Policy brief: adaptive cycling equipment for individuals with neurodevelopmental disabilities as durable medical equipment.

- Durable medical equipment (DME) policies require that the equipment be medically necessary; however, adaptive cycling equipment (bicycles and tricycles) are usually not deemed medically necessary. - Individuals with neurodevelopmental disabilities (NDD) are at high risk for secondary conditions, both physical and mental, that can be mitigated by increasing physical activity. - Significant financial costs are associated with the management of secondary conditions. - Adaptive cycling can provide improved physical health of individuals with NDD potentially reducing costs of comorbidities. - Expanding DME policies to include adaptive cycling equipment for qualifying individuals with NDD can increase access to equipment. - Regulations to ensure eligibility, proper fitting, prescription, and training can optimize health and wellbeing. - Programs for recycling or repurposing of equipment are warranted to optimize resources.

Clinical efficacy of instrumented gait analysis: Systematic review 2020 update.

BACKGROUND: This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA). RESEARCH QUESTION: What is the current evidence base pertaining to the clinical efficacy of 3DGA? METHODS: We identified English language articles published from September 2009 to October 2019 reporting primary research that used typical motion analysis laboratory methods to study human walking. Five gait laboratory experts classified articles according to the highest type of efficacy they addressed: type 1 (technical), 2 (diagnostic accuracy), 2b (outcome prediction), 3-4 (diagnostic thinking and treatment), 5 (patient outcome), 6 (societal). Articles classified into type 3-4 and higher were rated for quality using LEGEND. RESULTS: Of 2712 articles related to the efficacy of 3DGA, over 99% addressed technical (n = 313), diagnostic (n = 1466), or outcome prediction (n = 927) efficacy. Six type 3-4 studies showed that 3DGA changes treatment plans, increases clinicians' confidence in their treatment decisions, and increases agreement among clinicians. Two type 5 articles based on a randomized controlled trial demonstrated that patient outcomes improved only when 3DGA data were available and its recommendations were followed. A population-based type 5 study found that the incidence of severe crouch gait dropped from 25% to 4% following practice changes including the addition of 3DGA. The strength of evidence was mainly 3b (lesser quality prospective cohort studies) but also included stronger studies (three level 2 controlled clinical trials). SIGNIFICANCE: Literature related to the clinical efficacy of 3DGA has grown substantially over the last decade. Thousands of articles contribute to continued improvement of data collection and interpretation, as well as understanding of gait pathology and treatment. A smaller number of studies clearly demonstrate the efficacy of 3DGA in changing and reinforcing treatment decisions, increasing clinicians' confidence in treatment planning, and increasing agreement among clinicians, as well as the potential to improve patient outcomes.

Evaluation of the treatment of pectus carinatum with compressive orthotic bracing using three dimensional body scans.

PURPOSE: The purpose of this study is to measure the effectiveness of compressive orthotic brace therapy for the treatment of pectus carinatum using an adjusted Haller Index (HI) measurement calculated from 3D body scan (BS) images. METHODS: Pediatric patients with pectus carinatum were treated with either compressive orthotic bracing or observation. An adjusted BS Haller index (HI) was calculated from serial 3D BS images obtained on all patients. Medical records were evaluated to determine treatment with bracing and brace compliance more than 12hours daily. Compliant patient measurements were compared to non-compliant and non-brace groups. RESULTS: Forty patients underwent compressive orthotic bracing, while ten were observed. Twenty-three patients were compliant with bracing, and seventeen patients were non-compliant. Compliant patients exhibited an 8.2% increase, non-compliant patients had a 1.5% increase, and non-brace patients exhibited a 2.5% increase in BS HI. The change in BS HI of compliant patients was significantly different compared to non-brace patients (p=0.004) and non-compliant patients (p<0.001). CONCLUSIONS: Three dimensional BS is an effective, radiation free, and objective means to evaluate patients treated with compressive orthotic bracing.

Gait and participation outcomes in adults with cerebral palsy: a series of case studies using mixed methods.

