Influence of gait analysis on decision-marketing for lower extremity surgery

Relationship between health-related quality of life, spasticity, and function in children with cerebral palsy undergoing intgrathecal baclofen therapy

R AYYANGAR MD, L ENEBAK,  HUGH GARTON MD, M FOX RN
University of Michigan Medical Center, Ann Arbor, MI, USA

Objective: To examine the relationship between health-related quality of life (HRQOL) and measures of spasticity and function in children with cerebral palsy (CP) undergoing intrathecal baclofen (ITB) therapy.

Design: Longitudinal cohort study.

Setting: Tertiary care hospital.

Participants: Twenty-eight children (15 males, 13 females; aged 4-20y; mean age 12y 6mo) with CP (Gross Motor Function Classification System [GMFCS] Levels V, n=23; IV, n=2; and III, n=3) who were receiving chronic ITB therapy.

Method: The Child Health Questionnaire (CHQ), modified Ashworth scale (MAS), Gross Motor Function Measure (GMFM), and select scales of the Pediatric Evaluation Measure (GMFM), and select scales of the Pediatric Evaluation of Disability Inventory (PEDI) were used. Before and periodically following institutions of ITB therapy, study patients were assessed for tone with the MAS, and adaptive functioning using the GMFM, the Functional Independence Measure (FIM), select PEDI domains, and the CHQ. Bivariate correlation-analysis (BCA) between MAS and functional measures were performed at baseline and follow-up with the majority at 1 year (n=17), with a Bonferroni corrected p value of 0.004 accepted as evidence of significance. A mixed-model analysis, accounting for small sample size and missing data, was used to correlate MAS and measures of function with HRQOL as measured by the CHQ.

Results: At 12 months after starting ITB therapy, mean improvement in upper limb (UL) MAS was 0.58 (SD 0.71), while lower limb (LL) MAS improved by 1.03 (SD 1.28). No significant difference was noted in CHQ or any of its clinically relevant sub-scales. Similarly, correlations between improved MAS scores and changes in baseline to follow-up CHQ, were not statistically significant. BCA demonstrated strong correlations between the UL MAS, which inversely correlated to GMFM, FIM, PEDI-Self-care, PEDI-Mobility and PEDI-Caregiver Self-Care, and PEDI-Caregiver Self-care; all with p<_0.01), these did not meet our pre-specified p value for significance.

Conclusions: These results support a relationship between tone and function, and between tone and HRQOL among a group of children with CP receiving ITBT. In particular, lower levels of UL-spasticity but not LL-spasticity correlated with better function and demonstrated a strong relationship with functional status and need for caregiver assistance. This suggests that changes in UL-spasticity rather than LL-spasticity may be more likely to result in improved function and HRQOL and should be explored further.

 
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