A New Wearable System for Postural Balance Assessment: Comparison with EquiTest and Static Posturography in Healthy Adults

<b>Background</b>: Objective assessment of postural control is central to the clinical evaluation of vestibular disorders. Although force-platform-based posturography is considered the gold standard, its use may be limited by cost and infrastructural requirements. Wearable inertial measurement units (IMUs) represent a promising alternative; however, their clinical validation should account for intrinsic differences in measurement paradigms rather than strict metric equivalence. <b>Objective</b>: To preliminarily evaluate the within-session reliability of a wearable IMU-based medical device for balance assessment (Gravity), and its agreement with established static (SBP) and computerised dynamic posturographic systems (CDP) in healthy subjects. <b>Methods</b>: Sixty-three healthy adults were enrolled in two independent method comparison studies: a wearable IMU-based balance system versus a static stabilometric platform (GRAVITY vs. SVEP; <i>n</i> = 42) and a wearable IMU-based balance system versus computerised dynamic posturography (Gravity vs. EquiTest; <i>n</i> = 21). Gravity measurements were obtained simultaneously with reference systems across standardised sensory conditions. Within-session reliability and method agreement were assessed. <b>Results</b>: Within-session reliability of Gravity was outcome-dependent. Length-based components demonstrated higher repeatability (ICC (single) = 0.25-0.35; ICC (average) = 0.41-0.52), with narrower limits of agreement (LoA = ±9-12%) and lower measurement error (SEM = 3.3-4.3%). In comparison with SBP, length-based measures exhibited narrower limits (LoA = ±12-17) and more consistent relationships. Comparison with CDP revealed moderate agreement for composite and preferential scores (LoA: -2.20-7.07; -5.54-8.12). <b>Conclusions</b>: Gravity sensor may represent a clinically meaningful, outcome-dependent performance, with superior reliability and comparability for length-based postural measures compared with area-based measures. The device could provide balance assessments compatible with both static and dynamic posturographic systems, accounting for physiological variability. These findings support the potential clinical use of wearable IMU-based posturography, particularly in settings where conventional force-platform systems are not readily available, and warrant further validation in larger, more clinically diverse populations.