Construct validity of markerless three-dimensional gait biomechanics in healthy older adults

Background and aim Gait changes due to aging can result in functional limitations and a higher risk of falls, with older adults showing alterations in joint angles and moments. Marker-based gait analysis is not widely used in clinical settings due to its complexity and discomfort, especially in older adults. Recent advances in markerless motion capture, such as Theia3D, offer a promising alternative. This study aims to assess the construct validity of a markerless motion capture system for gait analysis in healthy older adults. Methods A cross-sectional study included 30 healthy community-dwelling older adults. Gait data was collected using marker-based and markerless motion capture systems in randomized order, with participants wearing tight-fitting minimal clothes plus 46 reflective markers attached, or their usual clothes, respectively. Joint kinematics (including range of motion) and kinetics were analyzed, and correlations between methods (Rxy) were assessed. Bland&Altman analysis was used to measure agreement. Root-mean-square differences (RMSD) were computed. Acceptable thresholds were set at <= 5 degrees for kinematic and at <= 10 % of signal amplitude for kinetics. Results Strong correlations (Rxy >= 0.7) were found between the systems for sagittal plane kinematics (except for the pelvis), particularly for knee and ankle joints. A low agreement was detected in sagittal plane hip and pelvis kinematics, along with RMSD exceeding 5 degrees. Weaker correlations and poor agreement were observed for transverse and frontal plane motions. Overall strong correlations were found for kinetics, except for the joint ankle inversion-eversion moment, and poor agreement for the frontal and transverse planes. Conclusion Overall markerless motion capture demonstrated good construct validity for measuring sagittal plane gait lower-limb gait kinematics (excluding pelvis) and kinetics in healthy older. However, considering the agreement between methods and the results for the other movement planes, further validation is required before markerless and marker-based systems can be used interchangeably in gait assessments.