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Validity of Wearable Inertial Sensors for Postural Sway Analysis: A Systematic Review
Giuseppe Prisco1, Noemi Pisani1, Maria Romano2
1Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy.
Diagnostics (Basel, Switzerland)
|July 15, 2026
Summary
Wearable inertial systems show promise for assessing postural sway velocity, offering a practical clinical alternative. However, spatial sway measures and dynamic tasks require further validation for accuracy.
Area of Science:
- Biomechanics
- Human Movement Analysis
- Wearable Technology
Background:
- Gold-standard postural sway assessment tools (force platforms, motion capture) are lab-bound.
- Wearable inertial systems (IMUs) offer a portable solution, but their validity needs rigorous comparison.
- A critical gap exists in comparing IMU sway data within the same physical (displacement) domain as reference systems.
Purpose of the Study:
- To critically review the validity of wearable inertial systems for postural sway assessment.
- To include only studies comparing IMU-derived sway parameters in the same physical domain as reference systems.
- To analyze methodological aspects influencing IMU-based postural sway assessment.
Main Methods:
- Systematic literature search of the Scopus database up to January 2026.
- Inclusion of studies comparing IMU sway parameters with gold standards in consistent units.
- Analysis of sensor placement, postural tasks, signal processing, sway parameters, and statistical validation.
Main Results:
- Eight studies (2015-2022) met inclusion criteria; most used a single lumbar IMU for quiet standing.
- Velocity-based sway parameters (e.g., mean sway velocity) showed moderate to high agreement with reference systems.
- Spatial sway metrics (e.g., ellipse area, RMS displacement) exhibited higher variability and potential bias.
Conclusions:
- Wearable inertial systems show significant potential for clinical assessment of velocity-related postural sway during quiet standing.
- Assessing spatial sway metrics and dynamic postural tasks with IMUs remains challenging.
- Standardizing validation protocols and signal processing is crucial for improving IMU-based postural sway analysis comparability and reproducibility.
