Measuring outcomes after lower limb surgery in children with cerebral palsy

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dc.contributor.advisor Stott, S en
dc.contributor.advisor Mackey, A en Wilson, Nichola en 2017-03-27T23:35:07Z en 2015 en
dc.identifier.uri en
dc.description.abstract Cerebral palsy (CP) is the most common physical disability affecting children, with an incidence of 2–2.5 per 1,000 live births. Children with CP frequently undergo orthopaedic surgery as part of their care, with reported improvements in gait pattern as measured by three-dimensional gait analysis (3DGA). However, evidence is lacking on the impact of this surgery on the child’s activity and participation in the community. The programme of research presented in this thesis aims to further the knowledge on outcome measures in these domains for lower limb orthopaedic surgery in children with CP. In the initial study, a mapping review of 229 papers published in the period 1990–2011 was carried out to identify the breadth of outcome measures used to report the results of lower limb orthopaedic surgery in children with CP. The review found that the majority of the studies reported only on changes in impairment of body structure and function, with the most commonly reported measures being clinical examination, 3DGA, and gait velocity. Only 9% of reported outcomes reflected activity and participation, an example of which is the Functional Mobility Scale (FMS). To further investigate this gap in the literature, the following three studies explored whether impairment-based measures can accurately reflect all aspects of free-living walking activity seen in children with CP and thus could, or should, be the only measures of outcome after surgery. Firstly, the relationship between community mobility measured by the FMS and an impairment-based measure of walking capacity, the six-minute walk test, was analysed. Only 20%–27% of the variance of the FMS was accounted for by variation in the six-minute walk test, suggesting that factors other than walking capacity significantly influence a child’s choice of mobility across different distances, e.g., wheelchair versus crutches. Daily step count as measured by the StepWatch™ activity monitor had a moderate level of association with the Gait Deviation Index, derived from 3DGA, and is calculated as a single representative score of gait deviation from normalcy (Spearman’s ρ=0.58). However, significant variations in levels of daily step activity were noted for any single Gait Deviation Index score. Capturing the intensity of walking activity using cadence bands showed that most steps captured by the activity monitor were incidental; our group of children with CP walked only 50.5 minutes per day at faster than a slow walking pace (>59 steps/minute) and only 3.3 minutes faster than a brisk pace (>120 steps/minute). Achieving an increase in moderate to high intensity activity or a decrease in sedentary behaviour may be a better outcome measure following surgery than a change in daily step count and would have potential long-term health benefits for the child. The final study investigated the feasibility of including measures of activity and participation in the assessment of outcomes at three and six months post lower limb orthopaedic surgery. The Gait Deviation Index was improved at three months, but walking activity in the community decreased by 42% and had not returned to baseline at six months. Surgery led to restriction in diversity and intensity of activities, but did not change enjoyment of these activities over the six-month study period. Data ascertainment of activity and participation measures was lower than for impairment of body structure and function, especially for those measures perceived by parents as different to usual care. In conclusion, measuring outcomes following lower limb orthopaedic surgery in the activity and participation domains has not been common but is increasing. Impairment-based measures have only moderate relationships with activity levels and cannot reflect all aspects of a child’s walking activity. However, families comply better with impairment-based measures because these are seen as standard of care. Making activity and participation outcome measures part of standard care would increase their use in outcome studies and provide valuable information for the future. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA99264913310302091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri en
dc.title Measuring outcomes after lower limb surgery in children with cerebral palsy en
dc.type Thesis en Surgery en The University of Auckland en Doctoral en PhD en
dc.rights.holder Copyright: The author en
dc.rights.accessrights en
pubs.elements-id 618864 en Medical and Health Sciences en School of Medicine en Surgery Department en
pubs.record-created-at-source-date 2017-03-28 en

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