Reliability, Validity and Utility of Inertial Sensor Systems for Postural Control Assessment in Sport Science and Medicine Applications: A Systematic Review

Abstract

Background

Recent advances in mobile sensing and computing technology have provided a means to objectively and unobtrusively quantify postural control. This has resulted in the rapid development and evaluation of a series of wearable inertial sensor-based assessments. However, the validity, reliability and clinical utility of such systems is not fully understood.

Objectives

This systematic review aims to synthesise and evaluate studies that have investigated the ability of wearable inertial sensor systems to validly and reliably quantify postural control performance in sports science and medicine applications.

Methods

A systematic search strategy utilising the PRISMA guidelines was employed to identify eligible articles through ScienceDirect, Embase and PubMed databases. In total, 47 articles met the inclusion criteria and were evaluated and qualitatively synthesised under two main headings: measurement validity and measurement reliability. Furthermore, studies that investigated the utility of these systems in clinical populations were summarised and discussed.

Results

After duplicate removal, 4374 articles were identified with the search strategy, with 47 papers included in the final review. In total, 28 studies investigated validity in healthy populations, and 15 studies investigated validity in clinical populations; 13 investigated the measurement reliability of these sensor-based systems.

Conclusions

The application of wearable inertial sensors for sports science and medicine postural control applications is an evolving field. To date, research has primarily focused on evaluating the validity and reliability of a heterogeneous set of assessment protocols, in a laboratory environment. While researchers have begun to investigate their utility in clinical use cases such as concussion and musculoskeletal injury, most studies have leveraged small sample sizes, are of low quality and use a variety of descriptive variables, assessment protocols and sensor-mounting locations. Future research should evaluate the clinical utility of these systems in large high-quality prospective cohort studies to establish the role they may play in injury risk identification, diagnosis and management. This systematic review was registered with the International Prospective Register of Systematic Reviews on 10 August 2018 (PROSPERO registration: CRD42018106363): https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=106363.

Appendix 1: Paper quality assessment based on the Downs and Black criteria

References	1	2	3	4	5	6	7	8	9	10	Total
Abe et al. [36]	0	0	1	1	1	1	0	0	1	1	6
Alberts et al. [26]	0	1	1	1	1	1	0	0	1	1	7
Alberts et al. [12]	0	1	1	1	1	1	0	0	1	1	7
Amick et al. [63]	0	0	1	1	1	1	0	0	1	1	6
Anderson et al. [72]	1	0	1	1	1	1	0	0	1	1	7
Baracks et al. [54]	1	0	1	1	1	1	0	0	1	1	7
Berkner et al. [50]	1	0	1	1	1	1	0	0	1	1	7
Bernstein et al. [56]	1	0	0	1	1	1	0	0	1	1	6
Betkner et al. [37]	0	0	1	0	1	1	0	0	1	1	5
Bonnet et al. [42]	0	1	0	1	0	0	0	0	0	0	2
Borges et al. [51]	1	0	1	1	0	1	0	0	1	1	6
Brown et al. [57]	1	0	1	0	1	1	0	0	1	1	6
Brown et al. [13]	1	1	1	0	1	1	0	0	1	1	7
Budini et al. [49]	0	0	1	0	1	1	0	0	1	1	5
Burghart et al. [27]	1	0	1	1	1	0	0	0	1	1	6
Chiu et al. [43]	0	0	1	1	1	1	0	0	1	1	6
Dabbs et al. [34]	0	0	1	1	1	1	0	0	1	1	6
Doherty et al. [52]	1	1	1	1	1	1	0	0	1	1	8
Dunn et al. [64]	0	0	0	1	1	1	0	0	1	1	5
Furman et al. [14]	0	0	1	1	1	0	0	0	1	1	5
Gera et al. [55]	1	0	1	1	1	1	0	0	1	1	7
Han et al. [61]	0	0	1	0	1	1	0	0	1	1	5
Heebner et al. [28]	1	1	1	1	1	1	0	0	1	1	8
Johnston et al. [48]	1	1	1	1	1	1	0	0	1	1	8
Johnston et al. [44]	1	1	1	1	1	1	0	0	1	1	8
Kim et al. [38]	1	0	1	1	1	1	0	0	1	1	7
King et al. [15]	1	0	1	1	1	1	0	0	1	1	7
King et al. [53]	1	0	1	1	1	1	0	0	1	1	7
Kosse et al. [39]	1	0	1	1	1	1	0	0	1	1	7
Linder et al. [17]	1	0	1	1	1	1	0	0	1	1	7
Martínez-Ramírez et al. [58]	0	0	1	1	1	1	0	0	1	1	6
Mohamed et al. [35]	0	0	1	1	1	1	0	0	1	1	6
Neville et al. [29]	1	1	1	1	1	1	0	0	1	1	8
Oliva Dominguez et al. [45]	0	0	1	1	0	1	0	0	1	1	5
Patterson et al. [41]	0	0	1	1	1	0	0	0	1	1	5
Patterson et al. [30]	0	0	1	1	1	1	0	0	1	0	5
Rouis et al. [31]	0	0	0	1	1	1	0	0	1	1	5
Salisbury et al. [40]	1	0	1	1	1	1	0	0	1	1	7
Schelldorfer et al. [46]	1	0	1	0	0	1	0	0	1	1	5
Seimetz et al. [32]	0	0	0	0	0	0	0	0	1	0	1
Senanayake et al. [59]	0	0	0	1	0	0	0	0	1	1	3
Shah et al. [25]	0	0	1	1	1	1	0	0	1	1	6
Simon et al. [16]	1	0	1	1	1	1	0	0	1	1	7
Whitney et al. [33]	0	1	1	1	1	0	0	0	1	1	6
Wilkerson et al. [60]	0	0	0	1	0	0	0	0	1	1	3
Williams et al. [62]	0	0	1	1	1	1	0	0	1	1	6
Yvon et al. [47]	0	0	1	0	1	1	0	0	1	1	5

1. Items legend: (1) is the hypothesis/aim/objective of the study clearly described? (2) Are the main outcomes to be measured clearly described in the Sects. 1 or 2? (3) Are the characteristics of the patients included in the study clearly described? (4) Are the main findings of the study clearly described? (5) Does the study provide estimates of the random variability in the data for the main outcomes? (6) Have actual probability or reliability values been reported (e.g. 0.035 rather than < 0.05) for the main outcomes except where the probability value is less than 0.001?). (7) Were the subjects asked to participate in the study representative of the entire population from which they were recruited? (8) Were those subjects who were prepared to participate representative of the entire population from which they were recruited? (9) If any of the results of the study were based on “data dredging”, was this made clear? (10) Were the statistical tests used to assess the main outcomes appropriate