The Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Dev Med Child Neurol. 2019 Oct;61(10):1189-1195. doi: 10.1111/dmcn.14178. Epub 2019 Feb 10.
To test the hypothesis that improvements in gait and function following individualized interdisciplinary interventions consisting of physical therapy, orthotics, spasticity management, and orthopaedic surgery using instrumented gait analysis are superior to 'usual care' in children with cerebral palsy (CP).
This was a prospective, single-blind, parallel-group, randomized controlled trial investigating the effectiveness of interventions based on the use of gait analysis. Primary outcome was gait (Gait Deviation Index) and secondary outcomes were walking and patient-reported outcome measures of function, disability, and health-related quality of life. Follow-ups were done at 26 weeks (questionnaires) and at the primary end point of 52 weeks (all outcomes).
Sixty participants with CP (39 males, 21 females, mean age 6y 10mo, standard deviation 1y 3mo, range 5y-9y 1mo) in Gross Motor Function Classification System levels I or II, were randomized to interventions with or without gait analysis. No significant or clinically relevant between-group differences in change scores of the primary or secondary outcomes were found. The recommended categories of interventions were dominated by non-surgical interventions and were applied in 36% to 86% of the participants.
Interventions using gait analysis were not superior to 'usual care' on gait, walking, or patient-reported outcomes in a sample of relatively young and independently walking children with CP not expected to need surgery.
Gait analysis in children with cerebral palsy in Gross Motor Function Classification System levels I or II recommends interdisciplinary interventions. Compliance to interventions recommended after gait analysis was low. No statistically significant advantages were identified for the intervention group versus the control group.
检验以下假设，即通过物理治疗、矫形器、痉挛管理和使用仪器步态分析的矫形手术等个体化多学科干预措施改善步态和功能的效果优于脑瘫（CP）儿童的“常规护理”。
这是一项前瞻性、单盲、平行组、随机对照试验，研究基于步态分析的干预措施的有效性。主要结果是步态（步态偏差指数），次要结果是行走以及功能、残疾和健康相关生活质量的患者报告结果测量。在 26 周（问卷）和 52 周的主要终点（所有结果）进行随访。
60 名 CP 参与者（39 名男性，21 名女性，平均年龄 6 岁 10 个月，标准差 1 岁 3 个月，范围 5 岁-9 岁 1 个月）在粗大运动功能分类系统水平 I 或 II 中，随机分配到有或没有步态分析的干预措施。主要或次要结果的变化评分在组间没有显著或临床相关的差异。建议的干预类别主要是手术干预，在 36%至 86%的参与者中应用。
在不太可能需要手术的相对年轻和独立行走的 CP 儿童样本中，步态分析的干预措施在步态、行走或患者报告的结果方面并不优于“常规护理”。
在 GMFCS 水平 I 或 II 的脑瘫儿童中进行步态分析推荐使用多学科干预。对步态分析后推荐的干预措施的依从性较低。干预组与对照组之间未发现统计学上显著的优势。
