Evaluating the accuracy and reliability of real-world digital mobility outcomes in older adults after hip fracture: Cross-sectional observational study

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• dc.contributor.author Berge, Martin A.
• dc.contributor.author García Aymerich, Judith
• dc.contributor.author Koch, Sarah
• dc.contributor.author Vereijken, Beatrix
• dc.date.accessioned 2025-06-06T07:07:00Z
• dc.date.available 2025-06-06T07:07:00Z
• dc.date.issued 2025
• dc.description.abstract Background: Algorithms estimating real-world digital mobility outcomes (DMOs) are increasingly validated in healthy adults and various disease cohorts. However, their accuracy and reliability in older adults after hip fracture, who often walk slowly for short durations, is underexplored. Objective: This study examined DMO accuracy and reliability in a hip fracture cohort considering walking bout (WB) duration, physical function, days since surgery, and walking aid use. Methods: In total, 19 community-dwelling participants were real-world monitored for 2.5 hours using a lower back wearable device and a reference system combining inertial modules, distance sensors, and pressure insoles. A total of 6 DMO estimates from 164 WBs from 58% (11/19) of the participants (aged 71-90 years; assessed 32-390 days after surgery; Short Physical Performance Battery [SPPB] scores of 3-12; gait speed range 0.39-1.34 m/s) were assessed against the reference system at the WB and participant level. We stratified by WB duration (all WBs, WBs of >10 seconds, WBs of 10-30 seconds, and WBs of >30 seconds) and lower versus higher SPPB scores and observed whether days since surgery and walking aid use affected DMO accuracy and reliability. Results: Across WBs, walking speed and distance ranged from 0.25 to 1.29 m/s and from 1.7 to 436.5 m, respectively. Estimation of walking speed, cadence, stride duration, number of steps, and distance stratified by WB duration showed intraclass correlation coefficients (ICCs) ranging from 0.50 to 0.99 and mean relative errors (MREs) from -6.9% to 12.8%. Stride length estimation showed poor reliability, with ICCs ranging from 0.30 to 0.49 and MREs from 6.1% to 13.2%. Walking speed and distance ICCs in the higher-SPPB score group ranged from 0.85 to 0.99, and MREs ranged from -10.1% to -1.7%. In the lower-SPPB score group, walking speed and distance ICCs ranged from 0.17 to 0.99, and MREs ranged from 13.5% to 32.6%. There was no discernible effect of time since surgery or walking aid use. Conclusions: In total, 5 accurate and reliable real-world DMOs were identified in older adults after hip fracture: walking speed, cadence, stride duration, number of steps, and distance. Accuracy and reliability of most DMOs improved when excluding WBs of <10 seconds and were higher for WBs of >30 seconds than for WBs of 10 to 30 seconds and for participants with higher physical function. DMOs capture daily gait as early as 1 month after surgery also in people using walking aids. However, as most WBs in this cohort were short, there was a trade-off between improving accuracy and reliability by excluding short WBs and losing a substantial amount of data. These results have important implications for establishing the clinical validity of DMOs and evaluating the effects of interventions on daily-life gait, thereby facilitating the design of optimal care pathways.
• dc.description.sponsorship This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative (IMI) 2 Joint Undertaking under grant 820820. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations. The authors thank the Mobilise-D technical validation study team of work package 2, all participants who devoted their time and energy to this taxing protocol in times of COVID-19, and Miriam Dinger at the Robert Bosch Foundation for Medical Research and Dr Tim Klüter at University Hospital Schleswig-Holstein for their indispensable help in recruiting patients. MAB acknowledges ChatGPT, an artificial intelligence model by OpenAI, for suggestions that helped improve the clarity of some sentences in this paper. SDD and LR were also supported by the Identifying Digital Endpoints to Assess Fatigue, Sleep, and Activities in Daily Living in Neurodegenerative Disorders and Immune-Mediated Inflammatory Diseases project that has received funding from the IMI 2 Joint Undertaking under grant agreement 853981. LR is a National Institute for Health and Care Research (NIHR) senior investigator. Both SDD and LR were supported by the NIHR Newcastle Biomedical Research Centre based at the Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust; Newcastle University; and the Cumbria, Northumberland, Tyne, and Wear NHS Foundation Trust. SDD and LR were also supported by the NIHR and Wellcome Trust Clinical Research Facility infrastructure at Newcastle upon Tyne Hospitals NHS Foundation Trust. SDD was supported by the UK Research and Innovation Engineering and Physical Sciences Research Council (grant reference EP/X031012/1 and EP/X036146/1). The Barcelona Institute for Global Health acknowledges support from grant CEX2018-000806-S funded by the Ministry of Science, Innovation, and Universities and the State Research Agency (MCIN/AEI/10.13039/501100011033) and support from the Government of Catalonia through the Research Centers of Catalonia program. The views expressed in this publication are those of the authors and do not necessarily reflect those of the IMI, the European Union, the European Federation of Pharmaceutical Industries and Associations, any associated partners, the NIHR, or the Department of Health and Social Care, who are not responsible for any use that may be made of the information contained herein.
• dc.format.mimetype application/pdf
• dc.identifier.citation Berge MA, Paraschiv-Ionescu A, Kirk C, Küderle A, Micó-Amigo E, Becker C, et al. Evaluating the accuracy and reliability of real-world digital mobility outcomes in older adults after hip fracture: Cross-sectional observational study. JMIR Form Res. 2025 May 20;9:e67792. DOI: 10.2196/67792
• dc.identifier.doi http://dx.doi.org/10.2196/67792
• dc.identifier.issn 2561-326X
• dc.identifier.uri http://hdl.handle.net/10230/70635
• dc.language.iso eng
• dc.publisher JMIR Publications
• dc.relation.ispartof JMIR Form Res. 2025 May 20;9:e67792
• dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/820820
• dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/853981
• dc.rights ©Martin A Berge, Anisoara Paraschiv-Ionescu, Cameron Kirk, Arne Küderle, Encarna Micó-Amigo, Clemens Becker, Andrea Cereatti, Silvia Del Din, Monika Engdal, Judith Garcia-Aymerich, Karoline B Grønvik, Clint Hansen, Jeffrey M Hausdorff, Jorunn L Helbostad, Carl-Philipp Jansen, Lars Gunnar Johnsen, Jochen Klenk, Sarah Koch, Walter Maetzler, Dimitrios Megaritis, Arne Müller, Lynn Rochester, Lars Schwickert, Kristin Taraldsen, Beatrix Vereijken. Originally published in JMIR Formative Research (https://formative.jmir.org), 20.05.2025. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Active aging
• dc.subject.keyword Cadence
• dc.subject.keyword Digital mobility assessment
• dc.subject.keyword Distance
• dc.subject.keyword Free living
• dc.subject.keyword Gait
• dc.subject.keyword Walking speed
• dc.subject.keyword Wearable device
• dc.title Evaluating the accuracy and reliability of real-world digital mobility outcomes in older adults after hip fracture: Cross-sectional observational study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion