Evaluation of gait features and factors affecting gait in children with atopic dermatitis

The aim of this study was to evaluate gait characteristics and factors affecting gait in children with atopic dermatitis (AD). A total of 100 children, including 50 patients aged 7-16 years who were diagnosed with AD according to Hanifin and Rajka criteria and 50 healthy volunteers who applied to the outpatient clinic of the Department of Skin and Venereal Diseases of Fırat University Hospital and 50 healthy volunteers who applied to the outpatient clinic of Pediatrics were included in the study. Dermatologic examinations were performed in all patients and Atopic Dermatitis Severity Score (SCORAD) was calculated. Detailed neurological examinations were performed in the Pediatric Neurology outpatient clinic of the Department of Pediatrics, physical examinations were performed in the Physical Medicine and Rehabilitation Department clinic, and gait analysis was performed with the Win-Track gait analysis platform (MEDICAPTEURS Technology, France). Clinical, laboratory and gait analysis data of the participants were recorded. Analyses were evaluated using the SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL) 22 package program. Descriptive data were presented as n, % values for categorical data and rank mean and standard deviation (SD) values for continuous data. The chi square test was used to compare categorical variables between groups. Since normality assumptions were not met, Mann Whitney U-test was used for the comparison of paired groups and Kruskal Wallis test was used for the comparison of more than two groups. Statistical significance level was accepted as p<0.05 in the analyses. There was no significant difference between the patient and control groups in terms of demographic characteristics (p>0.05). Vitamin B12 values were found to be statistically significantly higher in the patient group than in the control group (p<0.05). There was no statistically significant difference in other laboratory parameters (p>0.05). SCORAD index was mild in 35 (70%) patients and moderate and severe in 15 (30%) patients. In the patient group, the odds ratio (OR) of SCORAD index and IgE categories was 0.62, and OR of SCORAD index and vitamin D categories was 1.90. In 46 (92%) of patients and 45 (90%) of controls, the dominant limb was recorded as the right side. Among the spatiotemporal gait parameters, maximum foot pressure was lower on the left side and stride length was lower on the right side in the patient group (p<0.05). In the patient group, kinematic gait parameter angle right, SCORAD index was statistically lower in patients with moderate and severe gait parameters (mean rank (MR): 18.77) compared to mild gait parameters (MR: 28.39) (p<0.05). Among the spatiotemporal gait parameters, forefoot area right and total foot area right values were found to be statistically significantly lower in patients with body mass index (BMI) underweight and normal compared to overweight and obese patients. Hindfoot area right and hindfoot area left BMI were statistically lower in normal subjects than in overweight and obese subjects. Among subjects with normal BMI, 3rd step area, 2nd step mean and maximum pressure were significantly lower in overweight and obese subjects (p<0.05). 3rd step mean pressure was statistically significantly lower in subjects with normal IgE (MR: 21.42) than in subjects with high IgE (MR: 29.92), and step duration was statistically significantly higher in subjects with normal right IgE (MR: 30.21) than in subjects with high right IgE (MR: 20.40) (p<0.05). Forefoot area left, hindfoot area right, total area right, total area left, maximum pressure right, mean pressure right, body weight, body weight distribution right and body weight distribution left, 2nd step mean pressure, 3rd step mean pressure and 2nd step maximum pressure were found to be statistically significantly higher in those with mild/moderate low and low vitamin D than in those with normal (p<0.05). In conclusion, in this study, high serum IgE levels were thought to increase the likelihood of disease and low serum vitamin D levels were thought to increase both the likelihood and severity of disease. Low pressure and short stride length on the non-dominant limb side of patients with AD were found to be different gait characteristics from healthy controls. In 30% of patients with AD, SCORAD index was found to be moderate and severe and did not affect spatiotemporal gait parameters, but the angle value, which is the kinematic gait parameter on the dominant limb side, was found to be low in the group with moderate and severe SCORAD index. Spatiotemporal gait parameters were found to be affected by increased BMI, increased serum IgE levels and decreased serum vitamin D levels in patients with AD. Keywords: Atopic dermatitis, gait, Win-Track