Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis

BMC Musculoskeletal Disorders

Keith Rome²  Mark Boocock¹  Nicola Dalbeth³  Priya Parmar⁴  Matthew Carroll² 

[1] Department of Physiotherapy, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand;Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand;Department of Medicine, University of Auckland, Auckland, New Zealand;National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand

关键词: Gout;    Psoriatic arthritis;    Ankylosing spondylitis;    Rheumatoid arthritis;    Gait;   

Others  :  1227761
DOI  :  10.1186/s12891-015-0596-0

 received in 2014-12-12, accepted in 2015-05-27,  发布年份 2015

【 摘 要 】

Background

Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic review was to evaluate the spatiotemporal, foot and ankle kinematic, kinetic, peak plantar pressure and muscle activity parameters between patients with inflammatory arthritis and healthy controls.

Methods

An electronic literature search was performed on Medline, CINAHL, SportsDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Effect sizes with 95 % confidence intervals (CI) were calculated as the standardised mean difference (SMD). Meta-analysis was conducted if studies were homogenous.

Results

Thirty six studies with quality ranging from high to low met the inclusion criteria. The majority of studies reported gait parameters in Rheumatoid arthritis (RA). The gait pattern in RA was characterised by decreased walking speed (SMD 95 % CI −1.57, −2.25 to −0.89), decreased cadence (SMD −0.97, −1.49 to −0.45), decreased stride length (SMD −1.66, −1.84 to −1.49), decreased ankle power (SMD −1.36, −1.70 to −1.02), increased double limb support time (SMD 1.03, 0.84 to 1.22), and peak plantar pressures at the forefoot (SMD 1.11, 0.76 to 1.45). Walking velocity was reduced in psoriatic arthritis and gout with no differences in ankylosing spondylitis. No studies have been conducted in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus.

Conclusions

The review identified the majority of studies reporting gait adaptations in RA, but limited evidence relating to other IA conditions. Poor data reporting, small sample sizes and heterogeneity across IA conditions limit the interpretation of the findings. Future studies may consider a standardised analytical approach to gait analysis that will provide clinicians and researchers with objective evidence of foot function in people with IA.

【 授权许可】

   
2015 Carroll et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

Fig. 10.

Fig. 11.

Fig. 12.

Fig. 13.

Fig. 14.

