Mobility deviations in adults living with HIV: a cross-sectional assessment using gait analysis, functional performance and self-report

Overview & Synopsis

Background: Little is known about how HIV affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance and self-reported outcomes. This paper reports on gait biomechanics and -variability in people with HIV (PWH), and associations with clinical tests, self-reported function and falls. Methods: A cross-sectional study tested consecutively-sampled PWH (n=50) and HIV-seronegative participants (SNP, n=50). Participants underwent three-dimensional gait analysis, performed clinical tests (short walk- and single leg stance tests with and without dual tasking, chair-rise tests and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests and patient-reported outcomes were established. Results: PWH and SNP had comparable median ages (PWH 36.6 [IQR 32.0–45.6], SNP 31.1 [23.2–45.1]). Compared with SNP, PWH walked slower (adjusted mean difference [MD]=-0.2 m/s, 95% CI=-0.3; -0.1) with greater variability (adjusted MD=14.7, 95% CI=9.9; 19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD=1.9 seconds, 95% CI=1.00; 2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs=2.4°–2.8°, P=.012–.016), and knee kinematics (reduced flexion; adjusted MDs=2.3°–3.7°, P=.007–.027) were found in PWH during dual task walking. PWH’s 5STS moderately correlated with larger gait variability (usual pace r=-0.5; dual task r=-0.6), poorer self-reported mobility- (r=0.4) and self-care function (r=0.5), and fear of falling (P=.003). Conclusions: PWH presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH.