Aldegheri, Stefano

Artusi, Carlo Alberto

Bombieri, Nicola

Camozzi, Serena

Geroin, Christian

English

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Reply: “Human Pose Estimation IsApproximate: Limitations andConsiderations for its Use in Clinical Trials”Carlo Alberto Artusi, MD, PhD,1,2,* Christian Geroin, PhD,3 Serena Camozzi, PT,4 Stefano Aldegheri, PhD,5 andNicola Bombieri, PhD5We thank Dr. Kondo for the comments reported in his letterregarding our study on AutoPosturePD.1,2 We appreciate hisperspective and acknowledge that the gold standard for identify-ing anatomical landmarks of spinal levels is instrumental, involvingimaging methods such as X-ray, magnetic resonance imaging, orcomputed tomography. To date, direct measurement on thepatient’s back by palpation-based identification of anatomical land-marks, even when performed by trained medical professionals, ispractical but has demonstrated limited accuracy.3 Therefore, whilethe spinal level can be identified using one or more of thesemodalities, the major advantage of AutoPosturePD, based on theHuman Pose Estimation (HPE), lies in its ability to automaticallydetect the angles of axial postural abnormalities according to therecently proposed measurement methods and diagnostic criteria.4In our previous study,5 we validated AutoPosturePD againstthe “gold standard” (manual measurement), demonstrating lowmargins of error, with intraclass correlation coefficients above 0.9and a mean difference compared to the anatomical landmarkassessment of 0.6  3.1 for lateral trunk flexion, 0.3  2.5 foranterior trunk flexion with thoracic fulcrum, and 1.3  1.8for anterior trunk flexion with lumbar fulcrum.5 Because suchvalidation confirms the high accuracy of AutoPosturePD relativeto the gold standard (assuming in-person anatomical landmarkassessment is considered the gold standard for this type of evalua-tion), we see no reason why it should not be considered a viableoutcome measure in future clinical trials. Of course, this shouldideally be preceded by further validation in a larger PD popula-tion, as well as external validation by independent groups usingdifferent datasets.In fact, while it is true that AutoPosturePD measurements arederived from computational models,6 this is also the case for manywidely accepted clinical tools. Many commonly used “derived”measures, such as gait analysis with wearable inertial sensors, arenow being incorporated into clinical trials after validation againstgold-standard counterparts (eg, infrared motion capture).AutoPosturePD’s primary advantage in assessing axial pos-tural abnormalities in PD lies in its ability to provide a time-efficient, automated measurement that can be performedremotely. This is particularly relevant in clinical and researchsettings where in-person evaluations may not always befeasible.Over the past decade, technological advancements in DeepLearning applications for video analysis have significantly improvedthe accuracy of human keypoint prediction, leading to the wide-spread adoption of HPE software for human motion analysis.Beyond traditional application domains such as sports performanceanalysis, human-robot interaction, and gesture recognition,numerous research studies have implemented this computer visiontechnology for clinical applications. A common perspective acrossthese studies is that motion analysis using HPE software representsa very near future in trials and clinical practice.In conclusion, we appreciate the discussion on this topic andbelieve that, as technology evolves, automated tools likeAutoPosturePD can complement traditional assessments, ulti-mately enhancing accessibility and efficiency in both clinicalpractice and research settings.Author RolesAll authors have participated in the article preparation. Allauthors have approved the final submitted article. This article1Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy; 2Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino,Torino, Italy; 3Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy; 4Neurology Unit, Movement Disorders Division,Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy; 5Department of Computer Science, University of Verona, Verona,Italy*Correspondence to: Dr. Carlo Alberto Artusi, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy;E-mail: carloalberto.artusi@unito.itKeywords: postural abnormalities, pisa syndrome, camptocormia, Parkinson’s disease, quantitative assessment.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in anymedium, provided the original work is properly cited.Received 20 March 2025; accepted 18 February 2025.Published online 00 Month 2025 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mdc3.70075MOVEMENT DISORDERS CLINICAL PRACTICE 2025. doi: 10.1002/mdc3.700751© 2025 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.LETTER: PUBLISHED ARTICLECLINICAL PRACTICErepresents original work by the authors, has not been publishedelsewhere, and is not under consideration for publication else-where. (1) Research Project: A. Conception, B. Organization,C. Execution; (2) Statistical Analysis: A. Design, B. Execution,C. Review and Critique; (3) Manuscript Preparation: A. Writingof the first draft, B. Review and Critique.C.A.A.: 1A, 1C, 3A, 3BC.G.: 1B, 1C, 3A, 3BS.C.: SA: 1C, 3BS.A.: 1C, 3BN.B.: 1A, 1B, 3BDisclosuresEthical Compliance Statement: The authors confirm that theapproval of an institutional review board was not required forthis work. Informed consent was not obtained as no patientswere involved. We confirm that we have read the Journal’s posi-tion on issues involved in ethical publication and affirm that thiswork is consistent with those guidelines.Funding Sources and Conflict of Interest: None.Financial Disclosures for the Previous 12 Months: CAAreceived speaker honoraria from Abbvie, Bial, Zambon,Lusofarmaco. CG reports no financial disclosures. SC reports nofinancial disclosures. SA reports no financial disclosures. NBreports no financial disclosures. The authors declare that thereare no additional disclosures to report.Data Availability StatementNo data to be shared. ■References1. Kondo Y. Human pose estimation is approximate: limitations and consid-erations for its use in clinical trials. Mov Disord Clin Pract 2025.2. Artusi CA, Geroin C, Pandino C, et al. Dynamic video assessment of axialpostural abnormalities in Parkinson’s disease: a pilot study. Mov Disord ClinPract 2025.3. Robinson R, Robinson HS, Bjorke G, Kvale A. Reliability and validityof a palpation technique for identifying the spinous processes of C7 andL5. Man Ther 2009;14:409–414.4. Tinazzi M, Geroin C, Bhidayasiri R, et al. Task force consensus on nosol-ogy and cut-off values for axial postural abnormalities in parkinsonism.Mov Disord Clin Pract 2022;9:594–603.5. Artusi CA, Geroin C, Imbalzano G, et al. Assessment of axial posturalabnormalities in parkinsonism: automatic picture analysis software. MovDisord Clin Pract 2023;10:636–645.6. Aldegheri S, Artusi CA, Camozzi S, et al. Camera- and viewpoint-agnostic evaluation of axial postural abnormalities in people withParkinson’s disease through augmented human pose estimation. Sensors2023;23:3193.2 MOVEMENT DISORDERS CLINICAL PRACTICE 2025. doi: 10.1002/mdc3.70075LETTER: PUBLISHED ARTICLE REPLY: HUMAN POSE ESTIMATION 23301619, 0, Downloaded from https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.70075 by University Degli Studi Di Vero, Wiley Online Library on [14/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

Reply: "Human Pose Estimation Is Approximate: Limitations and Considerations for its Use in Clinical Trials"

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Reply: "Human Pose Estimation Is Approximate: Limitations and Considerations for its Use in Clinical Trials"

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