Nieuwenhuys Angela, Papageorgiou Eirini, Schless Simon-Henri, De Laet Tinne, Molenaers Guy, Desloovere Kaat
Neuromotor Research Group, Department of Rehabilitation Sciences, KU LeuvenLeuven, Belgium.
Faculty of Engineering Science, KU LeuvenLeuven, Belgium.
Front Hum Neurosci. 2017 Apr 12;11:185. doi: 10.3389/fnhum.2017.00185. eCollection 2017.
During a Delphi consensus study, a new joint gait classification system was developed for children with cerebral palsy (CP). This system, whose reliability and content validity have previously been established, identified 49 distinct joint patterns. The present study aims to provide a first insight toward the construct validity and clinical relevance of this classification system. The retrospective sample of convenience consisted of 286 patients with spastic CP (3-18 years old, GMFCS levels I-III, 166 with bilateral CP). Kinematic and kinetic trials from three-dimensional gait analysis were classified according to the definitions of the Delphi study, and one classified trial was randomly selected for each included limb ( = 446). Muscle weakness and spasticity were assessed for different muscle groups acting around the hip, knee, and ankle. Subsequently, Pearson Chi square tests, Cramer's V, and adjusted standardized residuals were calculated to explore the strength and direction of the associations between the joint patterns, and the different patient-specific characteristics (i.e., age, GMFCS level, and topographical classification) or clinical symptoms (muscle weakness and spasticity). Patient-specific characteristics showed several significant associations with the patterns of different joints, but the strength of most identified associations was weak. Apart from the knee during stance phase and the pelvis in the sagittal plane, the results systematically showed that the patterns with "minor gait deviations" were the most frequently observed. These minor deviations were found significantly more often in limbs with a lower level of spasticity and good muscle strength. Several other pathological joint patterns were moderately associated with weakness or spasticity, including but not limited to "outtoeing" for weakness and "intoeing" for spasticity. For the joints in the sagittal plane, significantly stronger associations were found with muscle weakness and spasticity, possibly because most of the evaluated muscles in this study mainly perform sagittal plane motions. Remarkably, the hip patterns in the coronal plane did not associate significantly with any of the investigated variables. Although further validation is warranted, this study contributes to the construct validity of the joint patterns of the Delphi consensus study, by demonstrating their ability to distinguish between clinically relevant subgroups in CP.
在一项德尔菲共识研究中，为脑性瘫痪（CP）儿童开发了一种新的关节步态分类系统。该系统的可靠性和内容效度此前已得到确立，它识别出了49种不同的关节模式。本研究旨在初步洞察该分类系统的结构效度和临床相关性。这项回顾性便利样本研究包括286例痉挛型CP患者（年龄3至18岁，GMFCS分级为I至III级，其中166例为双侧CP）。根据德尔菲研究的定义，对三维步态分析的运动学和动力学试验进行分类，为每个纳入的肢体随机选择一个分类试验（n = 446）。评估了髋关节、膝关节和踝关节周围不同肌肉群的肌力和痉挛情况。随后，计算Pearson卡方检验、Cramer's V和校正标准化残差，以探究关节模式与不同患者特定特征（即年龄、GMFCS分级和地形分类）或临床症状（肌力和痉挛）之间关联的强度和方向。患者特定特征显示出与不同关节模式存在若干显著关联，但大多数已识别关联的强度较弱。除了站立期的膝关节和矢状面的骨盆外，结果系统地显示，“轻度步态偏差”模式是最常观察到的。这些轻度偏差在痉挛程度较低和肌力良好的肢体中更常出现。其他几种病理性关节模式与肌力减弱或痉挛存在中度关联，包括但不限于因肌力减弱导致的“外八字”和因痉挛导致的“内八字”。对于矢状面的关节，发现与肌力减弱和痉挛的关联明显更强，这可能是因为本研究中评估的大多数肌肉主要进行矢状面运动。值得注意的是，冠状面的髋关节模式与任何研究变量均无显著关联。尽管有必要进行进一步验证，但本研究通过证明德尔菲共识研究中关节模式能够区分CP中临床相关亚组，为其结构效度做出了贡献。