【 参考文献 】

• [1]Hootman JM, Helmick CG, Brady TJ. A public health approach to addressing arthritis in older adults: the most common cause of disability. Am J Public Health. 2012; 102(3):426-33.
• [2]Epstein FH, Harris ED. Rheumatoid arthritis: pathophysiology and implications for therapy. N Engl J Med. 1990; 322(18):1277-89.
• [3]Frizziero A, Bonsangue V, Trevisan M, Ames PRJ, Masiero S. Foot tendinopathies in rheumatic diseases: etiopathogenesis, clinical manifestations and therapeutic options. Clin Rheumatol. 2013; 32(5):547-55.
• [4]Reveille JD, Arnett FC. Spondyloarthritis: update on pathogenesis and management. Am J Med. 2005; 118(6):592-603.
• [5]Richette P, Bardin T. Gout. Lancet. 2010; 375:318-28.
• [6]Platto MJ, O'Connell PG, Hicks JE, Gerber LH. The relationship of pain and deformity of the rheumatoid foot to gait and an index of functional ambulation. J Rheumatol. 1991; 18(1):38-43.
• [7]Turner D, Woodburn J, Helliwell P, Cornwall M, Emery P. Pes planovalgus in RA: a descriptive and analytical study of foot function determined by gait analysis. Musculoskeletal Care. 2003; 1(1):21-33.
• [8]Woodburn J, Nelson K, Siegel K, Kepple T, Gerber L. Multisegment foot motion during gait: proof of concept in rheumatoid arthritis. J Rheumatol. 2004; 31(10):1918-27.
• [9]Hyslop E, McInnes IB, Woodburn J, Turner DE. Foot problems in psoriatic arthritis: high burden and low care provision. Ann Rheum Dis. 2010; 69(5):928.
• [10]Del Din S, Carraro E, Sawacha Z, Guiotto A, Bonaldo L, Masiero S, Cobelli C. Impaired gait in ankylosing spondylitis. Med Biol Eng Comput. 2011; 49(7):801-9.
• [11]O'Connell PG, Lohmann Siegel K, Kepple TM, Stanhope SJ, Gerber LH. Forefoot deformity, pain, and mobility in rheumatoid and nonarthritic subjects. J Rheumatol. 1998; 25(9):1681-6.
• [12]Rome K, Survepalli D, Sanders A, Lobo M, McQueen F, McNair P, Dalbeth N. Functional and biomechanical characteristics of foot disease in chronic gout: A case-control study. Clin Biomech. 2011; 26(1):90-4.
• [13]Woodburn J, Helliwell P, Barker S. Three-dimensional kinematics at the ankle joint complex in rheumatoid arthritis patients with painful valgus deformity of the rearfoot. Rheumatology (Oxford). 2002; 41(12):1406-12.
• [14]Turner D, Woodburn J. Characterising the clinical and biomechanical features of severely deformed feet in rheumatoid arthritis. Gait Posture. 2008; 28(4):574-80.
• [15]Turner DE, Helliwell PS, Siegel KL, Woodburn J. Biomechanics of the foot in rheumatoid arthritis: Identifying abnormal function and the factors associated with localised disease ‘impact’. Clin Biomech. 2008; 23(1):93-100.
• [16]Turner DE, Helliwell PS, Emery P, Woodburn J. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord. 2006; 7:102-8. BioMed Central Full Text
• [17]Weiss RJ, Wretenberg P, Stark A, Palmblad K, Larsson P, Gröndal L, Broström E. Gait pattern in rheumatoid arthritis. Gait Posture. 2008; 28(2):229-34.
• [18]Khazzam M, Long JT, Marks RM, Harris GF. Kinematic changes of the foot and ankle in patients with systemic rheumatoid arthritis and forefoot deformity. J Orthop Res. 2007; 25(3):319-29.
• [19]Barn R, Turner DE, Rafferty D, Sturrock RD, Woodburn J. Tibialis posterior tenosynovitis and associated pes plano valgus in rheumatoid arthritis: EMG, multi‐segment foot kinematics and ultrasound features. Arthritis Care Res. 2012; 65(4):495-502.
• [20]Broström EW, Esbjörnsson A-C, von Heideken J, Iversen MD. Gait deviations in individuals with inflammatory joint diseases and osteoarthritis and the usage of three-dimensional gait analysis. Best Pract Res Clin Rheumatol. 2012; 26(3):409-22.
• [21]Woodburn J, Hyslop E, Barn R, McInnes I, Turner D. Achilles tendon biomechanics in psoriatic arthritis patients with ultrasound proven enthesitis. Scand J Rheumatol. 2013; 00:1-4.
• [22]Salvarani C, Cantini F, Macchioni P, Olivieri I, Niccoli L, Padula A, Boiardi L. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum. 1998; 41(7):1221-6.
• [23]Hietaharju A, Jääskeläinen S, Kalimo H, Hietarinta M. Peripheral neuromuscular manifestations in systemic sclerosis (scleroderma). Muscle Nerve. 1993; 16(11):1204-12.
• [24]Williams A, Crofts G, Teh L. ‘Focus on feet’–the effects of systemic lupus erythematosus: a narrative review of the literature. Lupus. 2013; 22(10):1017-23.
• [25]Baan H, Dubbeldam R, Nene AV, van de Laar MAFJ. Gait analysis of the lower limb in patients with rheumatoid arthritis: a systematic review. Semin Arthritis Rheum. 2012; 41(6):768-88.
• [26]Downs S, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998; 52(6):377-84.
• [27]Meyer S, Karttunen AH, Thijs V, Feys H, Verheyden G. How do somatosensory deficits in the arm and hand relate to upper limb impairment, activity, and participation problems after stroke? A systematic review. Phys Ther. 2014; 94(9):1220-31.
• [28]Liu Y, Davari-Farid S, Arora P, Porhomayon J, Nader ND. Early versus late initiation of renal replacement therapy in critically Ill patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2014; 28(3):557-63.
• [29]Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003; 327(7414):557.
• [30]Deeks JJ, Higgins J, Altman DG. Analysing data and undertaking meta-analyses. Cochrane handbook for systematic reviews of interventions: Cochrane book series. 2008.243-96.
• [31]Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Behav Stat. 1981; 6(2):107-28.
• [32]Cohen J. A power primer. Psychol Bull. 1992; 112(1):155-9.
