Soulard J1,2, Vaillant J1,2, Agier C1, Vuillerme N1,3
1Université Grenoble Alpes, AGEIS Laboratory, Grenoble, France, 2Grenoble University Hospital, Grenoble, France, 3Institut Universitaire de France, Paris, France
Background: Ankylosing spondylitis (AS) is a subtype of inflammatory rheumatic disease, affecting predominantly axial skeleton and sacro-iliac joints. The main clinical manifestations are spinal stiffness and inflammatory back pain, that yield adverse effects on gait control. At this point, however, some discrepancies exist regarding gait characteristics in AS as well as gait analysis protocols and parameters used.
Purpose: The review questions are twofold:
(1) what are the consequences of ankylosing spondylitis on gait? and
(2) which gait assessments are used with patients with AS?
Methods: The review protocol has been published in JMIR Res. Protocols. Three electronic databases were search systematically to identify studies satisfying the search criteria: PubMed, Pedro and Cochrane, with no limit to publication date. The research focused on original research, using Boolean operator "AND" and "OR" in the combination of the MESH descriptors, found in titles and/or abstracts: (Gait OR Walk OR Walking OR locomotor OR locomotion) AND (ankylosing spondylitis OR spondyloarthritis). English, original articles only were included.
Results: One hundred and sixty eight titles were identified by databases searching. After screening abstracts and full texts, 17 articles were included in the review. Among these 17 articles, 6 compared AS patients to healthy control individuals. Furthermore, 13 studies used clinical tests or gait speed only and 4 used instrumented tests with quantified gait parameters; Among the studies using clinical tests, 11 used the 6-minute walk distance (2 with control group; 1 with sig. diff with controls), 2 used the time to realize the TUG (1 with control group ; no sig. diff with controls) and 1 used the number of oversteps during the figure of 8 test (no control group). One studys used the parameter gait speed at a fast pace (0 with control group) and 4 at comfortable pace (3 with control group, no sig. diff with controls). Among the studies with instrumented gaits tests, 4 reported stride length (3 with control group; 1 with sig. diff with controls), 2 reported cadence (2 with control group, no sig. diff with controls), 2 reported hip range (2 with control group; 1 with sig. diff with controls) and 2 reported knee range (2 with control group, no sig. diff with controls).
Conclusion(s): Only few studies have assessed gait characteristics in AS patients. The most frequently used clinical assessment was the 6MWT, whereas instrumental gait tests used different protocols and parameters, with differences with controls that were not obvious. All in all, this review suggests that no consensus exists concerning gait analysis methods to study gait in patients with AS. Accordingly, future studies should focus on using standardized gait analysis methods involving both clinical and instrumental gait tests and a healthy control group.
Implications: Recent advancements in medical device technologies make it possible to democratize the kinetic kinematic analysis of walking. Interestingly, using wearable inertial sensors during clinical gait tests could provide quantitative measures of gait, that could advantageously help to follow AS evolution and assess drugs and non-pharmacological treatment efficacy in AS patients.
Keywords: Gait, Ankylosing spondylitis
Funding acknowledgements: - French Ministry of Health and Solidarity (PHRIP-16-0528)
- French National Research Agency (ANR-10-AIRT-05 and ANR-15-IDEX-02)
Purpose: The review questions are twofold:
(1) what are the consequences of ankylosing spondylitis on gait? and
(2) which gait assessments are used with patients with AS?
Methods: The review protocol has been published in JMIR Res. Protocols. Three electronic databases were search systematically to identify studies satisfying the search criteria: PubMed, Pedro and Cochrane, with no limit to publication date. The research focused on original research, using Boolean operator "AND" and "OR" in the combination of the MESH descriptors, found in titles and/or abstracts: (Gait OR Walk OR Walking OR locomotor OR locomotion) AND (ankylosing spondylitis OR spondyloarthritis). English, original articles only were included.
Results: One hundred and sixty eight titles were identified by databases searching. After screening abstracts and full texts, 17 articles were included in the review. Among these 17 articles, 6 compared AS patients to healthy control individuals. Furthermore, 13 studies used clinical tests or gait speed only and 4 used instrumented tests with quantified gait parameters; Among the studies using clinical tests, 11 used the 6-minute walk distance (2 with control group; 1 with sig. diff with controls), 2 used the time to realize the TUG (1 with control group ; no sig. diff with controls) and 1 used the number of oversteps during the figure of 8 test (no control group). One studys used the parameter gait speed at a fast pace (0 with control group) and 4 at comfortable pace (3 with control group, no sig. diff with controls). Among the studies with instrumented gaits tests, 4 reported stride length (3 with control group; 1 with sig. diff with controls), 2 reported cadence (2 with control group, no sig. diff with controls), 2 reported hip range (2 with control group; 1 with sig. diff with controls) and 2 reported knee range (2 with control group, no sig. diff with controls).
Conclusion(s): Only few studies have assessed gait characteristics in AS patients. The most frequently used clinical assessment was the 6MWT, whereas instrumental gait tests used different protocols and parameters, with differences with controls that were not obvious. All in all, this review suggests that no consensus exists concerning gait analysis methods to study gait in patients with AS. Accordingly, future studies should focus on using standardized gait analysis methods involving both clinical and instrumental gait tests and a healthy control group.
Implications: Recent advancements in medical device technologies make it possible to democratize the kinetic kinematic analysis of walking. Interestingly, using wearable inertial sensors during clinical gait tests could provide quantitative measures of gait, that could advantageously help to follow AS evolution and assess drugs and non-pharmacological treatment efficacy in AS patients.
Keywords: Gait, Ankylosing spondylitis
Funding acknowledgements: - French Ministry of Health and Solidarity (PHRIP-16-0528)
- French National Research Agency (ANR-10-AIRT-05 and ANR-15-IDEX-02)
Topic: Mental health; Human movement analysis
Ethics approval required: No
Institution: Prospero, publication of the review protocol in JMIR Res Protocols
Ethics committee: CRD42018102540
Reason not required: Systematic review registered in prospero
All authors, affiliations and abstracts have been published as submitted.
