{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:11:09Z","timestamp":1788210669599,"version":"build-2803163510"},"reference-count":45,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Force platforms and optoelectronic motion capture systems are considered gold standards for postural sway assessment, although their use is confined to dedicated laboratory settings. Wearable inertial systems represent a practical alternative; however, their validity compared with reference systems within a shared physical domain (i.e., displacement domain) remains insufficiently investigated. This methodological requirement, frequently overlooked in the existing literature, is here adopted as an explicit inclusion criterion for the first time to ensure an appropriate metrological comparison. This review critically examines the validity of inertial systems for postural sway assessment, only including studies in which sway parameters derived from inertial measurement units (IMUs) were expressed in the same physical domain as the corresponding reference measurements. Methods: A systematic search of the Scopus database was conducted to identify English-language studies published up to January 2026 that compared IMU-derived sway parameters with those obtained from gold-standard systems, using parameters expressed in consistent measurement units. Sensor placement, postural tasks, signal processing techniques, extracted sway parameters, and statistical validation methods were analyzed as key methodological aspects. Results: Eight studies published between 2015 and 2022 met the inclusion criteria. The predominant configuration consisted of a single lumbar-mounted IMU, and quiet bipedal standing was the most frequently investigated postural task. Velocity-based parameters, particularly mean sway velocity, demonstrated moderate to high agreement with reference systems. In contrast, spatial dispersion measures, including the 95% confidence ellipse area and root mean square displacement, showed greater variability and, in some cases, systematic bias in Bland\u2013Altman analyses. Conclusions: Wearable inertial systems demonstrated strong potential for estimating global and velocity-related sway parameters during quiet standing, supporting their clinical applicability. However, spatial metrics and dynamic postural tasks remain more challenging for IMU-based assessment. Methodological standardization of validation protocols and signal processing pipelines is essential to improve comparability and reproducibility across studies.<\/jats:p>","DOI":"10.3390\/diagnostics16132101","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"2101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Validity of Wearable Inertial Sensors for Postural Sway Analysis: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Giuseppe","family":"Prisco","sequence":"first","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Pisani","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-1115","authenticated-orcid":false,"given":"Maria","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9053-3139","authenticated-orcid":false,"given":"Francesco","family":"Amato","sequence":"additional","affiliation":[{"name":"Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5099-9786","authenticated-orcid":false,"given":"Fabrizio","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9746-2265","authenticated-orcid":false,"given":"Leandro","family":"Donisi","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","unstructured":"Shumway-Cook, A., and Woollacott, M.H. (2007). Motor Control: Translating Research into Clinical Practice, Lippincott Williams & Wilkins."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ivanenko, Y., and Gurfinkel, V.S. (2018). Human Postural Control. Front. Neurosci., 12.","DOI":"10.3389\/fnins.2018.00171"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chianese, M., Papallo, S., Prisco, G., De Micco, R., Tessitore, A., Gargiulo, P., Esposito, F., and Donisi, L. (2025). Exploring Brain Correlates of Muscular Activity and Postural Sway. Proceedings of the 2025 IEEE International Conference on Metrology for eXtended Reality, Artificial Intelligence and Neural Engineering (MetroXRAINE), IEEE.","DOI":"10.1109\/MetroXRAINE66377.2025.11340380"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.neures.2015.12.002","article-title":"Human Upright Posture Control Models Based on Multisensory Inputs; in Fast and Slow Dynamics","volume":"104","author":"Chiba","year":"2016","journal-title":"Neurosci. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1109\/10.532130","article-title":"Measures of Postural Steadiness: Differences between Healthy Young and Elderly Adults","volume":"43","author":"Prieto","year":"1996","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gaitpost.2015.10.014","article-title":"The Use of Force-Plate Posturography in the Assessment of Postural Instability","volume":"44","year":"2016","journal-title":"Gait Posture"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0966-6362(96)82849-9","article-title":"Human Balance and Posture Control during Standing and Walking","volume":"3","author":"Winter","year":"1995","journal-title":"Gait Posture"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Liau, B.-Y., Wu, F.-L., Lung, C.-W., Zhang, X., Wang, X., and Jan, Y.