Joseph Prince J S, Khattak Mohammed, Masudi Sundas T, Minta Louise, Perry Daniel C
University of Liverpool, Liverpool, UK.
Alder Hey Children's Hospital, Liverpool, UK.
Bone Jt Open. 2023 Nov 1;4(11):825-831. doi: 10.1302/2633-1462.411.BJO-2023-0060.R1.
Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes.
A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale ('not important' to 'critically important'). A consensus meeting was held to finalize the CMS.
Overall, 14 distinct measurements were identified in the systematic review, with Reimer's migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer's migration percentage and femoral head-shaft angle, were included in the CMS.
This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.
髋关节疾病在脑瘫（CP）儿童中很常见，会降低生活质量和功能。现有监测项目旨在通过放射学监测在早期治疗髋关节疾病以改善预后。然而，研究和监测项目报告的放射学结果不同，难以进行比较。我们旨在确定最重要的放射学测量指标，并制定一套用于临床实践、研究和监测项目的核心测量指标集（CMS）。
一项系统评价确定了先前在报告CP儿童髋关节放射学结果的研究中使用的测量指标清单。这些测量指标为在骨科医生和专科物理治疗师中开展的两轮德尔菲研究提供了依据。参与者用九点李克特量表（从“不重要”到“极其重要”）对每个测量指标进行评分。召开了一次共识会议以最终确定CMS。
总体而言，在系统评价中确定了14项不同的测量指标，其中赖默氏迁移百分比是报告最频繁的指标。这些测量指标在两轮德尔菲过程中呈现，同时还有参与者建议的另外两项测量指标。最终，赖默氏迁移百分比和股骨头-骨干角这两项测量指标被纳入CMS。
使用这套最低限度的标准化测量指标有可能促进髋关节监测项目的一致性，并可能简化工具的开发，比如用于在监测项目中自动进行分析的人工智能系统。这个核心指标集应是临床研究的最低要求，允许临床医生根据需要进行补充，这将便于在不同研究之间以及未来的荟萃分析中进行比较。
