Quantitative Movement Testing: Measuring Chronic Pain Patient Movements from a Single Smartphone Video
Authors: Pranav Mahajan, Amanda Wall, Eleonora Maria Camerone, Julie Stebbins, Eoin Kelleher, Shuangyi Tong, Annina Schmid, Katja Wiech, +2 more
Organizations: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. · Max Planck Institute of Biological Cybernetics, Tuebingen, Germany. · Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK. · Harvard Medical School, Boston, Massachusetts, USA. · Massachusetts General Hospital, Boston, Massachusetts, US. · Institute of Biomedical Engineering, University of Oxford, Oxford, UK. · Mayo Clinic, Florida, USA.
Chronic pain diminishes quality of life by decreasing functional ability, yet objectively measuring this functional impact remains challenging in real-world settings. While optical motion capture provides high precision for assessing altered movement quality, it is costly and restricted to laboratory environments. We aimed to develop and validate Quantitative Movement Testing (QMT), a computer vision pipeline extracting 3D kinematic biomarkers from standard monocular smartphone video, balancing clinical accessibility with biomechanical accuracy. We validated the QMT pipeline, utilising deep learning-based 3D pose-estimation, against gold-standard optical motion capture in healthy controls (N=13). Following leave-one-subject-out calibration to correct systematic bias, we deployed QMT in two prospective clinical cohorts to assess real-world utility: a pre- and post-intervention trial for fibromyalgia patients, and a 30-day longitudinal at-home monitoring study of chronic sciatica patients and healthy controls. In laboratory validation, QMT extracted clinical kinematic metrics with high agreement to optical motion capture, yielding strong correlations (r > 0.85) and low mean absolute errors. QMT demonstrated high test-retest reliability (r > 0.86) in fibromyalgia patients and successfully tracked day-to-day movement fluctuations in chronic sciatica. While real-world home settings introduced higher measurement variance than lab settings, QMT found group-level differences between healthy controls and sciatica patients based entirely on remote recordings. Monocular 3D pose estimation offers a scalable alternative to traditional assessments. QMT provides an objective, accessible biomarker for tracking disease progression and treatment response in clinical trials, though further research is needed to optimise reliability in home environments.
The Action Research Arm Test (ARAT) is a widely-used upper limb outcome measure in neurorehabilitation, but its ordinal scoring is subjective and suffers from limited sensitivity and specificity. We evaluated whether artificial-intelligence (AI)-based markerless motion capture (MMC), embedded into ARAT assessments during clinical routine, accurately reconstructs upper limb movement and yields valid, objective kinematic metrics carrying clinically meaningful information beyond the ordinal score. Across 47 sessions from 20 mixed-neurological patients (1,174 ARAT tasks), biomechanical reconstruction was accurate and robust across impairment levels, and kinematic metrics showed the discrimination pattern expected of a construct-valid measure. In longitudinal case studies, the metrics added the specificity and sensitivity the ordinal score lacks: a domain decomposition exposed patient-specific recovery profiles underlying equal ARAT gains (specificity), and kinematic improvement continued to be detected after the ARAT had saturated (sensitivity). MMC in clinical routine can thus provide valid, objective, sensitive, and specific kinematic measurement complementing ordinal scoring.
arly identification of motor impairment in infancy relies on expert visual assessment of spontaneous movement, motivating the development of automated, objective alternatives. One promising approach is using computer vision, which benefits from high quality pose estimation from video. In this study, we systematically evaluated three state-of-the-art pose estimation frameworks (MeTRAbs-ACAE, SAM 3D Body, and Sapiens) on 100 videos over 13 sessions of 8 infants recorded with a multi-view markerless motion capture system. We quantified keypoint detection accuracy using reprojection error, geometric consistency, and Procrustes-aligned 3D position error, and demonstrated proof-of-concept for fitting an inverse kinematic framework to infant data. While Sapiens achieved the lowest reprojection error and highest geometric consistency of the methods evaluated (22.8 pixels and 0.82, respectively), SAM 3D Body provided the most comprehensive 3D information for kinematic reconstruction with Procrustes-aligned position errors of 19 to 28 mm. We demonstrate in a case comparison example that biomechanical models fit to SAM 3D estimates distinguish representative movement patterns in infants related to motor development, as identified by a clinical expert. Together, these findings highlight both the promise and current limitations of 3D pose estimation for infant biomechanics and establish preliminary groundwork for scalable, video-based assessment of early motor development.
Cerebral Palsy (CP) is a neurological disorder of movement and the most common cause of lifelong physical disability in childhood. Approximately 75% of children with CP are ambulatory, and accurate gait assessment is central to preserving walking function, which deteriorates by mid-adulthood in a quarter to half of adults with CP. The Rodda and Graham classification system quantifies sagittal-plane gait deviations using ankle and knee z-scores derived from 3D Instrumented Gait Analysis (3D-IGA), but 3D-IGA is expensive and limited to specialized centers, while observational assessment shows only moderate inter-rater agreement. We developed a markerless gait analysis pipeline that quantifies Rodda and Graham knee and ankle z-scores directly from single-view clinical gait videos. Across 1,058 bilateral limb samples from 529 trials of 152 children (88 male, 63 female; age 12.1 ± 4.0 years; 60 distinct primary diagnoses, cerebral palsy the most common at n=54), the sagittal-view model achieved R2=0.80±0.02 and CCC =0.89±0.02 for knee z-scores and R2=0.57±0.02 and CCC =0.72±0.02 for ankle z-scores against 3D-IGA. Binary screening for excess knee flexion achieves AUROC =0.88, correctly identifying 83% of affected children, and applying Rodda and Graham rules yields 43±1% 7-class accuracy with macro-AUROC =0.78±0.01, ankle prediction error remaining the primary bottleneck. Beyond cross-sectional screening, continuous z-scores support longitudinal trajectory tracking across visits, providing a quantitative substrate for monitoring disease progression and treatment response unavailable from observational scales. These results demonstrate the feasibility of video-based z-score estimation, excess-flexion screening, and longitudinal trajectory tracking as a path toward scalable, objective gait assessment in low-resource clinical settings.