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

Lower extremity surgery improves gait in ambulatory children with cerebral palsy

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

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

Objectives: To evaluate the effects of lower extremity surgery in ambulatory children with cerebral palsy (CP) compared with a matched non-surgical group using the Gillette Gait Index (GGI).

Design: Prospective, longitudinal cohort outcomes study.

Setting: Seven pediatric orthopedic hospitals.

Participants: Participants (age 4-18y) had a diagnosis of spastic CP, were at Gross Motor Function Classification System (GMFCS) levels I to III, and able to complete a gait analysis. Five hundred and sixty-two participants completed baseline assessments; 387 returned for follow-up evaluation. Seventy-five children (mean age 11y 1mo [SD 4y 4mo]), at GMFCS levels I to III, receiving surgery to improve gait function (surgical group), were matched to a control group of 75 children without surgery (non-surgical group) within the study window. Surgery ranged from isolated muscle release to multilevel bony and soft tissue procedures.

Method: Each surgical case was matched to the non-surgical case minimizing the distance between normalized z-scores for age and Gross Motor Function Measure (GMFM) dimensions E at baseline, exactly matching sex, GMFCS level, and type of involvement. Participants completed gait analysis, oxygen consumption test, Gillette Functional Assessment Questionnaire, GMFM dimensions D and E, the Functional Independence Measure for Children, the Pediatric Outcomes Data Collection Instrument, and the Pediatric Quality of Life Inventory at baseline and a minimum of 12 months after baseline or surgery. GGI was calculated for all involved limbs. Change scores were compared using paired student’s t-tests (p<0.05). Mean differences between the groups are reported.

Results: At baseline there was no significant difference between the groups for age, height, weight, or outcome tool scores. At baseline there was a significant difference in GGI between the non-surgical and surgical groups only at GMFCS Level III. At follow-up there was a significant difference between the groups at GMFCS Level II. GGI decreased significantly (improved) between baseline and follow-up for all GMFCS levels in the surgical group but not in the non-surgical group. Changes in GGI between the non-surgical and surgical groups were significant at GMFCS levels II and III (Table F:7).

Conclusions: Surgical intervention results in changes in GGI not present in a matched non-surgical group. The non-surgical group did not demonstrate a significant decline in gait during the study period. The surgical group’s decrease in GCI demonstrates surgical intervention results in improved gait kinematics. This study provides the strongest level of evidence to date that lower extremity surgery in ambulatory children with CP improves gait and provides the foundation for a larger prospective, randomized clinical trial in orthopedic surgery. Future analysis will determine if gait improvements translate to improved function and quality of life.

Acknowledgements: This work is funded by Shriners Hospitals for Children Clinical Outcomes Study, 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