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

Outcome tool score changes with changes in GMFCS level

D OEFFINGER PHD A, A BAGLEY PHD B, G GORTON BS C, S ROGERS
MPH A, C TYLKOWSKI MD A, AND FUNCTIONAL ASSESSMENT
RESEARCH GROUP (FARG)

  1. 1. Shriners Hospitals for Children, Lexington, KY;
  2. 2. Sacramento, CA;
  3. 3. Springfield, MA, USA

Objectives: To establish if outcome tools are responsive when known changes in function occur, as measured by a change in Gross Motor Function Classification System (GMFCS) level.

Design: Prospective, longitudinal, multicenter outcomes study.

Participants: Convenience sample of 377 individuals with CP in GMFCS Levels I to III, from orthopedic clinics and motion laboratories.

Method: Gross Motor Function Measure (GMFM) dimension D and E, the Pediatric Quality of Life Inventory (PedsQL), Pediatric Outcomes Data Collection Instrument (PODCI), Functional Activities Questionnaire (FAQ), the Functional Independence Measure for Children (WeeFIM) scores, O 2 cost, temporal-spatial gait parameters, and GMFCS level were collected at baseline and at a 1-year follow-up visit. Change in function was defined as a verified change in GMFCS level change in GMFCS level between study visits. Changes occurred for 31 participants: 18 improved (I), 13 declined (D), and 346 had no change (NC). Change scores were the difference between follow-up and baseline. Analyses of variance were used to compare among groups with post-hoc Tukey tests for results (p<_0.05). Clionically relevant changes (CRC) to achievea medium (0.5) and large effect size (0.8) were established and used for reference (CRC=desired effect size *\/2 *\/ (1-r) * standard deviation of change score; r is the correlation between baseline and follow-up).

 Results: Mean age of participants was 11y (SD 4y 4mo) with 1y 5mo (SD 5mo) between visits and no difference among groups. Individual treatment plans were followed between visits, with 87 participants undergoing surgery (I, n=9; D, n=6; NC, n=72). Mean changes in outcome scores are reported for tools where significant differences between the NC versus D and I versus D groups were found (Table D:1). For the I group, all tools except Velocity and Stride Length exceeded the medium effect size. For the D group, all tools except for PODCI Global and Transfers exceeded the large effect size. No change score in the NC group exceeded the medium effect size.

Conclusions: Outcome tool change scores reported suggest that they are responsive when a change in function large enough to cause a change in GMFCS level occurs. Appropriate directional changes in outcome scores related to GMFCS level changes were found. The magnitudes of change scores are categorized as observable changes. Tools that were based on functional assessments, including temporal-spatial parameters, were found to differentiate between those who improved and declined and found to be the most responsive. These findings are probably related to the use of a functional classification system as a measure of change.

Acknowledgements: Funded by Shriners Hospitals for Children Clinical Outcomes Study Advisory Board, grant no.9140.

 
Gallery
Gal 1 Gal 2
Supporting Organizations
 
   
   
   
 
Online Feature Partner
 
   
   
 
Locations of visitors to this page
 
 

© 2010 all rights reserved. maintained by Classic Infomedia