-K. (2019). Complexity-Based Measures of Postural Sway during Walking at Different Speeds and Durations Using Multiscale Entropy. Entropy, 21.","DOI":"10.3390\/e21111128"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Suzuki, Y., Morimoto, H., Kiyono, K., Morasso, P.G., and Nomura, T. (2016). Dynamic Determinants of the Uncontrolled Manifold during Human Quiet Stance. Front. Hum. Neurosci., 10.","DOI":"10.3389\/fnhum.2016.00618"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1515\/hukin-2015-0195","article-title":"Directional Measures of Postural Sway as Predictors of Balance Instability and Accidental Falls","volume":"52","author":"Beck","year":"2016","journal-title":"J. Hum. Kinet."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Allsopp, T.J., and Dornhoffer, J.L. (2026). Computerized Dynamic Posturography. Diagnosis and Treatment of Vestibular Disorders, Springer.","DOI":"10.1007\/978-3-032-11740-3_7"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Meletani, S., Scataglini, S., Mandolini, M., Scalise, L., and Truijen, S. (2024). Experimental Comparison between 4D Stereophotogrammetry and Inertial Measurement Unit Systems for Gait Spatiotemporal Parameters and Joint Kinematics. Sensors, 24.","DOI":"10.3390\/s24144669"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Sotirakis, H., Hatzitaki, V., Munoz-Martel, V., Mademli, L., and Arampatzis, A. (2019). Center of Pressure Feedback Modulates the Entrainment of Voluntary Sway to the Motion of a Visual Target. Appl. Sci., 9.","DOI":"10.3390\/app9193952"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13047-021-00504-5","article-title":"New Anatomical Reference Systems for the Bones of the Foot and Ankle Complex: Definitions and Exploitation on Clinical Conditions","volume":"14","author":"Conconi","year":"2021","journal-title":"J. Foot Ankle Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"12273","DOI":"10.1038\/s41598-019-47613-7","article-title":"Neuromuscular Organisation and Robustness of Postural Control in the Presence of Perturbations","volume":"9","author":"Santuz","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Rentz, C., Kaiser, V., Jung, N., Turlach, B.A., Sahandi Far, M., Peterburs, J., Boltes, M., Schnitzler, A., Amunts, K., and Dukart, J. (2024). Sensor-Based Gait and Balance Assessment in Healthy Adults: Analysis of Short-Term Training and Sensor Placement Effects. Sensors, 24.","DOI":"10.3390\/s24175598"},{"key":"ref_17","first-page":"707","article-title":"Clinical Stabilometry Standardization: Feet Position in the Static Stabilometric Assessment of Postural Stability","volume":"33","author":"Scoppa","year":"2017","journal-title":"Acta Med. Mediterr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"7928","DOI":"10.1038\/s41598-023-34692-w","article-title":"The Effect of Chronic Low Back Pain on Postural Control during Quiet Standing: A Meta-Analysis","volume":"13","author":"Park","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.gaitpost.2021.07.005","article-title":"Postural Stability in Athletes: The Role of Sport Direction","volume":"89","author":"Andreeva","year":"2021","journal-title":"Gait Posture"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Prisco, G., Pirozzi, M.A., Santone, A., Cesarelli, M., Esposito, F., Gargiulo, P., Amato, F., and Donisi, L. (2025). Combining Postural Sway Parameters and Machine Learning to Assess Biomechanical Risk Associated with Load-Lifting Activities. Diagnostics, 15.","DOI":"10.3390\/diagnostics15010105"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Henriques, J., Neves, N., and de Carvalho, P. (2020). Potential Biomechanical Overload on Skeletal Muscle Structures in Students During Walk with Backpack. Proceedings of the XV Mediterranean Conference on Medical and Biological Engineering and Computing\u2014MEDICON 2019, Springer International Publishing.","DOI":"10.1007\/978-3-030-31635-8"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1586\/17434440.2016.1153421","article-title":"Potential of APDM Mobility Lab for the Monitoring of the Progression of Parkinson\u2019s Disease","volume":"13","author":"Mancini","year":"2016","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Nascimento, L.M.S., Bonfati, L.V., Freitas, M.L.B., Mendes Junior, J.J.A., Siqueira, H.V., and Stevan, S.L. (2020). Sensors and Systems for Physical Rehabilitation and Health Monitoring\u2014A Review. Sensors, 20.","DOI":"10.3390\/s20154063"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Maher, C., Szeto, K., and Arnold, J. (2021). The Use of Accelerometer-Based Wearable Activity Monitors in Clinical Settings: Current Practice, Barriers, Enablers, and Future Opportunities. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-07096-7"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Subramaniam, S., Faisal, A.I., and Deen, M.J. (2022). Wearable Sensor Systems for Fall Risk Assessment: A Review. Front. Digit. Health, 4.","DOI":"10.3389\/fdgth.2022.921506"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/EDE.0b013e3181fe7999","article-title":"PRISMA Statement","volume":"22","author":"Takkouche","year":"2011","journal-title":"Epidemiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s11136-017-1765-4","article-title":"COSMIN Risk of Bias Checklist for Systematic Reviews of Patient-Reported Outcome Measures","volume":"27","author":"Mokkink","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"578","DOI":"10.4085\/1062-6050-50.2.01","article-title":"Using Accelerometer and Gyroscopic Measures to Quantify Postural Stability","volume":"50","author":"Alberts","year":"2015","journal-title":"J. Athl. Train."