I read with great interest the recent article by Artusi et al 1 describing the dynamic video assessment of axial postural abnormalities using AutoPosturePD for postural angle calculation. Although the authors acknowledge certain technical limitations of AutoPosturePD, I believe that fundamental considerations beyond merely technical improvements are necessary before its implementation in clinical trials.
A critical limitation of human posture‐estimation technologies, including AutoPosturePD, is their inherent nature as computational approximations rather than direct clinical measurements. It is essential to acknowledge that their outputs are estimates derived from computational models. Although previous studies have shown strong correlations with actual measurements, 2 , 3 presenting these computational estimates as direct measurements in the results is misleading.
Consider, for example, the Timed Up‐and‐Go test; even if the video analysis software could automatically calculate the time required with high reproducibility, researchers would likely hesitate to report these computed estimates as primary outcome measures in clinical trials. The gold standard is direct measurement by trained clinicians using a stopwatch. Similarly, this principle applies to postural angle calculation. Although automated systems offer convenience, expert clinical identification of anatomical landmarks remains indispensable.
We propose that postural assessment software should follow an approach similar to that of the NeuroPostureApp, 4 in which clinicians and researchers directly select anatomical landmarks for angle calculations. This methodology ensures that the critical identification of anatomical points remain under clinical expertise, whereas the software serves purely as a measurement tool. Therefore, we urge careful consideration regarding the use of human posture‐estimation technologies in clinical trials.
Author Roles
(1) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique.
Y.K.: 1A, 1B
Disclosures
Ethical Compliance Statement: We confirm that the approval of an institutional review board was not required for this work. Informed patient consent was not necessary for this work. We confirm that we have read the journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.
Funding Sources and Conflicts of Interest: The authors report no sources of funding and no conflicts of interest.
Financial Disclosures for Previous 12 Months: The authors declare that there are no additional disclosures to report.
Acknowledgments
We thank Editage (www.editage.jp) for English language editing.
Relevant disclosures and conflict of interest are listed at the end of this article.
Data Availability Statement
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
References
- 1. Artusi CA, Geroin C, Pandino C, et al. Dynamic video assessment of axial postural abnormalities in Parkinson's disease: a pilot study. Mov Disord Clin Pract 2025;12(8):1214–1215. 10.1002/mdc3.14329. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Associated Data
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Data Availability Statement
Data sharing is not applicable to this article as no new data were created or analyzed in this study.