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Quantitative gait analysis can support clinical decision-making. These analyses can be performed using wearable sensors, nonwearable sensors, or a combination of both. However, to date, they have not been widely adopted in clinical practice. Technology adoption literature has highlighted the clinical efficacy of technology and the users’ perspective on the technology (eg, ease of use and usefulness) as some factors that influence their widespread adoption.
To assist with the clinical adoption of quantitative gait technologies, this scoping review will synthesize the literature on their clinical efficacy and clinician perspectives on their use in the clinical care of adult patient populations.
This scoping review protocol follows the Joanna Briggs Institute methodology for scoping reviews. The review will include both peer-reviewed and gray literature (ie, conference abstracts) regarding the clinical efficacy of quantitative gait technologies and clinician perspectives on their use in the clinical care of adult patient populations. A comprehensive search strategy was created in MEDLINE (Ovid), which was then translated to 4 other databases: CENTRAL (Ovid), Embase (Ovid), CINAHL (EBSCO), and SPORTDiscus (EBSCO). The title and abstract screening, full-text review, and data extraction of relevant articles will be performed independently by 2 reviewers, with a third reviewer involved to support the resolution of conflicts. Data will be analyzed using content analysis and summarized in tabular and diagram formats.
A search of relevant articles will be conducted in all 5 databases, and through hand-searching in Google Scholar and PEDro, including articles published up until December 2022. The research team plans to submit the final scoping review for publication in a peer-reviewed journal in 2023.
The findings of this review will be presented at clinical science conferences and published in a peer-reviewed journal. This review will inform future studies designed to develop, evaluate, or implement quantitative gait analysis technologies in clinical practice.
DERR1-10.2196/39767
Gait impairments increase risk of falls and the level of disability, thus negatively influencing a person’s involvement in society and quality of life. There are many causes of gait impairments, including neurological, musculoskeletal, and other health conditions. Gait assessments are an important aspect of a clinical assessment because they provide clinicians with information to support diagnosis, risk assessment, and treatment planning, with the goal of optimizing a person’s independence and physical function. In clinical practice, gait assessments are primarily performed using observational gait analysis, which involves a clinician’s visual assessment of the patient’s gait [
Inertial sensors (eg, accelerometers and gyroscopes)
Force sensors (eg, instrumented insoles)
Electromyography
Flexible goniometers
Ultrasonic sensors
Pressure sensor mats
Force plates (eg, ground reaction force plates)
Motion capture
Vision-based gait assessment [
Research on quantitative gait analysis technologies has increased nearly 10-fold over the last 10 years [
There are many factors that influence technology adoption [
In applying these learnings to the clinical adoption of quantitative gait analysis technologies, we then consider some factors that influence their successful adoption to be clinical efficacy and effectiveness, and clinicians’ perspectives on the use of gait technologies in practice (ie, perceived barriers or facilitators to ease the use and usefulness of the technology, and beyond). As there are many different gait analysis technologies, consideration must be given to how and whether the above factors differ between each respective technology, patient population, and clinical context. A visual representation of how we consider these factors to influence the clinical adoption of quantitative gait technologies in the care of adult populations is shown in
To our knowledge, no previous review has synthesized the evidence for clinical efficacy and a clinician’s perspective that influences the use of gait technologies in the clinical care of adult patient populations. A preliminary search for similar existing scoping and systematic reviews was conducted up until April 2021 in PubMed and Google Scholar. Two related systematic reviews were published in 2011 [
The objective of this scoping review is to describe the factors influencing the clinical adoption of quantitative gait analysis technologies with a focus on their clinical efficacy, and clinicians’ perspectives on their use in the clinical care of adult patient populations. We will also explore how these components differ across gait technology types, patient populations, and clinical contexts. A scoping review approach has been chosen to explore the extent of literature on this broad topic and is a necessary step in identifying how gait technologies can be integrated into clinical practice.
Factors influencing the clinical adoption of quantitative gait analysis technologies.
