Article

There are conflicting reports about the stability of the Gross Motor
Function Classification System (GMFCS) in children with cerebral palsy (CP) after
orthopaedic surgery. We studied the stability of the GMFCS in children with
bilateral spastic CP after single-event multilevel surgery, using the Gait
Profile Score (GPS) as the primary outcome measure. METHOD: This was a
retrospective cohort study of 107 children (46 females, 61 males) with bilateral
spastic CP, classified as GMFCS level II or III, who underwent surgery at a
single tertiary institution between 1997 and 2008. The mean age at surgery was 10
years 7 months (SD 2 y 8 mo). The primary outcome measure was the GPS. Changes in
GMFCS level were studied at multiple time points before and after intervention.
RESULTS: Gait dysfunction was partially corrected, with a mean improvement of 28%
in the GPS. The GMFCS remained stable and unchanged in 95% of children and
improved by one level in 5% of children. The improvement in GPS was three times
the minimal clinically important difference. The mean age at final postoperative
GPS assessment was 11 years 10 months (SD 2 y 10 mo) and at final GMFCS
assessment was 15 years 7 months (SD 3 y 9 mo). INTERPRETATION: Stability of the
GMFCS was confirmed in the majority of children with bilateral spastic CP after
single-event multilevel surgery, despite statistically and clinically significant
improvements in gait dysfunction and functional mobility. This information is
important in realistic goal-setting and in counselling families.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS