Evaluating the efficacy of gait analysis as an objective metric for persistent postural–perceptual dizziness

Persistent postural – perceptual dizziness (PPPD) is a chronic, disabling vestibular disorder for which diagnosis remains largely dependent on subjective symptom reporting. The current lack of objective evaluation tools presents considerable challenges to its accurate identification and clinical management. This study aims to systematically evaluate the gait characteristics of patients with PPPD and assess the diagnostic utility of gait parameters, to provide an objective basis for the clinical diagnosis of PPPD. Clinical data, cranial magnetic resonance imaging (MRI) and gait parameters obtained from free-walking tests on flat ground and carpet surfaces were collected from 51 PPPD patients and 50 controls recruited at Shaanxi Provincial People's Hospital between February 2024 and February 2025. Gait parameters were recorded using a Wearable Sensor-based Gait Capture System. Gait parameter analysis showed that the gait speed, stride length, and step frequency were significantly reduced in patients with PPPD, although the support time was significantly prolonged ( p < 0.05). Further multivariable logistic regression analysis revealed that lower gait speed (flat ground OR = 0.571, p = 0.025; carpet OR = 0.347, p < 0.001) and history of vertigo attacks (flat ground OR = 11.526, p = 0.001; carpet OR = 11.383, p = 0.002) were all associated with PPPD. Receiver operating characteristic (ROC) curve analysis demonstrated that gait speed on flat ground had an area under the curve (AUC) of 0.749, which increased to 0.844 in the combined model (gait speed, age, sex, BMI, anxiety-depressive symptoms, and history of vertigo attacks). Furthermore, gait speed on the carpet had an AUC of 0.833, which improved to 0.893 in the same combined model, higher than that for flat ground ( p = 0.006). When compared with the control group, patients with PPPD demonstrated distinct alterations in gait features, especially gait speed. Such parameters might represent a candidate objective metric supporting diagnostic assessment. The predictive model incorporating gait speed, age, sex, BMI, anxiety-depressive symptoms and history of vertigo attacks showed good diagnostic performance for PPPD, especially when assessed via the carpet free-walking test.