Digital Biomarkers of Gait and Balance in Diabetic Foot, Measurable by Wearable Inertial Measurement Units: A Mini Review

Gu Eon Kang, Angeloh Stout, Ke'Vaughn Waldon, Seungmin Kang, Amanda L Killeen, Peter A Crisologo, Michael Siah, Daniel Jupiter, Bijan Najafi, Ashkan Vaziri, Lawrence A Lavery, Gu Eon Kang, Angeloh Stout, Ke'Vaughn Waldon, Seungmin Kang, Amanda L Killeen, Peter A Crisologo, Michael Siah, Daniel Jupiter, Bijan Najafi, Ashkan Vaziri, Lawrence A Lavery

Abstract

People with diabetic foot frequently exhibit gait and balance dysfunction. Recent advances in wearable inertial measurement units (IMUs) enable to assess some of the gait and balance dysfunction associated with diabetic foot (i.e., digital biomarkers of gait and balance). However, there is no review to inform digital biomarkers of gait and balance dysfunction related to diabetic foot, measurable by wearable IMUs (e.g., what gait and balance parameters can wearable IMUs collect? Are the measurements repeatable?). Accordingly, we conducted a web-based, mini review using PubMed. Our search was limited to human subjects and English-written papers published in peer-reviewed journals. We identified 20 papers in this mini review. We found preliminary evidence of digital biomarkers of gait and balance dysfunction in people with diabetic foot, such as slow gait speed, large gait variability, unstable gait initiation, and large body sway. However, due to heterogeneities in included papers in terms of study design, movement tasks, and small sample size, more studies are recommended to confirm this preliminary evidence. Additionally, based on our mini review, we recommend establishing appropriate strategies to successfully incorporate wearable-based assessment into clinical practice for diabetic foot care.

Keywords: diabetic foot; diabetic neuropathies; digital technology; foot ulcer; gait; inertial measurement unit; peripheral arterial disease; postural balance; walking; wearable electronic devices.

Conflict of interest statement

G.E.K., A.S., K.W., S.K., A.L.K., P.A.C., M.S., D.J. and L.A.L. declare no conflict of interest. B.N. and A.V. are a consultant, a founder, and the CEO of BioSensics LLC, respectively, which is a manufacturer of one of the IMUs referenced in this review; however, they were not involved in the selection of papers and their contributions were limited to technical discussion, interpretation of the results, and reviewing and editing of the manuscript. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart for selecting papers.
Figure 2
Figure 2
The number of papers for each task.
Figure 3
Figure 3
The number of papers for each sensor type.
Figure 4
Figure 4
The number of papers for each gait variable.
Figure 5
Figure 5
The number of papers for each quiet standing variable.

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