Adaptive Gait Biofeedback With Participant-Held-Out Modeling and Participant-Specific Updating in Chronic Ankle Instability

Adaptive gait biofeedback may support repeated practice in chronic ankle instability, but its evaluation must address model performance and human response. We evaluated a temporal convolutional classifier on protocol-defined, angle-derived GOOD/BAD gait-cycle labels using participant-held-out leave-one-subject-out (LOSO) cross-validation in 20 participants. Seven participants in the adaptive-intervention group completed nine sessions over three weeks, with one motion-capture recording analyzed per session. Models updated after failed sessions were compared offline with their parent models on the same-session validation subset used for candidate selection and the first subsequent adaptive-session recording. Frontal-plane ankle angle was compared between the adaptive group and 10 sequentially enrolled controls at Baseline, Post, and 7-day Retention. Across 20 held-out folds, mean fold-level area under the receiver operating characteristic curve (AUROC) was 0.948, sensitivity for angle-threshold-exceeding BAD cycles was 0.941, and specificity for angle-threshold-meeting GOOD cycles was 0.366. Mean BAD-class F1 was higher in candidate models by 0.187 on the same-session subset and 0.118 on the first subsequent recording. At Post, the adaptive group had a baseline-adjusted frontal-plane ankle angle 5.168 degrees lower than controls (95% confidence interval, 1.766-8.569 degrees lower); the Retention contrast was uncertain. These findings characterize population-model discrimination and offline participant-specific updating during repeated biofeedback use, alongside a nonrandomized Post frontal-plane ankle angle association. They do not establish independent clinical gait classification or a causal benefit of updating.