Alterations in Temporal-Spatial Gait Parameters in People with Multiple Sclerosis – a Systematic Review

Background:   People with multiple sclerosis (MS) frequently experience progressive gait and walking dysfunction that contributes to significant disability. Particularly, alterations in temporal-spatial gait parameters have been observed using instrumented walkways, and are associated with poorer walking ability and reduced levels of participation. An understanding of alterations in temporal-spatial parameters associated with advancing MS will allow the clinician to better identify gait-related abnormalities that would benefit from targeted rehabilitation interventions.

Objectives:  The purpose of this systematic review was to identify differences in temporal-spatial gait parameters in individuals with MS compared to healthy controls. 

Methods:  A search of SCOPUS and CINAHL databases was conducted in October 2014. Case-control studies measuring temporal-spatial parameters of gait with an instrumented walkway in individuals with MS as compared to healthy controls were included for review. Three reviewers assessed study validity with the Critical Appraisal Skills Programme's (Oxford, UK) Case Control Study Checklist (CCSC) which results in a score of 0 (low validity) to 9 (high validity).

Results:  Four studies met the inclusion criteria. The median CCSC score was 7/9 (range 7-8, interquartile range=0.5) indicating high internal and external validity of the results. A total of 185 people with MS with a range of EDSS scores from 0-6.5 were included in these studies. Outcome measures varied between studies and included the following measures: walking velocity; step and stride length; step time; base of support; stance and swing time; double-limb support time; cycle time; percent of cycle spent in single- and double-limb support and swing phase; and variability in step length, width and time.

Conclusions: People with MS have gait patterns that are different from age- and sex-matched controls. Compared with control subjects, people with MS had reduced step length, cadence, and walking velocity, and increased base of support, double-limb support time, stance time, swing time, and variability in step time. A trend was observed that the magnitude of these differences correlated with increasing MS-disease severity. People with MS may present with changes in temporal-spatial parameters of gait that emerge early in the disease process that may be missed with simple observational analysis. Use of an instrumented walkway to conduct a detailed gait analysis will allow prompt identification of these changes which will enable clinicians to prevent further deterioration through early intervention.