To systematically review and critically evaluate literature, on the effect of exercise and physical therapy interventions on gait disturbances in individuals with HD.
A systematic review was conducted using the Joanna Briggs Institute’s (JBI) Manual for Evidence Synthesis and pre-registered with the International Prospective Register of Systematic Reviews. PROSPERO (reg. CRD42024495477). We searched the CINAHL, MEDLINE, PEDro, PubMed, and Scopus electronic databases. Inclusion criteria included: adults with HD who are pre-symptomatic or prodromal or have manifest disease. Interventions included exercise and physical therapy interventions such as prescription of gait aids and orthoses. Main Outcomes were spatiotemporal gait parameters including mean speed, step length, stride length, step width, cadence, double limb support (% or duration), single limb support (% or duration). We excluded case studies, abstracts and non-English language papers. We used Covidence software to screen, select and manage references. Independent reviewers used JBI appraisal tools to critically appraise studies. Data on gait disturbances were extracted and synthesized, using narrative synthesis and meta-analysis where possible (random effects model) to generate forest plots and calculate effect sizes.
Initial searches identified 1,430 studies, 762 studies were screened, and 12 studies (total 278 participants) were included. Generally, studies were of moderate to high quality. Studies reported statistically significant improvements in self-selected gait speed, stride length, and base of support, particularly when implementing multimodal exercise interventions, exergames, rhythmic metronome cueing and prescribing assistive devices. Limited improvements were observed in cadence, step length and kinematic angle data for the hip, knee, and ankle joints. Results were reported according to PRISMA guidelines.
This rigorous systematic review shows exercise and physical therapy interventions have potential to improve gait disturbances in individuals with HD. However, the results should be interpreted cautiously due to significant heterogeneity across the small studies with relatively limited long-term follow-up. Larger scale trials with standardized gait outcomes are warranted to support the evidence base for interventions focusing on gait in this population.
- This study updates and informs clinicians on the specific effects of exercise-based interventions on gait parameters in people with HD.
- Knowledge gaps are identified and future research proposed.
gait
systematic review
