Real-World Wrist-Derived Digital Mobility Outcomes in People with Multiple Long-Term Conditions: A Comparison of Algorithms

Digital Mobility outcomes can serve as objective biomarkers of health, but their validation in populations with multiple long-term conditions (MLTCs) based on wrist-worn devices remains unexplored. We refined, improved, and introduced novel algorithms, specifically tailored and adapted for (i) gait sequence detection, (ii) initial contact identification, and (iii) stride length estimation from a single wrist-worn device. Validation was performed using data from 28 participants with co-occurring MLTCs performing a 2.5 h real-world monitoring session. Reference data from an established multi-sensor system were used to assess algorithm performance across diverse gait patterns of co-occurring MLTCs. Twenty-eight participants (mean age 70.4 years, 43% females) had a median of three co-occurring MLTCs. Among six gait sequence detection methods, improved versions of the Kheirkhahan algorithm performed best (accuracy = 0.92, specificity = 0.96). For initial contact detection (nine methods tested), Shin's algorithm achieved the highest performance index (0.85) followed by McCamley (0.84). Stride length estimation was most accurate using novel approaches based on the Weinberg method (performance index > 0.70). The proposed fine-tuned algorithms, the newly developed adaptive variants, and the foot-length augmented versions demonstrated robust performance, surpassing many existing methods and addressing the complexity of gait patterns in MLTCs. These findings enable scalable, real-time mobility monitoring in complex clinical populations using accessible wearable technology.