This scoping review protocol follows the recommendations outlined in the Joanna Briggs Institute (JBI) methodology for scoping reviews [
The conduct and reporting of results will conform to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist [
A list of inclusion and exclusion criteria can be seen in
All adult patient populations (18 years and older)
All health care professionals
Quantitative gait analysis technologies
Clinical efficacy studies (ie, efficacy and effectiveness)
Clinician perspectives on the use of gait technologies in practice
Clinical setting
Gait training technologies
Gait technologies used solely to measure movement or activity levels
Gait technologies in the development or preliminary validation phase
There are 2 categories of participants included in this review. The first category of participants includes all adult patient populations (18 years and older), and the second category of participants includes all health care professionals. There will be no restrictions with regards to gender, sex, or ethnicity.
There are three components to the concept of this scoping review: (1) quantitative gait analysis technologies, (2) clinical efficacy (ie, efficacy and effectiveness), and (3) clinicians’ perspectives on the use of gait technologies in practice (eg, perceived barriers or facilitators to ease of use and usefulness of technology or factors beyond ease of use and usefulness). First, gait analysis technologies are defined as those used to quantitatively measure the different phases of gait for the purpose of assessment or monitoring changes in gait. This can include collecting kinetic or kinematic measures or muscle function data. By this definition, articles studying gait training technologies or technologies used solely to measure movement or activity levels (eg, number of steps per day) will be excluded. Additionally, studies focused on gait technology development or preliminary validation will be excluded from this review. Second, we define clinical efficacy similarly to the “diagnostic thinking and treatment efficacy” and “patient outcomes” categories as outlined by Wren et al [
There are no restrictions on geographical location or cultural factors in this review. The context of this scoping review includes “clinical care,” which encompasses a wide range of settings, including but not limited to hospitals, homes, community-based locations, and private health clinics. Because we are investigating clinician perspectives, it is likely that many of the articles will be qualitative in nature. Thus, the context of these papers may include interview or focus group settings.
Primary research studies of all designs, including both quantitative and qualitative work, as well as gray literature (ie, conference abstracts), will be included in this review. Secondary research studies (eg, systematic reviews) and other gray literature (eg, textbooks and dissertations) will be excluded from this review. Additionally, articles and conference abstracts will be excluded if there are no reported results.
A 3-step search strategy was performed as outlined by the JBI methodology for scoping reviews [
Only articles written in the English language will be included in this review because that is the language understood by the authors. Both peer-reviewed and gray literature (ie, conference abstracts) discussed in the above 3-step search strategy will be included in this review. Conference abstracts are included to increase the comprehensiveness of this review and will be searched in Embase (Ovid) and CENTRAL (Ovid). These 2 databases were chosen because conference proceedings are indexed in Embase (Ovid), with some also being found in CENTRAL (Ovid). There is no date limit on the articles included in this review, because to our knowledge, no other scoping review has addressed this specific question. An information specialist at the University Health Network was involved in the development and review of the search strategies created in all 5 databases. The complete MEDLINE (Ovid) search strategy can be found in
Covidence (Veritas Health Innovation) systematic review software will be used for the management of the articles identified in the search strategy. Prior to performing the formal selection process, pilot testing will be completed with 4 reviewers (YS, LC, AI, and KKP). In accordance with the JBI methodology for scoping reviews, 25 titles and abstracts will be chosen for the reviewers to screen based on the inclusion criteria previously mentioned [
During the formal screening process, 2 reviewers (YS and LC) will independently perform title and abstract screening. Both reviewers must agree on the inclusion of the article for it to be processed in the full-text review stage. Conflicts between the 2 reviewers at this stage will be resolved by a third reviewer (AI). Once title and abstract screening is complete, pilot testing for the full-text review stage will begin with the same 4 reviewers (YS, LC, AI, and KKP). Similar to the pilot testing for title and abstract screening, all 4 reviewers will independently read 5 full-text articles and assess them for inclusion. Any discrepancies during the pilot testing will result in further refinement of the inclusion criteria. The formal full-text review process will begin once 75% agreement or more is reached during pilot testing. Once the pilot testing is complete, both reviewers (YS and LC) will independently read the full-text articles for inclusion. Where articles are agreed upon for exclusion but the chosen exclusion criteria differ between reviewers, both reviewers (YS and LC) will decide on the most appropriate exclusion criteria by consensus. A third reviewer (AI) will resolve conflicts as they pertain to including and excluding articles. The complete review process will be illustrated using a flow diagram and included in the appendices of the scoping review. A short explanation regarding the inclusion and exclusion of sources of evidence will also be included in the appendices of the scoping review.
