Marois Pierre, Letellier Guy, Marois Mikaël, Ballaz Laurent
Marie Enfant Rehabilitation Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.
Paediatric Department, Université de Montréal, Montreal, QC, Canada.
Front Neurol. 2024 Mar 8;15:1347361. doi: 10.3389/fneur.2024.1347361. eCollection 2024.
The Gross Motor Function Measure is used in most studies measuring gross motor function in children with cerebral palsy. In many studies, including those evaluating the effect of hyperbaric treatment, the Gross Motor Function Measure variations were potentially misinterpreted because of the lack of control groups. The Gross Motor Function Measure Evolution Ratio (GMFMER) uses historical data from the Gross Motor Function Classification System curves and allows to re-analyze previous published studies which used the Gross Motor Function Measure by considering the natural expected evolution of the Gross Motor Function Measure. As the GMFMER is defined by the ratio between the recorded Gross Motor Function Measure score increase and the expected increase attributed to natural evolution during the duration of the study (natural evolution yields a GMFMER of 1), it becomes easy to assess and compare the efficacy of different treatments.
The objective of this study is to revisit studies done with different dosage of hyperbaric treatment and to compare the GMFMER measured in these studies with those assessing the effects of various recommended treatments in children with cerebral palsy.
PubMed Searches were conducted to included studies that used the Gross Motor Function Measure to evaluate the effect of physical therapy, selective dorsal rhizotomy, botulinum toxin injection, hippotherapy, stem cell, or hyperbaric treatment. The GMFMER were computed for each group of the included studies.
Forty-four studies were included, counting 4 studies evaluating the effects of various dosage of hyperbaric treatment in children with cerebral palsy. Since some studies had several arms, the GMFMER has been computed for 69 groups. The average GMFMER for the groups receiving less than 2 h/week of physical therapy was 2.5 ± 1.8 whereas in context of very intensive physical therapy it increased to 10.3 ± 6.1. The GMFMER of stem cell, selective dorsal rhizotomy, hippotherapy, and botulinum toxin treatment was, 6.0 ± 5.9, 6.5 ± 2.0, 13.3 ± 0.6, and 5.0 ± 2.9, respectively. The GMFMER of the groups of children receiving hyperbaric treatment were 28.1 ± 13.0 for hyperbaric oxygen therapy and 29.8 ± 6.8 for hyperbaric air.
The analysis of the included studies with the GMFMER showed that hyperbaric treatment can result in progress of gross motor function more than other recognized treatments in children with cerebral palsy.
粗大运动功能测量量表在大多数测量脑瘫患儿粗大运动功能的研究中被使用。在许多研究中，包括那些评估高压治疗效果的研究，由于缺乏对照组，粗大运动功能测量量表的变化可能被误解。粗大运动功能测量量表演变率（GMFMER）使用来自粗大运动功能分类系统曲线的历史数据，并允许通过考虑粗大运动功能测量量表的自然预期演变来重新分析以前发表的使用该量表的研究。由于GMFMER由研究期间记录的粗大运动功能测量量表得分增加与归因于自然演变的预期增加之间的比率定义（自然演变产生的GMFMER为1），因此很容易评估和比较不同治疗方法的疗效。
本研究的目的是重新审视使用不同剂量高压治疗的研究，并将这些研究中测量的GMFMER与评估脑瘫患儿各种推荐治疗效果的GMFMER进行比较。
在PubMed上进行检索，纳入使用粗大运动功能测量量表评估物理治疗、选择性脊神经后根切断术、肉毒杆菌毒素注射、马术治疗、干细胞或高压治疗效果的研究。为纳入研究的每组计算GMFMER。
共纳入44项研究，其中4项研究评估了不同剂量高压治疗对脑瘫患儿的影响。由于一些研究有多个组，因此为69个组计算了GMFMER。接受每周少于2小时物理治疗的组的平均GMFMER为2.5±1.8，而在非常密集的物理治疗情况下，该值增加到10.3±6.1。干细胞、选择性脊神经后根切断术、马术治疗和肉毒杆菌毒素治疗的GMFMER分别为6.0±5.9、6.5±2.0、13.3±0.6和5.0±2.9。接受高压治疗的儿童组中，高压氧治疗的GMFMER为28.1±13.0，高压空气治疗的GMFMER为29.8±6.8。
用GMFMER对纳入研究进行分析表明，与其他公认的治疗方法相比，高压治疗可使脑瘫患儿的粗大运动功能取得更大进展。
