Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

Abstract

Background: Gait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD. Research question: Thus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD. Methods: In line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool. Results: Seven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level. Significance: A convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD.

Impact of chronic obstructive pulmonary disease on passive viscoelastic components of the musculoarticular system

“…Many studies showed that patients with COPD present difficulties in maintaining upright standing 13 , 47 – 51 and stable walking 11 , 12 , 47 , 52 , 53 , with increased risk of falling 11 , 12 , 54 – 58 . Although the identification of specific causes for these motor disabilities is an open discussion 1 , most of the authors consider muscle weakness and limited oxygen supply as the main factors responsible for gait and balance alterations 13 , 47 , 50 , 54 , 59 .…”

Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD

“…Gait assessment may be of clinical value as gait abnormalities have been reported in patients with COPD, including reduced cadence, reduced stride length and increased double support time as compared to healthy subjects [3,4,5,6,7]. Though PR has proven to increase gait speed in patients with COPD [39], a comprehensive analysis of gait characteristics after PR is lacking.…”

“…Walking has been reported as a problematic activity in daily life in patients with chronic obstructive pulmonary disease (COPD) [1,2]. Patients with COPD are characterized by gait alterations as compared to healthy older adults [3,4,5,6,7]. These gait alterations, in particular changes in the inherent stride-to-stride fluctuations, have been associated with non-communicable diseases [8,9] and falls in the aging population [10,11,12,13].…”

Proposed novel treatment paradigm of aberrant gait and balance kinematics in patients with severe COPD

“…In a recent review of seven studies comprising 375 elderly patients (64-75 years) with predominantly severe COPD, Zago et al reported that gait abnormalities observed in these patients comprised of reduced step length and rhythm, and spatiotemporal inconsistency in gait patterns during ambulation. 8 In addition, Morlino et al proposed that aberrant gait and balance kinematics observed in patients with severe COPD could be related, in part, to damaged neuronal circuits that subserve those functional outcomes in the brain. 2 Despite recent progress in medical research, the pathogenesis of aberrant gait and balance kinematics observed in patients with severe COPD remains elusive.…”