{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T20:50:02Z","timestamp":1775163002034,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Research Foundation - Flanders","doi-asserted-by":"publisher","award":["T004716N"],"award-info":[{"award-number":["T004716N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>This study\u2019s aim is threefold: (I) Evaluate movement quality parameters of gait in people with hip or knee osteoarthritis (OA) compared to asymptomatic controls from a single trunk-worn 3D accelerometer. (II) Evaluate the sensitivity of these parameters to capture changes at 6-weeks, 3-, 6-, and 12-months following total knee arthroplasty (TKA). (III) Investigate whether observed changes in movement quality from 6-weeks and 12-months post-TKA relates to changes in patient-reported outcome measures (PROMs). We invited 20 asymptomatic controls, 20 people with hip OA, 18 people pre- and post-TKA to our movement lap. They wore a single trunk-worn accelerometer and walked at a self-selected speed. Movement quality parameters (symmetry, complexity, smoothness, and dynamic stability) were calculated from the 3D acceleration signal. Between groups and between timepoints comparisons were made, and changes in movement quality were correlated with PROMs. We found significant differences in symmetry and stability in both OA groups. Post-TKA, most parameters reflected an initial decrease in movement quality at 6-weeks post-TKA, which mostly normalised 6-months post-TKA. Finally, improved movement quality relates to improvements in PROMs. Thus, a single accelerometer can characterise movement quality in both OA groups and post-TKA. The correlation shows the potential to monitor movement quality in a clinical setting to inform objective, data-driven personalised rehabilitation.<\/jats:p>","DOI":"10.3390\/s22082955","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T22:48:45Z","timestamp":1649803725000},"page":"2955","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Movement Quality Parameters during Gait Assessed by a Single Accelerometer in Subjects with Osteoarthritis and Following Total Joint Arthroplasty"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9218-7604","authenticated-orcid":false,"given":"Jill","family":"Emmerzaal","sequence":"first","affiliation":[{"name":"Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium"},{"name":"REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristoff","family":"Corten","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Ziekenhuis Oost Limburg, 3600 Genk, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5071-2124","authenticated-orcid":false,"given":"Rob","family":"van der Straaten","sequence":"additional","affiliation":[{"name":"REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1370-2090","authenticated-orcid":false,"given":"Liesbet","family":"De Baets","sequence":"additional","affiliation":[{"name":"Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, 1050 Brussel, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3206-9796","authenticated-orcid":false,"given":"Sam","family":"Van Rossom","sequence":"additional","affiliation":[{"name":"Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-947X","authenticated-orcid":false,"given":"Annick","family":"Timmermans","sequence":"additional","affiliation":[{"name":"REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-3747","authenticated-orcid":false,"given":"Ilse","family":"Jonkers","sequence":"additional","affiliation":[{"name":"Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6158-9483","authenticated-orcid":false,"given":"Benedicte","family":"Vanwanseele","sequence":"additional","affiliation":[{"name":"Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","first-page":"646","article-title":"Burden of major musculoskeletal conditions","volume":"81","author":"Woolf","year":"2003","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hodt-Billington, C., Helbostad, J.L., Vervaat, W., Rognsv\u00e5g, T., and Moe-Nilssen, R. (2011). Changes in gait symmetry, gait velocity and self-reported function following total hip replacement. Measures of Symmetry in Gait. Methodological Principles and Clinical Choices, University of Bergen.","DOI":"10.2340\/16501977-0849"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1002\/acr.22015","article-title":"Biomechanical deviations during level walking associated with knee osteoarthritis: A systematic review and meta-analysis","volume":"65","author":"Mills","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1002\/jor.22924","article-title":"Biomechanical gait features associated with hip osteoarthritis: Towards a better definition of clinical hallmarks","volume":"33","author":"Meyer","year":"2015","journal-title":"J. Orthop. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.joca.2012.09.012","article-title":"Osteoarthritis as a disease of mechanics","volume":"21","author":"Felson","year":"2013","journal-title":"Osteoarthr. Cartil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.joca.2016.09.023","article-title":"Osteoarthritis year in review 2016: Mechanics","volume":"25","author":"Saxby","year":"2017","journal-title":"Osteoarthr. Cartil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.clinbiomech.2014.05.008","article-title":"Gait and gait-related activities of daily living after total hip arthroplasty: A systematic review","volume":"29","author":"Kolk","year":"2014","journal-title":"Clin. Biomech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gaitpost.2011.12.024","article-title":"Post-operative gait analysis in total hip replacement patients\u2014A review of current literature and meta-analysis","volume":"36","author":"Ewen","year":"2012","journal-title":"Gait Posture"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.1016\/j.jbiomech.2007.05.020","article-title":"Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients","volume":"40","author":"Foucher","year":"2007","journal-title":"J. Biomech."