Spatiotemporal Gait Parameters in Adults With Premanifest and Manifest Huntington's Disease: A Systematic Review

Objective To systematically review and critically evaluate literature on spatiotemporal gait deviations in individuals with pre manifest and manifest Huntington's Disease (HD) in comparison with healthy cohorts. Methods We conducted a systematic review, guided by the Joanna Briggs Institute's Manual for Evidence Synthesis and pre -registered with the International Prospective Register of Systematic Reviews. Eight electronic databases were searched. Studies comparing spatiotemporal footstep parameters in adults with premanifest and manifest HD to healthy controls were screened, included and critically appraised by independent reviewers. Data on spatiotemporal gait changes and variability were extracted and synthesised. Meta-analysis was performed on gait speed, cadence, stride length and stride length variability measures. Results We screened 2,721 studies, identified 1,245 studies and included 25 studies (total 1,088 participants). Sample sizes ranged from 14 to 96. Overall, the quality of the studies was assessed as good, but reporting of confounding factors was often unclear. Meta-analysis found spatiotemporal gait deviations in participants with HD compared to healthy controls, commencing in the premanifest stage. Individuals with premanifest HD walk significantly slower (-0.17 m/s; 95% confidence interval [CI] [-0.22,-0.13]), with reduced cadence (-6.63 steps/min; 95% CI [-10.62,-2.65]) and stride length (-0.09 m; 95% CI [-0.13,-0.05]). Stride length variability was also increased in premanifest cohorts by 2.18% (95% CI [0.69, 3.68]), with these changes exacerbated in participants with manifest disease. Conclusion Findings suggest individuals with premanifest and manifest HD display significant spatiotemporal footstep deviations. Clinicians could monitor individuals in the premanifest stage of disease for gait changes to identify the onset of Huntington's symptoms.