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

Effect of upper limb botulinum toxin type-A therapy on health-related quality of life in children with hemiplegic cerebral palsy


  1. 1. Department of Paediatric Rehabilitaion, Princess Margaret Hospital (PMH);
  2. 2. School of Population Health, University of Western Australia, Perth, WA, Australia.

Introduction: Health-related quality of life (HRQoL) is an essential health outcome in any clinical traial. Despite increasing evidence of the efficacy of upper limb botulinum toxin type-A (BTX-A), few studies have assessed the impact on HRQoL. While function may improve, this cannot be directly correlated with an improvement in HRQoL. Most oaediatric studies use parent proxy reports for child HRQoL. The reliability of proxy reports is questionable. The World Health Organization recommends that age-related or developmentally appropriate paediatric self-resport HRQoL instruments be applied concurrently with a generic measure. 1

Method: Design: randomized controlled trial.

Participants: Twenty-two children with hemiplegic cerebral palsy (CP) aged 7 years to 14 years 11 months (12 intervention, 10 control). Intervention: one series BTX-A injections (dose 1-2U/kg/muscle) into upper limb. HRQoL assessed at baseline, and 1, 3, and 6 months post-injection by administration of Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL 3.0 Cerebral Palsy Module. Outcome measures: change in PedsQL scores.

Results: Between treatment groups, there was a significant difference in the generic parent report physical score (p=0.048). A significant linear trend was observed for scores including generic child report physical score ((p=0.046), generic parent report total score (p=0.028) and CP child report total score (p=0.035). Congruent with the clinical effect of BTX-A, a curved relationship over time was observed for scores including generic child report psychological (p=0.032) and total scores (p=0.038). Age group analysis showed significant differences between generic child report physical and total scores with the younger age group (7-9y) having higher scores than the 10 to 12 years or 13 to 15 years group.

Conclusion: Awareness of treatment influences the parental perception of their child’s HRQoL in the physical domain only. The linear trends observed in total scores suggest participation in a trial positively impacts on self-report and proxy HRQoL. Correlation with functional scores is needed to confirm whether the observe curved relationship in scores corresponds with functional change.


  1. 1. World Helath Organization DOMH (1999) Measurement of Quality of Life in Children, Geneva: World Health Organization.
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