Caserta Antoni, Morgan Prue, Williams Cylie
Monash Health Community, Cranbourne, Victoria, Australia; Monash University, Department of Physiotherapy, Frankston, Victoria, Australia.
Monash University, Department of Physiotherapy, Frankston, Victoria, Australia.
Gait Posture. 2019 Jan;67:181-186. doi: 10.1016/j.gaitpost.2018.10.007. Epub 2018 Oct 10.
Idiopathic toe walking (ITW) is a diagnosis of exclusion for children walking on their toes with no medical cause. This systematic review aimed to identify and evaluate the clinical utility, validity and reliability of the outcome measures and tools used to quantify lower limb changes within studies that included children with ITW.
The following databases were searched from inception until March 2018: Ovid MEDLINE, EBESCO, Embase, CINAHL Plus, PubMed. Inclusion criteria were studies including children with ITW diagnosis, reporting use of measurement tools or methods describing lower limb characteristics, published in peer-reviewed journals, and in English. The relevant psychometric properties of measurement tools were extracted, and assessed for reported reliability and validity. Included articles were assessed for risk of bias using McMaster quality assessment tool. Results were descriptively synthesized and logistic regression used to determine associations between common assessments.
From 3164 retrieved studies, 37 full texts were screened and 27 full texts included. There were 27 different measurement tools described across joint range of motion measurement, gait analysis, electromyography, accelerometer, strength, neurological or radiology assessment. Interventional studies were more likely to report range of motion and gait analysis outcomes, than observational studies. Alvarez classification tool in conjunction with Vicon motion system appeared the contemporary choice for describing ITW gait. There was no significant association between the use of range of motion and gait analysis outcomes and any other outcome tool or assessment in all studies (p > 0.05).There was limited reliability and validity reporting for many outcome measures.
This review highlighted that a consensus statement should be considered to guide clinicians and researchers in the choice of the most important outcome measures for this population. Having a standard set of measures will enable future treatment trials to collect similar measures thus allowing future systematic reviews to compare results.
特发性足尖行走（ITW）是对无医学原因而用足尖行走儿童的排除性诊断。本系统评价旨在识别和评估用于量化包括ITW儿童在内的研究中下肢变化的结局指标和工具的临床实用性、有效性和可靠性。
检索以下数据库自建库至2018年3月的数据：Ovid MEDLINE、EBESCO、Embase、CINAHL Plus、PubMed。纳入标准为：研究纳入ITW诊断儿童，报告使用测量工具或描述下肢特征的方法，发表于同行评审期刊且为英文。提取测量工具的相关心理测量学特性，并评估报告的可靠性和有效性。使用麦克马斯特质量评估工具对纳入文章进行偏倚风险评估。对结果进行描述性综合分析，并使用逻辑回归确定常见评估之间的关联。
从检索到的3164项研究中，筛选出37篇全文，纳入27篇全文。在关节活动范围测量、步态分析、肌电图、加速度计、力量、神经学或放射学评估中描述了27种不同的测量工具。与观察性研究相比，干预性研究更有可能报告活动范围和步态分析结果。阿尔瓦雷斯分类工具与Vicon运动系统结合似乎是描述ITW步态的当代选择。在所有研究中，活动范围和步态分析结果的使用与任何其他结局工具或评估之间均无显著关联（p>0.05）。许多结局指标的可靠性和有效性报告有限。
本综述强调应考虑制定共识声明，以指导临床医生和研究人员为该人群选择最重要的结局指标。拥有一套标准的指标将使未来的治疗试验能够收集相似的指标，从而使未来的系统评价能够比较结果。