This review will also include a critical appraisal of all full-text articles included in this review. The critical appraisal will be used to assess the quality of the study design, methods, and analysis of the included literature. The JBI critical appraisal tools will be used, as this is recommended to authors who are conducting reviews following JBI guidelines [
A draft data extraction form has been created in accordance with the JBI methodology for scoping reviews [
The data extraction form will be piloted by both reviewers (YS and LC) on 3 articles to ensure that relevant information is being extracted. Pilot testing will involve both reviewers (YS and LC) extracting data from 3 articles. The first reviewer (YS) will check for consistency in the extracted information between both reviewers. Both reviewers will then meet to discuss whether additional modification of the data extraction form is needed. Recognizing that the development of the data extraction form is iterative, modifications may be made throughout the extraction process by both reviewers. For modifications to be made, both reviewers will need to agree upon the added information categories. If disagreements arise, a third reviewer (AI) will be involved. The included literature will be divided between both reviewers (YS and LC); one will complete data extraction and the other will review the extraction for accuracy.
The results of this scoping review will be synthesized and presented using both quantitative and qualitative methods. Quantitative methods will include counts of the number of unique clinical uses, clinician perspectives, types of gait analysis technologies used, patient populations, and clinical contexts. Qualitative methods will be used to organize the findings into
This scoping review does not require research ethics board approval.
There was no patient or public involvement in the development of this protocol.
Results of this proposed scoping review will be presented in both a tabular format and a diagram. The table will display the quantitative analysis of the results. Results of the critical appraisal for each study will be shared within the text of the scoping review as well as in tabular format. The diagram will display the qualitative results and be similar to what is shown in
A search of relevant articles will be conducted in all 5 databases and through hand searching in Google Scholar and PEDro, including articles published up until December 2022. The research team plans to submit the final scoping review for publication in a peer-reviewed journal in 2023. If we experience any delays to the timeline (eg, a greater number of papers to screen than expected), we will recruit others to assist with screening and data extraction.
Preliminary research suggests gait analysis technologies have a role in clinical decision-making [
To our knowledge, this will be the first review to synthesize the evidence on the clinical efficacy and a clinician’s perspective on the use of gait technologies in the clinical care of adult patient populations. This review differs from related systematic reviews [
This review has some limitations. First, this review will only consider conference abstracts as a source of gray literature, and second, this review will only consider studies written in the English language. Thus, relevant articles may be missed if written in another language.
We anticipate that this review will provide insights into the clinical adoption of quantitative gait analysis technologies by highlighting their role in clinical decision-making and clinician perspectives on using gait technologies in practice. The results of this review can also be used to inform and guide future work focusing on facilitating the translation of technologies into practice. Recognizing the role of this review in technology adoption and clinical sciences, the results will be disseminated at clinical science conferences and through publication in a peer-reviewed journal.
MEDLINE search string.
Joanna Briggs Institute
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews
We would like to acknowledge Jessica Babineau, the information specialist with the University Health Network Library and Information Services, for her assistance in developing the search strategy. This research was supported by AGE-WELL NCE Inc, a member of the Networks of Centres of Excellence Program, and a Canadian Institute of Health Research Project Grant (169166).
YS led the development of the search string and protocol. LS was the second reviewer on the scoping review and provided feedback to the protocol. KKP provided feedback on the protocol and is the cosupervisor of the first author. AI provided feedback on the search strategy and protocol and is the primary supervisor of the first author.
None declared.