Posture and movement classification: The comparison of tri-axial accelerometer numbers and anatomical placement

Patient compliance is important when assessing movement, particularly in a free-living environment when patients are asked to don their own accelerometers. Reducing the number of accelerometers could increase patient compliance. The aims of this study were (1) to determine and compare the validity of different accelerometer combinations and placements for a previously developed posture and dynamic movement identification algorithm. Custom-built activity monitors, each containing one tri-axial accelerometer, were placed on the ankles, right thigh, and waist of 12 healthy adults. Subjects performed a protocol in the laboratory including static orientations of standing, sitting, and lying down, and dynamic movements of walking, jogging, transitions between postures, and fidgeting to simulate free-living activity. When only one accelerometer was used, the thigh was found to be the optimal placement to identify both movement and static postures, with a misclassification error of 10%, and demonstrated the greatest accuracy for walking/fidgeting and jogging classification with sensitivities and positive predictive value (PPVs) greater than 93%. When two accelerometers were used, the waist-thigh accelerometers identified movement and static postures with greater accuracy than the thigh-ankle accelerometers (with a misclassification error of 11% compared to 17%). However, the thigh-ankle accelerometers demonstrated the greatest accuracy for walking/ fidgeting and jogging classification with sensitivities and PPVs greater than 93%. Movement can be accurately classified in healthy adults using tri-axial accelerometers placed on one or two of the following sites: waist, thigh, or ankle. Posture and transitions require an accelerometer placed on the waist and an accelerometer placed on the thigh.