Mobility Deviations in Adults With Human Immunodeficiency Virus: A Cross-Sectional Assessment Using Gait Analysis, Functional Performance, and Self-Report

Karina Berner; Arnaud Gouelle; Hans Strijdom; M Faadiel Essop; Ingrid Webster; Quinette Louw

doi:10.1093/ofid/ofab425

Mobility Deviations in Adults With Human Immunodeficiency Virus: A Cross-Sectional Assessment Using Gait Analysis, Functional Performance, and Self-Report

Open Forum Infect Dis. 2021 Aug 17;8(9):ofab425. doi: 10.1093/ofid/ofab425. eCollection 2021 Sep.

Authors

Karina Berner¹, Arnaud Gouelle^{2

3}, Hans Strijdom⁴, M Faadiel Essop⁵, Ingrid Webster⁴, Quinette Louw¹

Affiliations

¹ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
² Gait and Balance Academy, ProtoKinetics, Havertown, Pennsyvania, USA.
³ Laboratory Performance, Santé, Métrologie, Société, UFR STAPS, (Unit for Teaching and Research - Sciences and Techniques for Physical Activities and Sports), Reims, France.
⁴ Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁵ Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Cape Town, South Africa.

Abstract

Background: Little is known about how human immunodeficiency virus (HIV) affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance, and self-reported outcomes. This paper reports on (1) gait biomechanics and variability in people with HIV (PWH) and (2) associations with clinical tests, self-reported function, and falls.

Methods: A cross-sectional study tested consecutively sampled PWH (n = 50) and HIV-seronegative participants ([SNP] n = 50). Participants underwent 3-dimensional gait analysis, performed clinical tests (short walk and single leg stance tests with and without dual tasking, chair-rise tests, and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests, and patient-reported outcomes were established.

Results: People with HIV and SNP had comparable median ages (PWH = 36.6, interquartile range [IQR] = 32.0-45.6]; SNP = 31.1, IQR = 23.2-45.1). Compared with SNP, PWH walked slower (adjusted mean difference [MD] = -0.2 meters per second [m/s], 95% confidence interval [CI] = -0.3 to -0.1) with greater variability (adjusted MD = 14.7 variability score points, 95% CI = 9.9-19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD = 1.9 seconds, 95% CI = 1.00-2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs = 2.4°-2.8°, P = .012-.016) and knee kinematics (reduced flexion; adjusted MDs = 2.3°-3.7°, P = .007-.027) were found in PWH during dual-task (DT) walking. The PWH's 5STS moderately correlated with larger gait variability (usual pace r = -0.5; dual task r = -0.6), poorer self-reported mobility (r = 0.4) and self-care function (r = 0.5), and fear of falling (P = .003).

Conclusions: People with HIV presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH.

Keywords: HIV infection; chair rise time; gait variability; kinematics; physical function.