A prospective cohort study of the effects of lower extremity orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy.

BACKGROUND: Lower-extremity musculotendinous surgery is standard treatment for ambulatory children with deformities such as joint contractures and bony torsions resulting from cerebral palsy (CP). However, evidence of efficacy is limited to retrospective, uncontrolled studies with small sample sizes focusing on gait variables and clinical examination measures. The aim of this study was to prospectively examine whether lower-extremity musculotendinous surgery in ambulatory children with CP improves impairments and function measured by gait and clinical outcome tools beyond changes found in a concurrent matched control group. METHODS: Seventy-five children with spastic CP (Gross Motor Function Classification System levels I to III, age 4 to 18 y) that underwent surgery to improve gait were individually matched on the basis of sex, Gross Motor Function Classification System level, and CP subtype to a nonsurgical cohort, minimizing differences in age and Gross Motor Function Measure Dimension E. At baseline and at least 12 months after baseline or surgery, participants completed gait analysis and Gross Motor Function Measure, and parents completed outcome questionnaires. Mean changes at follow-up were compared using analysis of covariance adjusted for baseline differences. RESULTS: Surgery ranged from single-level soft tissue release to multilevel bony and/or soft tissue procedures. At follow-up, after correcting for baseline differences, Gillette Gait Index, Pediatric Outcomes Data Collection Instrument Expectations, and Pediatric Quality of Life Inventory (PedsQL) Physical Functioning improved significantly for the surgical group compared with the nonsurgical group, which showed minimal change. CONCLUSIONS: On the basis of a matched concurrent data set, there was significant improvement in function after 1 year for a surgical group compared with a nonsurgical group as measured by the Gillette Gait Index, with few significant changes noted in outcome measures. Changes over 1 year are minimal in the nonsurgical group, supporting the possibility of ethically performing a randomized controlled trial using nonsurgical controls. LEVEL OF EVIDENCE: Therapeutic level 2. Prospective comparative study.

Clinical applications of outcome tools in ambulatory children with cerebral palsy.

This article provides an overview of outcome tools commonly used to assess ambulatory children with cerebral palsy, research findings from a recent large multi-center study, and ways to integrate the research findings into clinical practice. The information presented in this article and in the referenced articles provides information on: outcome tools' discriminatory ability and responsiveness; readily available comparison data on 7 commonly used outcome tools that can be used at the point of care; prediction equations for the Parent report Pediatric Outcomes Data Collection Instrument (PODCI) by age and Gross Motor Function Classification System (GMFCS) level; and minimum clinically important difference thresholds by GMFCS level. This information can help clinicians select the best outcome tools to discriminate among severity levels and avoid ceiling effects. The scores provided allow direct comparisons between a specific patient and a matched cohort, assisting clinicians in the creation of comprehensive and individualized evaluation and management plans. Use of appropriate outcome tools to assess children with cerebral palsy can lead to best practices and reduced costs in the clinical setting.