Accuracy of Monocular Two-Dimensional Pose Estimation Compared With a Reference Standard for Kinematic Multiview Analysis: Validation Study

BACKGROUND: Expensive optoelectronic systems, considered the gold standard, require a laboratory environment and the attachment of markers, and they are therefore rarely used in everyday clinical practice. Two-dimensional (2D) human pose estimations for clinical purposes allow kinematic analyses to be carried out via a camera-based smartphone app. Since clinical specialists highly depend on the validity of information, there is a need to evaluate the accuracy of 2D pose estimation apps. OBJECTIVE: The aim of the study was to investigate the accuracy of the 2D pose estimation of a mobility analysis app (Lindera-v2), using the PanopticStudio Toolbox data set as a reference standard. The study aimed to assess the differences in joint angles obtained by 2D video information generated with the Lindera-v2 algorithm and the reference standard. The results can provide an important assessment of the adequacy of the app for clinical use. METHODS: To evaluate the accuracy of the Lindera-v2 algorithm, 10 video sequences were analyzed. Accuracy was evaluated by assessing a total of 30,000 data pairs for each joint (10 joints in total), comparing the angle data obtained from the Lindera-v2 algorithm with those of the reference standard. The mean differences of the angles were calculated for each joint, and a comparison was made between the estimated values and the reference standard values. Furthermore, the mean absolute error (MAE), root mean square error, and symmetric mean absolute percentage error of the 2D angles were calculated. Agreement between the 2 measurement methods was calculated using the intraclass correlation coefficient (ICC[A,2]). A cross-correlation was calculated for the time series to verify whether there was a temporal shift in the data. RESULTS: The mean difference of the Lindera-v2 data in the right hip was the closest to the reference standard, with a mean value difference of –0.05° (SD 6.06°). The greatest difference in comparison with the baseline was found in the neck, with a measurement of –3.07° (SD 6.43°). The MAE of the angle measurement closest to the baseline was observed in the pelvis (1.40°, SD 1.48°). In contrast, the largest MAE was observed in the right shoulder (6.48°, SD 8.43°). The medians of all acquired joints ranged in difference from 0.19° to 3.17° compared with the reference standard. The ICC values ranged from 0.951 (95% CI 0.914-0.969) in the neck to 0.997 (95% CI 0.997-0.997) in the left elbow joint. The cross-correlation showed that the Lindera-v2 algorithm had no temporal lag. CONCLUSIONS: The results of the study indicate that a 2D pose estimation by means of a smartphone app can have excellent agreement compared with a validated reference standard. An assessment of kinematic variables can be performed with the analyzed algorithm, showing only minimal deviations compared with data from a massive multiview system.