BackgroundGait and balance deficits are reported in adults with HIV infection and are associated with reduced quality of life. Current research suggests an increased fall-incidence in this population, with fall rates among middle-aged adults with HIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control, and cognitive function. However, due to disease progression and complications related to ongoing inflammation, these systems may be compromised in people with HIV. Consequently, locomotor impairments may result that can contribute to higher-than-expected fall rates. The aim of this review was to synthesize the evidence regarding objective gait and balance impairments in adults with HIV, and to emphasize those which could contribute to increased fall risk.MethodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of published observational studies was conducted in March 2016. Methodological quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible.ResultsSeventeen studies were included, with fair to low methodological quality. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation-time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using both instrumented and clinical tests. Outcomes were mainly related to center of pressure, postural reflex latencies, and timed clinical tests. There is some agreement that adults with HIV walk slower and have increased center of pressure excursions and -long loop postural reflex latencies, particularly under challenging conditions.ConclusionsGait and balance impairments exist in people with HIV, resembling fall-associated parameters in the elderly. Impairments are more pronounced during challenging conditions, might be associated with disease severity, are not influenced by antiretroviral therapy, and might not be associated with peripheral neuropathy. Results should be interpreted cautiously due to overall poor methodological quality and heterogeneity. Locomotor impairments in adults with HIV are currently insufficiently quantified. Future research involving more methodological uniformity is warranted to better understand such impairments and to inform clinical decision-making, including fall-prevention strategies, in this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1682-2) contains supplementary material, which is available to authorized users.

Introduction: Wearable inertial measurement units (IMUs) enable gait analysis in the clinic, but require calibrations that may affect subsequent gait measurements. This study assessed concurrent validity and within-session reliability of gait kinematics measured by a frequently calibrated IMU-based system. Calibration pose accuracy and intra-rater repeatability, and IMU orientation tracking accuracy, were additionally quantified. Methods: Calibration poses and gait were recorded in 15 women using IMUs and optical motion capture (OMC) (reference standard) simultaneously. Participants performed six consecutive trials: each comprising a calibration pose and a walk. IMU tracking was assessed separately (once-off) using technical static and dynamic tests. Differences of > 5 constituted clinical significance. Results: Concurrent validity for gait revealed clinically significant between-system differences for sagittal angles (root-mean-square error [RMSE] 6.7 e15.0 ; bias À9.3 e3.0) and hip rotation (RMSE 7.9 ; bias À4.2). After removing modelling offsets, differences for all angles (except hip rotation) were < 5. Gait curves correlated highly between systems (r > 0.8), except hip rotation, pelvic tilt and-obliquity. Within-session reliability of IMU-measured gait angles was clinically acceptable (standard error of measurement [SEM] < 5). Calibration poses were repeatable (SEM 0.3 e2.2). Pose accuracy revealed mean absolute differences (MAD) < 5 for all angles except sagittal ankle, hip and pelvis. IMU tracking accuracy demonstrated RMSE 2.0. Conclusion: A frequently calibrated IMU system provides reliable gait measurements; comparing highly to OMC after removing modelling differences. Calibration poses can be implemented accurately for most angles and consistently. IMU-measured gait data are clinically useful and comparable within participants, but should not be compared to OMC-measured data.

Background Rehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)‘s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability. Methods This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012–2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018–2022). Results Trends for YLDs counts per condition year (1990–2017) and forecasted values (2018–2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions. Conclusion Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.

Research training has been identified as the foundation for all programmes in the health science professions. [1] Undergraduate exposure is associated with improved scholarship [2] -a key competency that is promoted by the Health Professions Council of South Africa (HPCSA). [3] Familiarity with doing or using research fosters analytical thinking and develops skills for informed decision-making in patient service delivery and care. [4] Although not all rehabilitation students may become primary researchers, all practitioners will need to evaluate, interpret and use research for evidence-based practice (EBP). [5] Previous studies investigating research competencies for undergraduates predominantly focused on the medical and nursing professions. [6][7][8] However, certain competencies may be more relevant to rehabilitation. [9,10] Rehabilitation students should be equipped with knowledge, skills, attitudes and tasks that are relevant to the current clinical context and professional research needs. For example, knowledge of pretrial studies or alternative designs to traditional randomised controlled trials (e.g. practice-based evidence trials [10] and health services research [11] ) may be particularly important for rehabilitation research. [10] Although not synonymous, EBP and research are closely related concepts. [4] Educators in rehabilitation are increasingly restructuring research curricula towards EBP. [12,13] Research training may be used to cover EBP, and vice versa. [1,14] The Sicily Statement on EBP provides a five-step framework to use when developing curricula: (i) research question formulation; (ii) searching for best evidence; (iii) critically evaluating the evidence; (iv) applying the evidence to clinical practice; and (v) monitoring performance. [15] However, an investigation of existing physiotherapy coursework and EBP coverage [14] indicated that some research competencies are poorly defined in the learning outcomes, while others are not addressed at all. A standardised set of minimum core research competencies needs to be defined more explicitly to benchmark standards for research methods (RM) training in the undergraduate rehabilitation curriculum.Recently, 86 EBP competencies were identified in a systematic review involving health professionals, regardless of the discipline or level of training. [16] The findings were generalised to all health professions, leaving it to educators to 'advance competencies depending on the needs and desires of learners' . [16] No similar reviews exist that focus on research competencies or rehabilitation. This review aimed to provide a comprehensive overview of the existing literature regarding core research competencies that may be required by rehabilitation undergraduates. As a secondary outcome, a list of recommendations regarding the implementation of such competencies was compiled. MethodsA scoping review was conducted according to the methodological framework developed by Arksey and O'Malley [17] and refined by Levac et al. [18] The six-step process includes...