The Edinburgh visual gait score - The minimal clinically important difference.

OBJECTIVE: The primary aim was to define the minimal clinically important difference (MCID) of the Edinburgh Visual Gait Score (EVGS) using correlations with the Gross Motor Function Classification System (GMFCS) and the Functional Assessment Questionnaire (FAQ). The secondary aim was to confirm the numerical value of the MCID in the Gait Profile Score (GPS). METHOD: The EVGS and GPS scores for 151 patients with diplegic cerebral palsy (GMFCS Levels I-III) were retrospectively identified from a database held at the study centre. One-hundred and forty-one patients had FAQ data available. RESULTS: The EVGS and GPS correlated with increasing GMFCS level (p<0.001) and FAQ score (p<0.001). A gradient of 3.8 (2.9-4.7) for the EVGS and 2.9 (2.1-3.7) for the GPS corresponded to a one-level change in GMFCS level. A gradient of 1.9 (1.3-2.4) for EVGS and 1.5 (1.1-2.0) for GPS corresponded to a one-point change in FAQ. CONCLUSIONS: The authors propose an MCID value of 2.4 for the EVGS; representing the improvement in gait score after surgery that is likely to reflect a clinical improvement in function. This MCID is closely related to other studies defining post-operative improvements in kinematic data (GPS) and may offer guidance to post-surgical changes that might reasonably be expected to either improve or prevent deteriorating function.

Using a goal attainment scale in the evaluation of outcomes in patients with diplegic cerebral palsy.

A goal attainment scale (GAS) was used to evaluate outcomes of surgical and non-surgical interventions to improve gait in 45 children with diplegic cerebral palsy. Personal goals were recorded during pre-intervention gait analysis in two groups. Twenty children underwent orthopaedic surgery (Group 1) and 25 children received a non-operative intervention (Group 2). Children and/or their carers were contacted post-intervention by telephone to complete a GAS questionnaire, rating the achievement of goals on a 5-point scale. The goals were similar in both groups. The composite GAS was transformed into a standardised measure (T-score) for each patient. Both groups on average achieved their goals (mean T-score for Group 2 was 56.3, versus 47.1 for Group 1). The difference between these two means was significant (p=0.010). Additionally, 16 children had undergone a follow-up gait analysis during the study period, but the relationship between their Gait Profile Score and GAS was not statistically significant. Both surgical and non-surgical interventions enabled children to achieve their goals, although Group 1 reported higher achievements. The GAS reflects patient's/parent's/carer's aspirations and may be as relevant as post-intervention kinematic or kinetic outcomes.

The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I-III.

OBJECTIVE: To determine the relationship between the Edinburgh Visual Gait Score (EVGS) and the Gait Profile Score (GPS). METHOD: Three dimensional gait data and EVGS scores from 151 diplegic children (Gross Motor Function Classification System (GMFCS) levels I-III) were used for analysis. RESULTS: The EVGS correlated strongly with GPS (r=0.816). There was a significant difference in both gait scores between each level of the GMFCS. CONCLUSIONS: The strong correlation of GPS with EVGS implies that any advantages of using GPS can also be applied to centres without 3-dimensional gait analysis facilities if the EVGS is used.

In vivo studies of 111In-labelled canine lymphocytes.

[111In]oxine was used to label canine periperal blood lymphocytes from two normal animals and one animal with breast carcinoma. Using 150 microCi of [111In]oxine to label 50 X 10(6) cells yielded a labeling efficiency between 40 and 75% and a viability of about 95%. Gamma camera images obtained 24-44 h after injection showed uptake in the subcutaneous lymph nodes of the head, neck, axilla, pelvis and popliteal regions. Uptake in the liver, spleen, bowel, and bone marrow was also seen. In the animal bearing breast carcinoma, uptake occurred in the tumor, lungs and in a draining sinus in the left axilla. These results suggest that 111In labeled lymphocytes are useful in visualizing regional lymph nodes and may be valuable in assessing tumor recognition by these cells in vivo.