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

Influence of gait analysis on decision-marketing for lower extremity surgery
RM KAY MD1,2, TA WREN PHD 1,2,RE BOWEN MD 4,
NY OTSUKAMD 3, AA SCADUTOMD4, LS CHANPHD5,
M SHENGMS1, R HARAMA1.

1Childrens Orthopaedic Center, Childrens Hospital Los Angeles, CA.
2Orthopaedic Surgery, Keck-University of Southem California School of Medicine, Los Angeles, CA.
3Orthopaedic Surgery, Shriners Hospital Los Angeles, Los Angeles, CA.
4 Orthopaedic Surgery, Shriners Hospital Los Angeles, CA.
5 Keck-University of Southem California School of Medicine, Los Angeles, CA, USA.

Background/Objectives: Gait analysis is frequently used in evaluation of children with cerebral palsy (CP).The purpose of this study was to examine the influence of gait analysis on the decision-making for lower extremity surgery (LES) in children with CP.
Design: Prospective, randomised control trial.
Participants and Setting: One hundred and thirty ambulatory children with CP, in a randomised, controlled trial (RCT) underwent gait analysis before planned lower extremity orthopaedic surgery.
Materials/Methods: The subjects were randomised to two groups:
(1)Treatment group, in which the surgeon received the patient’s gait analysis report and
(2) Control group, in which the surgeon did not receive the report. Data on LES were collected at three times: (1) referral by treating surgeon before gait analysis, (2) recommendations by gait laboratory surgeon after gait analysis, and (3) actual surgery performed. The main outcome measure was the relative acceptance (RA) between the Treatment and Control groups, where accepted the gait analysis recommendation for LES (RA>1 indicates reinforcement of the plan by the gait analysis).Statistical significance was determined using the two-sided Fisher’s exact test.
Results: In patients in whom both the referring physician and gait lab physician recommended a specific surgical procedure, the chance that the procedure was performed was higher in the treatment group (76/84=90%) then the control group (69/106=65%)(RA 1.39;P<0.001). In patients in whom the referring physician recommended a procedure which was subsequently not recommended by the gait lab physician, the frequency with which the procedure was performed was lower in the treatment group(19/49=39%)then the control group (32/45=71%).(RA 2.12; P=0.002).In patients in whom the referring physician did not recommend a procedure which was then recommended by the gait lab physician, the likelihood that the procedure was performed was greater in the treatment group (32/225=14%) then the control group (12/194=6%). (RA 2.30; P=0.01).In patients in whom neither the referring physician nor the gait lab physician recommended a specific surgical procedure, the chance that the procedure was performed was<1% in each group (8/1,163 in the treatment group and 10/1267 in the control group (RA 1.00; P=0.817).
Conclusions/Significance: The results from this ongoing randomized, controlled trial indicate that the information from a gait study impact surgical decision –making in children with CP who undergo orthopaedic surgery.

 
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