BACKGROUND: There is a paucity of information on long-term outcomes of adults with cerebral palsy (CP) who received orthopedic interventions in childhood. Clinical effectiveness research requires assessment of outcomes that account for personal and environmental factors that may mediate the effects of treatment, in addition to body structures & function, activity, and participation. OBJECTIVE/HYPOTHESIS: The purpose of this study is to provide a descriptive analysis of characteristics associated with gait and participation outcomes in a series of case studies of adults with CP. METHODS: Participants had follow up gait analysis and clinical evaluation in adulthood and assessment of outcomes with the FIM instrument, the SF-36 Health survey, the Canadian Occupational Performance Measure, and semi-structured questions. RESULTS: Twenty-two out of 26 participants (mean age = 25 years; GMFCS level I (n = 9); II (n = 3); III (n = 11); IV (n = 3)) maintained or improved childhood gait abilities, with levels of participation in society similar to age matched peers. Higher level of severity and personal choices impacted gait abilities in the four who declined. Majority of participants lost range of motion in hip flexion and knee extension, had pain, reported a fitness program, and increased in weight status. Personal factors and environmental factors played a role in both gait and participation outcomes. CONCLUSION: Promotion of fitness activities and social advocacy are warranted for adults with CP. Clinical effectiveness research of long-term impact of orthopedic interventions should account for treatment effects on body structures & function, activity, participation, and modifying effects of personal, and environmental factors.

Rasch analysis of items from two self-report measures of motor function: determination of item difficulty and relationships with children's ability levels.

AIM: The aim of this article was to determine item measurement properties of a set of items selected from the Gillette Functional Assessment Questionnaire (FAQ) and the Pediatric Outcome Data Collection Instrument (PODCI) using Rasch analysis, and to explore relationships between the FAQ/PODCI combined set of items, FAQ walking scale level, Gross Motor Function Classification System (GMFCS) levels, and the Gait Deviation Index on a common measurement scale. METHOD: Rasch analysis was performed on data from a retrospective chart review of parent-reported FAQ and PODCI data from 485 individuals (273 males; 212 females; mean age 9 y 10 mo, SD 3 y 10 mo) who underwent first-time three-dimensional gait analysis. Of the 485 individuals, 289 had a diagnosis of cerebral palsy (104 GMFCS level I, 97 GMFCS level II, 69 GMFCS level III, and 19 GMFCS level IV). Rasch-based person abilities and item difficulties based on subgroups defined by the FAQ walking scale level, Gait Deviation Index, and the GMFCS level were compared. RESULTS: The FAQ/PODCI item set demonstrated necessary Rasch characteristics to support its use as a combined measurement scale. Item groupings at similar difficulty levels were consistent with the mean person abilities of subgroups based on FAQ walking scale level, Gait Deviation Index, and GMFCS level. INTERPRETATION: Rasch-derived person ability scores from the FAQ/PODCI combined item set are consistent with clinical measures. Rasch analysis provides insights that may improve interpretation of the difficulty of motor functions for children with disabilities.

Accuracy, reliability, and validity of a 3-dimensional scanner for assessing torso shape in idiopathic scoliosis.