• [33]Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive meta-analysis version 2. Biostat, Englewood, NJ; 2005.
• [34]Woodburn J, Turner D, Helliwell P, Barker S. A preliminary study determining the feasibility of electromagnetic tracking for kinematics at the ankle joint complex. Rheumatology (Oxford). 1999; 38(12):1260-8.
• [35]Barn R, Turner DE, Rafferty D, Sturrock RD, Woodburn J. Tibialis posterior tenosynovitis and associated pes Plano valgus in rheumatoid arthritis: electromyography, multisegment foot kinematics, and ultrasound features. Arthritis Care & Res. 2013; 65(4):495-502.
• [36]Bowen CJ, Culliford D, Allen R, Beacroft J, Gay A, Hooper L, Burridge J, Edwards CJ, Arden NK. Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months. J Foot Ankle Res. 2011; 4(1):25. BioMed Central Full Text
• [37]Dubbeldam R, Nene AV, Buurke JH, Groothuis-Oudshoorn CGM, Baan H, Drossaers-Bakker KW, van de Laar MAFJ, Hermens H. Foot and ankle joint kinematics in rheumatoid arthritis cannot only be explained by alteration in walking speed. Gait Posture. 2011; 33(3):390-5.
• [38]Yavuz M, Husni E, Botek G, Davis BL. Plantar shear stress distribution in patients with rheumatoid arthritis relevance to foot pain. J Am Podiatr Med Assoc. 2010; 100(4):265-9.
• [39]Rome K, Dixon J, Gray M, Woodley R. Evaluation of static and dynamic postural stability in established rheumatoid arthritis: exploratory study. Clin Biomech. 2009; 24(6):524-6.
• [40]Eppeland S, Myklebust G, Hodt-Billington C, Moe-Nilssen R. Gait patterns in subjects with rheumatoid arthritis cannot be explained by reduced speed alone. Gait Posture. 2009; 29(3):499-503.
• [41]Schmiegel A, Vieth V, Gaubitz M, Rosenbaum D. Pedography and radiographic imaging for the detection of foot deformities in rheumatoid arthritis. Clin Biomech. 2008; 23(5):648-52.
• [42]Schmiegel A, Rosenbaum D, Schorat A, Hilker A, Gaubitz M. Assessment of foot impairment in rheumatoid arthritis patients by dynamic pedobarography. Gait Posture. 2008; 27(1):110-4.
• [43]Laroche D, Ornetti P, Thomas E, Ballay Y, Maillefert JF, Pozzo T. Kinematic adaptation of locomotor pattern in rheumatoid arthritis patients with forefoot impairment. Exp Brain Res. 2007; 176(1):85-97.
• [44]Laroche D, Pozzo T, Ornetti P, Tavernier C, Maillefert JF. Effects of loss of metatarsophalangeal joint mobility on gait in rheumatoid arthritis patients. Rheumatology (Oxford). 2006; 45(4):435-40.
• [45]Semple R, Turner DE, Helliwell PS, Woodburn J. Regionalised centre of pressure analysis in patients with rheumatoid arthritis. Clin Biomech. 2007; 22(1):127-9.
• [46]Rosenbaum D, Schmiegel A, Meermeier M, Gaubitz M. Plantar sensitivity, foot loading and walking pain in rheumatoid arthritis. Rheumatology (Oxford). 2006; 45(2):212-4.
• [47]Tuna H, Birtane M, Taştekin N, Kokino S. Pedobarography and its relation to radiologic erosion scores in rheumatoid arthritis. Rheumatol Int. 2005; 26(1):42-7.
• [48]Otter SJ, Bowen CJ, Young AK. Forefoot plantar pressures in rheumatoid arthritis. J Am Podiatr Med Assoc. 2004; 94(3):255-60.
• [49]Woodburn J, Helliwell PS. Relation between heel position and the distribution of forefoot plantar pressures and skin callosities in rheumatoid arthritis. Ann Rheum Dis. 1996; 55(11):806-10.
• [50]Siegel KL, Kepple TM, O'Connell PG, Gerber LH, Stanhope SJ. A technique to evaluate foot function during the stance phase of gait. Foot Ankle Int. 1995; 16(12):764-70.
• [51]Fransen M, Heussler J, Margiotta E, Edmonds J. Quantitative gait analysis—comparison of rheumatoid arthritic and non-arthritic subjects. Aust J Physiother. 1994; 40(3):191-9.
• [52]Isacson J, Broström LÅ. Gait in rheumatoid arthritis: an electrogoniometric investigation. J Biomech. 1988; 21(6):451-3.
• [53]Minns R, Craxford AD. Pressure under the forefoot in rheumatoid arthritis a comparison of static and dynamic methods of assessment. Clin Orthop Relat Res. 1984; 187:235.
• [54]Simkin A. The dynamic vertical force distribution during level walking under normal and rheumatic feet. Rheumatol Rehabil. 1981; 20(2):88-97.
• [55]Stauffer RN, Chao EY, Györy AN. Biomechanical gait analysis of the diseased knee joint. Clin Orthop Relat Res. 1977; 126:246-55.
• [56]Mangone M, Scettri P, Paoloni M, Procaccianti R, Spadaro A, Santilli V. Pelvis-shoulder coordination during level walking in patients with ankylosing spondylitis. Gait Posture. 2011; 34(1):1-5.
• [57]Zebouni L, Helliwell P, Howe A, Wright V. Gait analysis in ankylosing spondylitis. Ann Rheum Dis. 1992; 51(7):898-9.
• [58]Hyslop E, Woodburn J, McInnes I, Semple R, Newcombe L, Hendry G, Rafferty D, De Mits S, Turner D. A reliability study of biomechanical foot function in psoriatic arthritis based on a novel multi-segmented foot model. Gait Posture. 2010; 32(4):619-26.
• [59]Rao S. Quantifying foot function in individuals with rheumatoid arthritis: recent advances and clinical implications. Arthritis Care Res. 2013; 65(4):493-4.
• [60]Deschamps K, Staes F, Roosen P, Nobels F, Desloovere K, Bruyninckx H, Matricali GA. Body of evidence supporting the clinical use of 3D multisegment foot models: A systematic review. Gait Posture. 2011; 33(3):338-49.
• [61]Della Croce U, Leardini A, Chiari L, Cappozzo A. Human movement analysis using stereophotogrammetry: Part 4: assessment of anatomical landmark misplacement and its effects on joint kinematics. Gait Posture. 2005; 21(2):226-37.