Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Temple University, Philadelphia, PA, USA.
Gait Posture. 2020 Jul;80:274-279. doi: 10.1016/j.gaitpost.2020.05.031. Epub 2020 May 23.
This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA).
What is the current evidence base pertaining to the clinical efficacy of 3DGA?
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.
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).
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.
本文更新了我们 2011 年关于三维仪器步态分析（3DGA）临床疗效的系统评价。
目前关于 3DGA 临床疗效的证据基础是什么？
我们确定了 2009 年 9 月至 2019 年 10 月发表的英文文章，这些文章报道了使用典型运动分析实验室方法研究人类行走的原始研究。五名步态实验室专家根据他们所解决的最高疗效类型对文章进行分类：1 型（技术）、2 型（诊断准确性）、2b 型（结果预测）、3-4 型（诊断思维和治疗）、5 型（患者结果）、6 型（社会效益）。将文章分类为 3-4 型及以上的文章使用 LEGEND 进行质量评估。
在与 3DGA 疗效相关的 2712 篇文章中，超过 99%的文章涉及技术（n=313）、诊断（n=1466）或结果预测（n=927）疗效。六项 3-4 型研究表明，3DGA 改变了治疗计划，增加了临床医生对治疗决策的信心，并增加了临床医生之间的一致性。两篇基于随机对照试验的 5 型文章表明，只有当 3DGA 数据可用且遵循其建议时，患者的结果才会改善。一项基于人群的 5 型研究发现，在包括增加 3DGA 在内的实践改变后，严重的蹲伏步态发生率从 25%降至 4%。证据的强度主要为 3b（质量较低的前瞻性队列研究），但也包括了更强的研究（三项 2 级对照临床试验）。
过去十年，关于 3DGA 临床疗效的文献大量增加。数千篇文章有助于继续改进数据收集和解释，以及了解步态病理和治疗。少数研究清楚地证明了 3DGA 在改变和加强治疗决策、增加临床医生对治疗计划的信心以及增加临床医生之间的一致性方面的疗效，以及改善患者结局的潜力。
