-Wallis test and evaluated the associations using Spearman's correlation analysis. Results: Participants were classified as having low (n = 103), moderate (n = 24), or high (n = 29) fall risk. TUG performance significantly increased across the fall-risk groups. Significant between-group differences were observed in cadence, half-step length, walking speed, test duration, and functional mobility, whereas plantar pressure magnitude and gait symmetry did not differ significantly. Spearman correlation analysis showed significant negative correlations between TUG time and sex (rs = -0.357), half-step length (rs = -0.617), walking speed (rs = -0.577), and cadence (rs = -0.420). Significant positive correlations were observed with weight-bearing time (right: rs = 0.584; left: rs = 0.461), test duration (rs = 0.376), and number of steps acquired (rs = 0.356) (all p ≤ 0.003). Overall, TUG performance was primarily associated with dynamic gait and functional mobility. Conclusions: Integrated functional mobility and spatiotemporal gait screening significantly differentiate fall risk and provide clinically actionable mobility-support guidance in a mass-gathering pre-Hajj clinical workflow.