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1109\/JSEN.2015.2489381","article-title":"A Wearable and Modular Inertial Unit for Measuring Limb Movements and Balance Control Abilities","volume":"16","author":"Bertolotti","year":"2016","journal-title":"IEEE Sens. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.clinbiomech.2018.10.003","article-title":"Establishing the Waist as the Better Location for Attaching a Single Accelerometer to Estimate Center of Pressure Trajectories","volume":"60","author":"Chen","year":"2018","journal-title":"Clin. Biomech."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ekvall Hansson, E., and Tornberg, \u00c5. (2019). Coherence and Reliability of a Wearable Inertial Measurement Unit for Measuring Postural Sway. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4238-8"},{"key":"ref_32","first-page":"984","article-title":"Concurrent Validity of a Developed Accelerometry-Based Device for Postural Sway Assessment","volume":"42","author":"Suttanon","year":"2020","journal-title":"Songklanakarin J. Sci. Technol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Germanotta, M., Mileti, I., Conforti, I., Del Prete, Z., Aprile, I., and Palermo, E. (2021). Estimation of Human Center of Mass Position through the Inertial Sensors-Based Methods in Postural Tasks: An Accuracy Evaluation. Sensors, 21.","DOI":"10.3390\/s21020601"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"19094","DOI":"10.1038\/s41598-021-98695-1","article-title":"A Comparison of Head Movements Tests in Force Plate and Accelerometer Based Posturography in Patients with Balance Problems Due to Vestibular Dysfunction","volume":"11","author":"Janc","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3233\/THC-212924","article-title":"Agreement between Inertial Measurement Unit and Optoelectronic System to Measure Postural Sway","volume":"30","author":"Vagnini","year":"2022","journal-title":"Technol. Health Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1038\/s41578-022-00460-x","article-title":"End-to-End Design of Wearable Sensors","volume":"7","author":"Ates","year":"2022","journal-title":"Nat. Rev. Mater."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Donisi, L., Jacob, D., Guerrini, L., Prisco, G., Esposito, F., Cesarelli, M., Amato, F., and Gargiulo, P. (2023). sEMG Spectral Analysis and Machine Learning Algorithms Are Able to Discriminate Biomechanical Risk Classes Associated with Manual Material Liftings. Bioengineering, 10.","DOI":"10.3390\/bioengineering10091103"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Prisco, G., Romano, M., Esposito, F., Cesarelli, M., Santone, A., Donisi, L., and Amato, F. (2024). Capability of Machine Learning Algorithms to Classify Safe and Unsafe Postures during Weight Lifting Tasks Using Inertial Sensors. Diagnostics, 14.","DOI":"10.3390\/diagnostics14060576"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"108642","DOI":"10.1016\/j.measurement.2020.108642","article-title":"Benchmarking between Two Wearable Inertial Systems for Gait Analysis Based on a Different Sensor Placement Using Several Statistical Approaches","volume":"173","author":"Donisi","year":"2021","journal-title":"Measurement"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Prisco, G., Komici, K., Mercaldo, F., Donisi, L., Cesarelli, M., Guerra, G., and Santone, A. (2023). A Machine Learning Approach to Classify Ventilatory Efficiency. Proceedings of the 2023 IEEE International Conference on Metrology for eXtended Reality, Artificial Intelligence and Neural Engineering (MetroXRAINE), IEEE.","DOI":"10.1109\/MetroXRAINE58569.2023.10405678"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ler\u00edn-Calvo, A., Prisco, G., Fern\u00e1ndez-Maza, E., N\u00fa\u00f1ez-Gonz\u00e1lez, M., Santiago-Lorrio, G., Donisi, L., and Lerma-Lara, S. (2025). Assessing the Validity and Reliability of a Single Lumbar-Mounted IMU System for Gait Analysis. Sensors, 25.","DOI":"10.3390\/s25247643"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Prisco, G., Cesarelli, G., Romano, M., Picillo, M., Ricciardi, C., Esposito, F., Barone, P., Cesarelli, M., and Donisi, L. (2025). Validity of a Novel Algorithm to Compute Spatiotemporal Parameters Based on a Single IMU Placed on the Lumbar Region. Sensors, 25.","DOI":"10.3390\/s25185822"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jarm, T., Cvetkoska, A., Mahni\u010d-Kalamiza, S., and Miklavcic, D. (2021). Influence of the Backpack on School Children\u2019s Gait: A Statistical and Machine Learning Approach. Proceedings of the 8th European Medical and Biological Engineering Conference, Springer International Publishing.","DOI":"10.1007\/978-3-030-64610-3_131"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Tong, C.Y., Zhu, R.T.-L., Ling, Y.T., Scheeren, E.M., Lam, F.M.H., Fu, H., and Ma, C.Z.-H. (2023). Muscular and Kinematic Responses to Unexpected Translational Balance Perturbation: A Pilot Study in Healthy Young Adults. Bioengineering, 10.","DOI":"10.3390\/bioengineering10070831"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Reimann, H., and Bruijn, S.M. (2024). The Condition for Dynamic Stability in Humans Walking with Feedback Control. PLoS Comput. Biol., 20.","DOI":"10.1371\/journal.pcbi.1011861"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2101\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T09:02:59Z","timestamp":1783328579000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":45,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16132101"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16132101","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]}}}