Gait parameters of Parkinson’s disease compared with healthy controls: a systematic review and meta-analysis

Abstract

We systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).

Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson’s Disease

“…Alterations in quantitative gait parameters are consistently seen in PD, as replicated in many studies. 28 This has been found to be present not only in the early stages of PD 17 but also in the prodromal stages before the onset of obvious motor symptoms (such as in those with REM sleep-behavior disorder [RBD]). 29 Concordantly, the occurrence of falls can be seen early on in a subset of patients, 30 associated with an increased risk of fracture even prior to diagnosis in a significant number.…”

The effect of body weight-supported overground gait training for patients with Parkinson’s disease: A retrospective case-control observational study

“…Gait speed is strictly related to stride length. The low walking speed in patients with Parkinson's disease is due to a reduction in stride length [32]. Both Nordic walking and BWSOGT increase self-selected walking speed, possibly via an increase in stride length.…”

A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease

“…Unpredictable appearance of signs of the disease, early or late onset time, hesitations in the diagnosis, current treatments with drugs or physical therapy, subjective evaluations performed in the clinical setting and lack of consistency in gait features make the interpretation of gait findings in patients with Parkinson’s disease (pwPD) unclear and difficult to classify 1 – 6 . Among the different spatiotemporal gait variables, speed is the gold standard in gait assessment because it is relatively easy to measure and normative data are readily available 7 – 10 . Some studies have advocated gait speed as the best expression of locomotor control, combining the influence of alterations or adaptations occurring anywhere in the brain locomotor centres 11 , 12 .…”

“…Some studies have advocated gait speed as the best expression of locomotor control, combining the influence of alterations or adaptations occurring anywhere in the brain locomotor centres 11 , 12 . In pwPD, gait speed is reduced 10 , 13 – 15 , is linked with falls 16 and with impaired quality of life 17 , and is highly sensitive to ageing 18 .…”

“…However, gait speed alone does not explain the underlying spatiotemporal gait abnormalities. In addition to reduced gait speed, pwPD typically have smaller stride length, longer double support time and increased variability and asymmetry 4 , 10 , 19 , 20 . While some variables show clear differences with respect to matched controls 21 , there is little agreement about gait variability and asymmetry 4 , 21 .…”