STUDY DESIGN: Prospective cohort with concurrent controls. OBJECTIVE: To establish accuracy, reliability, and validity of the Vitronic 3D Body Scanner for the evaluation of torso asymmetry in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Improved appearance is an important expectation of treatment for patients with scoliosis and their parents. Despite being the "gold standard" for quantifying outcomes, Cobb angles do not explain perception of appearance or quality of life. Surface topography is an attractive noninvasive alternative to radiography but has not been studied in the context of patient-centered outcomes. METHODS: Thirty-six adolescents with idiopathic scoliosis undergoing surgical correction had pre- and postoperative radiographs and evaluation of standing posture, torso surface shape, and responses to the Scoliosis Research Society-22 and Spinal Appearance Questionnaire. Twenty-one adolescents without scoliosis were evaluated for comparison. Scanner accuracy was assessed by scanning an object of known dimensions. Within-session reliability of body shape measures constructed from scan data was assessed. Discriminant validity was assessed by examining pre- to postoperative differences. Concurrent validity was examined through correlations of scan measures with radiographs, optoelectronic measures of posture, and self-report responses to the Scoliosis Research Society-22 and Spinal Appearance Questionnaire. RESULTS: Scan system measurement error was 1.74 ± 1.56 mm. Within-session reliability was excellent for the control (intraclass correlation coefficient = 0.83) and scoliosis (intraclass correlation coefficient = 0.94) groups. Medial/lateral torso shift, rotation, and right/left asymmetry differed significantly among the preoperative, postoperative, and control groups (analysis of variance, P < 0.05). Torso asymmetry measures correlated with radiographical measures (r = 0.43-0.51), optoelectronical measures of posture and symmetry (r = 0.33-0.75), and appearance and quality-of-life domains of the Scoliosis Research Society-22 (r = 0.35-0.64) and the Spinal Appearance Questionnaire (r = 0.48-0.67). CONCLUSION: The Vitronic 3D Body Scanner has sufficient accuracy, reliability, and validity to monitor torso asymmetry due to scoliosis. Scan-based measures differentiate between normal and pathological and between preoperative and postoperative body shape and show good correlation with measures of appearance and quality of life.

Efficacy of clinical gait analysis: A systematic review.

The aim of this systematic review was to evaluate and summarize the current evidence base related to the clinical efficacy of gait analysis. A literature review was conducted to identify references related to human gait analysis published between January 2000 and September 2009 plus relevant older references. The references were assessed independently by four reviewers using a hierarchical model of efficacy adapted for gait analysis, and final scores were agreed upon by at least three of the four reviewers. 1528 references were identified relating to human instrumented gait analysis. Of these, 116 original articles addressed technical accuracy efficacy, 89 addressed diagnostic accuracy efficacy, 11 addressed diagnostic thinking and treatment efficacy, seven addressed patient outcomes efficacy, and one addressed societal efficacy, with some of the articles addressing multiple levels of efficacy. This body of literature provides strong evidence for the technical, diagnostic accuracy, diagnostic thinking and treatment efficacy of gait analysis. The existing evidence also indicates efficacy at the higher levels of patient outcomes and societal cost-effectiveness, but this evidence is more sparse and does not include any randomized controlled trials. Thus, the current evidence supports the clinical efficacy of gait analysis, particularly at the lower levels of efficacy, but additional research is needed to strengthen the evidence base at the higher levels of efficacy.

Factor- and item-level analyses of the 38-item activities scale for kids-performance.

AIM: Children and adolescents highly value their ability to participate in relevant daily life and recreational activities. The Activities Scale for Kids-performance (ASKp) instrument measures the frequency of performance of 30 common childhood activities, and has been shown to be valid and reliable. A revised and expanded 38-item ASKp (ASKp38) version has been reported in recent literature and is currently used in clinical research. The aim of this paper is to assess the factor structure and item-level statistics of the ASKp38. METHOD: Our study used factor analyses and Rasch analyses to determine the item-set dimensionality and to calculate item-level statistics respectively, for existing ASKp38 data from 200 children (104 males; 96 females; mean age 12y 7mo; SD 2y 8mo; range 6-20y) with physical disabilities. The children had a variety of physical impairments including cerebral palsy (n = 105; range 8-13 y), limb salvage (n = 18; range 11-20y), arthrogryposis (n = 13; 6-17y), and other, including individuals with spina bifida and spinal cord injury (n = 64; 8-19 y). RESULTS: A two-factor model, with components of activities of daily living and play, most optimally fit the data. Item-fit statistics based on this two-factor model demonstrated adequate fit and content coverage. INTERPRETATION: The ASKp38 appears to consist of two factors, defined as (1) activities of daily living and (2) play, and may be used to measure the frequency of activity performance on two corresponding subscales.