Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis

Background Multiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls. Objective This systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions. Methods A systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions. Results Forty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD = 1.27, 95% CI{0.93, 1.61}), velocity (SMD = 1.12, 95% CI{0.85, 1.39}), double support duration (SMD = 0.85, 95% CI{0.51, 1.2}), step length (SMD = 1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD = 1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD = 0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD = 1.15, 95% CI{0.42, 1.88}). Conclusions MS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.