Can early subclinical gait changes in children with haemophilia be identified using the GAITRite walkway.
Development of haemophilic arthropathy has long-term implications for functional mobility in people with haemophilia, but early manifestations are often asymptomatic and difficult to identify. Earlier identification of joint damage may improve outcomes. The aim of this case note review was to determine whether the GAITRite system (electronic pressure sensitive walkway) could identify early changes in gait patterns in boys with haemophilia compared with their peers. Clinic data from medical and physiotherapy notes of boys with severe haemophilia were compared with data from age and leg length-matched controls. Data from two consecutive walks at preferred speed were collected on all participants using the GAITRite system. Clinic assessment notes from 26 boys (aged 7-17 years) with severe haemophilia were identified. Of these, 20 boys had no evidence of joint pathology on assessment and six boys had radiographic evidence of arthropathy. When these data were compared with normal controls, there were statistically significant increases in swing time, stance time, single support and double support in the asymptomatic group (P < 0.01) suggesting subtle early compensatory changes in gait pattern. The children with arthropathy had additional significant differences in their gait compared with matched controls. These differences included normalized velocity, step length, stride length, step time and base of support (P < 0.01). The GAITRite system appears sensitive enough to identify early subtle changes in gait and differentiate between asymptomatic boys with haemophilia and those with arthropathy in comparison with a matched control group. The electronic walkway is an accessible and portable means of providing quantitative gait analysis in the clinical environment. This is an important finding as early identification of gait changes may provide clinicians with the opportunity to intervene with the aim of arresting progression of joint damage.
Bladen
M
M
Haemophilia Centre, Great Ormond St. Hospital, Great Ormond Street, London, UK. bladem@gosh.nhs.uk
Alderson
L
L
Khair
K
K
Liesner
R
R
Green
J
J
Main
E
E
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D005684:Gait / Q000502:physiology*; D006467:Hemophilia A / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity