title: Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic review was to evaluate the spatiotemporal, foot and ankle kinematic, kinetic, peak plantar pressure and muscle activity parameters between patients with inflammatory arthritis and healthy controls.
  
  
  METHODS
  An electronic literature search was performed on Medline, CINAHL, SportsDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Effect sizes with 95% confidence intervals (CI) were calculated as the standardised mean difference (SMD). Meta-analysis was conducted if studies were homogenous.
  
  
  RESULTS
  Thirty six studies with quality ranging from high to low met the inclusion criteria. The majority of studies reported gait parameters in Rheumatoid arthritis (RA). The gait pattern in RA was characterised by decreased walking speed (SMD 95% CI -1.57, -2.25 to -0.89), decreased cadence (SMD -0.97, -1.49 to -0.45), decreased stride length (SMD -1.66, -1.84 to -1.49), decreased ankle power (SMD -1.36, -1.70 to -1.02), increased double limb support time (SMD 1.03, 0.84 to 1.22), and peak plantar pressures at the forefoot (SMD 1.11, 0.76 to 1.45). Walking velocity was reduced in psoriatic arthritis and gout with no differences in ankylosing spondylitis. No studies have been conducted in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus.
  
  
  CONCLUSIONS
  The review identified the majority of studies reporting gait adaptations in RA, but limited evidence relating to other IA conditions. Poor data reporting, small sample sizes and heterogeneity across IA conditions limit the interpretation of the findings. Future studies may consider a standardised analytical approach to gait analysis that will provide clinicians and researchers with objective evidence of foot function in people with IA.
authors.affiliation: Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand. matthew.carroll@aut.ac.nz.
authors.forename: Matthew
authors.initials: M
authors.lastname: Carroll
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand. pparmar@aut.ac.nz.
authors.forename: Priya
authors.initials: P
authors.lastname: Parmar
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand. n.dalbeth@auckland.ac.nz.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.affiliation: Department of Physiotherapy, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand. mboocock@aut.ac.nz.
authors.forename: Mark
authors.initials: M
authors.lastname: Boocock
authors.affiliation: Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand. krome@aut.ac.nz.
authors.forename: Keith
authors.initials: K
authors.lastname: Rome
mesh_terms: D000842:Ankle / Q000503:physiopathology*; D001168:Arthritis / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D005528:Foot / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D007700:Kinetics; D018482:Muscle, Skeletal / Q000502:physiology; D011312:Pressure