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s00776-008-1285-8","article-title":"Is gait normal after total knee arthroplasty? Systematic review of the literature","volume":"14","author":"Milner","year":"2009","journal-title":"J. Orthop. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/jor.21545","article-title":"Knee biomechanics early after knee replacement surgery predict abnormal gait patterns 12 months postoperatively","volume":"30","author":"Levinger","year":"2012","journal-title":"J. Orthop. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.gaitpost.2018.04.047","article-title":"The use of wearable devices for walking and running gait analysis outside of the lab: A systematic review","volume":"63","author":"Benson","year":"2018","journal-title":"Gait Posture"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kobsar, D., Masood, Z., Khan, H., Khalil, N., Kiwan, M.Y., Ridd, S., and Tobis, M. (2020). Wearable inertial sensors for gait analysis in adults with osteoarthritis\u2014A scoping review. Sensors, 20.","DOI":"10.3390\/s20247143"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0966-6362(02)00190-X","article-title":"Assessment of spatio-temporal gait parameters from trunk accelerations during human walking","volume":"18","author":"Zijlstra","year":"2003","journal-title":"Gait Posture"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0021-9290(03)00233-1","article-title":"Estimation of gait cycle characteristics by trunk accelerometry","volume":"37","author":"Helbostad","year":"2004","journal-title":"J. Biomech."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1007\/s00167-007-0373-1","article-title":"ACL deficiency affects stride-to-stride variability as measured using nonlinear methodology","volume":"15","author":"Moraiti","year":"2007","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.humov.2011.06.002","article-title":"Human movement variability, nonlinear dynamics, and pathology: Is there a connection?","volume":"30","author":"Stergiou","year":"2011","journal-title":"Hum. Mov. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jelekin.2019.03.007","article-title":"Linear and nonlinear measures of gait variability after anterior cruciate ligament reconstruction","volume":"46","author":"Andrade","year":"2019","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12984-018-0398-3","article-title":"SPARC: A new approach to quantifying gait smoothness in patients with Parkinson\u2019s disease","volume":"15","author":"Beck","year":"2018","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.gaitpost.2013.05.002","article-title":"Estimating fall risk with inertial sensors using gait stability measures that do not require step detection","volume":"38","author":"Riva","year":"2013","journal-title":"Gait Posture"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Van Schooten, K.S., Pijnappels, M., Rispens, S.M., Elders, P.J., Lips, P., Daffertshofer, A., Beek, P.J., and Van Dieen, J.H. (2016). Daily-life gait quality as predictor of falls in older people: A 1-year prospective cohort study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0158623"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12984-015-0090-9","article-title":"On the analysis of movement smoothness","volume":"12","author":"Balasubramanian","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12984-019-0579-8","article-title":"Movement smoothness during a functional mobility task in subjects with Parkinson\u2019s disease and freezing of gait\u2013an analysis using inertial measurement units","volume":"16","author":"Pinto","year":"2019","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.gaitpost.2012.05.028","article-title":"Analysis of gait and balance through a single triaxial accelerometer in presymptomatic and symptomatic Huntington\u2019s disease","volume":"37","author":"Dalton","year":"2013","journal-title":"Gait Posture"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.gaitpost.2017.08.023","article-title":"Smoothness of gait detects early alterations of walking in persons with multiple sclerosis without disability","volume":"58","author":"Pau","year":"2017","journal-title":"Gait Posture"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"H1643","DOI":"10.1152\/ajpheart.1994.266.4.H1643","article-title":"Physiological time-series analysis: What does regularity quantify?","volume":"266","author":"Pincus","year":"1994","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/jor.22023","article-title":"Grand challenge competition to predict in vivo knee loads","volume":"30","author":"Fregly","year":"2012","journal-title":"J. Orthop. Res."},{"key":"ref_28","unstructured":"Roetenberg, D., Luinge, H., and Slycke, P. (2009). Xsens MVN: Full 6DOF Human Motion Tracking Using Miniature Inertial Sensors, Xsens Motion Technologies BV. Technical Report."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/S0268-0033(98)00090-4","article-title":"A new method for evaluating motor control in gait under real-life environmental conditions. Part 2: Gait analysis","volume":"13","year":"1998","journal-title":"Clin. Biomech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/0021-9290(86)90120-X","article-title":"When and how does steady state gait movement induced from upright posture begin?","volume":"19","author":"Breniere","year":"1986","journal-title":"J. Biomech."