73 Trunk movements in people with HSP Results In total, 147 persons diagnosed with HSP, and with available gait analyses and balance scores were screened for eligibility. Sixty participants were excluded for the following reasons: concomitant neurological or orthopedic conditions (n=15), inability to walk eight meters barefoot without the use of walking aids (n=38), or age below 18 (n=8). As a result, 86 (58 men) participants were included with a mean age of 48 years (range: 19-75 years). A molecular diagnosis was present in 43 participants: (SPG4 (n=26); SPG7 (n=5); SPG30 (n=3), SPG31 (n=3), SPG11 (n=2), SPG10 (n=1), SPG17 (n=1), SPG3A (n=1) and SPG9 (n=1)). The initial absolute interrater agreement in the classification of trunk movements during gait was 83% (κ = 0.74). After discussion and through consensus, 100% agreement was reached. Thirty-five participants (41%) were classified as having moderately increased trunk movements, while 13 participants (15%) had markedly increased trunk movements. Thirty-eight participants (44%) were classified as having normal trunk movements. Participants with markedly increased trunk movements were on average younger than participants with moderately increased trunk movements (33.2±13 years vs. 48.2±11 years; p<0.001). Participants with normal trunk movements were 51.8±12 years old, which was significantly different from the group with markedly increased trunk movements (p<0.001), but not from the group with moderately increased trunk movements. Figure 1 shows the balance scores for each category of observed trunk movements for 68 participants (BBS score) and 51 participants (Mini-BESTest score); note that both balance scores were available for 33 participants. Participants with moderately increased trunk movements scored 2.0 points lower on the BBS (p=0.002) and 2.3 points lower on the Mini-BESTest (p=0.043) than those with normal trunk movements. Participants with markedly increased trunk movements scored 4.0 points lower on the BBS (p=0.037) and 4.6 points lower on the Mini-BESTest (p=0.004) than those with moderately increased trunk movements. Participants with markedly increased trunk movements scored 6.0 points lower on the BBS (p<0.001) and 6.9 points on Mini-BESTest (p<0.001) compared to participants with normal trunk movements. In total, 11 participants (13%) were categorized as toe walkers. They were on average younger than participants without toe walking (37.0±14 vs. 49.1±12 years; p=0.003). The group of participants with markedly increased trunk movements included a higher percentage of toe walkers than the group with moderately increased trunk movements (69% vs 6%; p<0.001). None of the patients with normal trunk movements showed toe walking. 5
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