File
Berner K.1, Morris L.1, Baumeister J.2, Louw Q.1
1Stellenbosch University, Department of Interdisciplinary Health Sciences, Division of Physiotherapy, Tygerberg, Cape Town, South Africa, 2Europa-Universität Flensburg, Exercise & Neuroscience Unit, Institute of Health, Nutrition and Sports Sciences, Flensburg, Germany
Background: Gait and balance deficits are reported in adults with HIV and are associated with reduced quality of life (QOL). Current research suggests an increased fall-incidence in this population, with fall-rates among middle-aged adults with HIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control, and cognitive function. However, due to disease progression and complications related to ongoing inflammation, these systems are compromised in people with HIV. Consequently, this population presents with locomotor impairments which contribute to higher-than-expected fall-rates.
Purpose: The aim of this review was to synthesize the evidence regarding objective gait and balance impairments in adults with HIV, and to emphasize those which could contribute to increased fall-risk.
Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Six computerised databases (PubMed, Science Direct, EBSCOhost, Scopus, ProQuest Medical Library, Google Scholar) were searched during March 2016 for published observational studies. Methodological quality was assessed using the NIH Quality Assessment tool for Observational Cohort and Cross Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible.
Results: The search produced 799 hits of which 17 studies were included. Methodological quality was fair to low. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using instrumented and clinical tests. Outcomes were mainly related to center of pressure (COP), postural reflex latencies, and time to complete clinical tests. There is some agreement that adults with HIV walk slower and have increased COP excursions and -long loop postural reflex latencies, particularly under challenging conditions.
Deficits might be associated with disease severity, are not influenced by antiretroviral therapy, and are not associated with peripheral neuropathy.
Conclusion(s): Results suggest that young to middle-aged adults with HIV have gait and balance impairments resembling those predisposing elderly populations to falls. However, these results should be interpreted cautiously due to overall poor methodological quality and heterogeneity. Locomotor impairments in adults with HIV are currently insufficiently quantified and there is a need for high quality gait- and balance analysis studies using more robust quantitative assessments, such as three-dimensional biomechanical motion analysis.
Implications: This review alerts physiotherapists to the importance of considering potential locomotor deficits in adults with HIV, and provides a first step to guide future primary research. A better understanding of such impairments may inform more focused physiotherapy evaluation and treatment, including fall-prevention strategies, and contribute to improved QOL among people with HIV.
Funding acknowledgements: South African Medical Research Council (SAMRC) National Health Scholars Programme, SAMRC Self-Initiated Research Grant, and Harry Crossley Foundation.
Topic: Oncology, HIV & palliative care
Ethics approval: No ethical approval was required.
All authors, affiliations and abstracts have been published as submitted.