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1080\/02640414.2010.507250","article-title":"Motor variability in sports: A non-linear analysis of race walking","volume":"28","author":"Preatoni","year":"2010","journal-title":"J. Sports Sci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Sch\u00fctte, K.H., Maas, E.A., Exadaktylos, V., Berckmans, D., Venter, R.E., and Vanwanseele, B. (2015). Wireless tri-axial trunk accelerometry detects deviations in dynamic center of mass motion due to running-induced fatigue. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0141957"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/0167-2789(93)90009-P","article-title":"A practical method for calculating largest Lyapunov exponents from small data sets","volume":"65","author":"Rosenstein","year":"1993","journal-title":"Phys. D Nonlin. Phenom."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2588","DOI":"10.1007\/s10439-010-0018-2","article-title":"Estimating dynamic gait stability using data from non-aligned inertial sensors","volume":"38","author":"Bruijn","year":"2010","journal-title":"Ann. Biomed. Eng."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.gaitpost.2018.08.010","article-title":"Maximum Lyapunov exponent revisited: Long-term attractor divergence of gait dynamics is highly sensitive to the noise structure of stride intervals","volume":"66","author":"Terrier","year":"2018","journal-title":"Gait Posture"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"20120999","DOI":"10.1098\/rsif.2012.0999","article-title":"Assessing the stability of human locomotion: A review of current measures","volume":"10","author":"Bruijn","year":"2013","journal-title":"J. R. Soc. Interface"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s10439-012-0668-3","article-title":"The appropriate use of approximate entropy and sample entropy with short data sets","volume":"41","author":"Yentes","year":"2013","journal-title":"Ann. Biomed. Eng."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"H2039","DOI":"10.1152\/ajpheart.2000.278.6.H2039","article-title":"Physiological time-series analysis using approximate entropy and sample entropy","volume":"278","author":"Richman","year":"2000","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_39","first-page":"1507","article-title":"Estimating movement smoothness from inertial measurement units","volume":"8","author":"Shirota","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_40","unstructured":"Portney, L.G., and Watkins, M.P. (2009). Foundations of Clinical Research: Applications to Practice, Pearson\/Prentice Hall."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: Fundamental algorithms for scientific computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat. Methods"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.joca.2020.12.009","article-title":"Osteoarthritis year in review 2020: Mechanics","volume":"29","author":"Wilson","year":"2021","journal-title":"Osteoarthr. Cartil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.joca.2018.10.012","article-title":"Trunk movement asymmetry associated with pain, disability, and quadriceps strength asymmetry in individuals with knee osteoarthritis: A cross-sectional study","volume":"27","author":"Iijima","year":"2019","journal-title":"Osteoarthr. Cartil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1053\/apmr.2001.26812","article-title":"Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis","volume":"82","author":"Watelain","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.clinbiomech.2010.07.015","article-title":"Stride-to-stride variability is altered during backward walking in anterior cruciate ligament deficient patients","volume":"25","author":"Zampeli","year":"2010","journal-title":"Clin. Biomech."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.gaitpost.2015.01.004","article-title":"Toward new sensitive measures to evaluate gait stability in focal cerebellar lesion patients","volume":"41","author":"Hoogkamer","year":"2015","journal-title":"Gait Posture"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1115\/1.2800760","article-title":"Dynamic stability of passive dynamic walking on an irregular surface","volume":"129","author":"Su","year":"2007","journal-title":"J. Biomech. Eng."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1002\/jor.22022","article-title":"Entropy analysis of tri-axial leg acceleration signal waveforms for measurement of decrease of physiological variability in human gait","volume":"30","author":"Tochigi","year":"2012","journal-title":"J. Orthop. Res."},{"key":"ref_49","first-page":"603","article-title":"A comprehensive assessment of gait accelerometry signals in time, frequency and time-frequency domains","volume":"22","author":"Lowry","year":"2013","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S210","DOI":"10.1016\/S0021-9290(07)70206-3","article-title":"Lyapunov exponent estimation for human gait acceleration signals","volume":"40","author":"TenBroek","year":"2007","journal-title":"J. Biomech."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/8\/2955\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:35Z","timestamp":1760136755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/8\/2955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,12]]},"references-count":50,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["s22082955"],"URL":"https:\/\/doi.org\/10.3390\/s22082955","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-832370\/v1","asserted-by":"object"}]},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,12]]}}}