Evaluating Large Language Models for Gait Classification Using Text-Encoded Kinematic Waveforms

Abstract

Background: Machine learning (ML) enhances gait analysis but often lacks the level of interpretability desired for clinical adoption. Large Language Models (LLMs) may offer explanatory capabilities and confidence-aware outputs when applied to structured kinematic data. This study therefore evaluated whether general-purpose LLMs can classify continuous gait kinematics when represented as textual numeric sequences and how their performance compares to conventional ML approaches. Methods: Lower-body kinematics were recorded from 20 participants performing seven gait patterns. A supervised KNN classifier and a class-independent One-Class SVM (OCSVM) were compared against zero-shot LLMs (GPT-5, GPT-5-mini, GPT-4.1, and o4-mini). Models were evaluated using Leave-One-Subject-Out (LOSO) cross-validation. LLMs were tested both with and without explicit reference gait statistics. Results: The supervised KNN achieved the highest performance (multiclass Matthews Correlation Coefficient, MCC = 0.88). The best-performing LLM (GPT-5) with reference grounding achieved a multiclass MCC of 0.70 and a binary MCC of 0.68, outperforming the class-independent OCSVM (binary MCC = 0.60). Performance of the LLM was highly dependent on explicit reference information and self-rated confidence; when restricted to high-confidence predictions, multiclass MCC increased to 0.83 on the filtered subset. Notably, the computationally efficient o4-mini model performed comparably to larger models. Conclusion: When continuous kinematic waveforms were encoded as textual numeric tokens, general-purpose LLMs, even with reference grounding, did not match supervised multiclass classifiers for precise gait classification and are better regarded as exploratory systems requiring cautious, human-guided interpretation rather than diagnostic use.