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Molenaers G, Desloovere K, Fabry G, Cock PD. The effects of quantitative gait assessment and botulinum toxin A on musculoskeletal surgery in children with cerebral palsy. J Bone Joint Surg Am 2006; 88:161-170. This is a retrospective review of 424 children with ambulatory CP treated at one centre from 1985 to 2001. Three historical cohorts were compared, separated by the introduction of gait analysis in 1990 and the addition of botulinum toxin-A in 1996. Children in Group 1, who did not have the benefit of gait analysis or botulinum toxin, underwent surgery significantly earlier than those in Group 2, who had the benefit of gait analysis. The association between the introduction of gait analysis and the delay of surgery could be attributable to change in philosophy with the times rather than the introduction of gait analysis. Furthermore, delay of surgery is, at best, a proxy for, and not necessarily representative of, improved outcomes
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Molenaers G, Desloovere K, Fabry G, Cock PD. The effects of quantitative gait assessment and botulinum toxin A on musculoskeletal surgery in children with cerebral palsy. J Bone Joint Surg Am 2006; 88:161-170. This is a retrospective review of 424 children with ambulatory CP treated at one centre from 1985 to 2001. Three historical cohorts were compared, separated by the introduction of gait analysis in 1990 and the addition of botulinum toxin-A in 1996. Children in Group 1, who did not have the benefit of gait analysis or botulinum toxin, underwent surgery significantly earlier than those in Group 2, who had the benefit of gait analysis. The association between the introduction of gait analysis and the delay of surgery could be attributable to change in philosophy with the times rather than the introduction of gait analysis. Furthermore, delay of surgery is, at best, a proxy for, and not necessarily representative of, improved outcomes.
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Chang FM, Seidl AJ, Muthusamy M, et al. Effectiveness of instrumented gait analysis in children with cerebral palsy: comparison of outcomes. J Pediatr Orthop 2006; 26:612-616. Twenty children with ambulatory CP were recommended orthopaedic surgery after undergoing gait analysis. Ten children did not follow through with these recommendations and underwent unspecified alternative non-operative treatments, while the other 10 completed the surgical procedures recommended. The surgical group experienced 'a higher percentage' of positive (44, gait outcomes compared with the group that did not follow the gait analysis-based surgical recommendations 26, The data are insufficient to support the authors' conclusion that 'gait performance can be significantly improved when gait analysis is used to determine the appropriate surgical intervention, Little information exists about the comparability of the two groups at baseline other than the similarity of the surgical recommendations bas
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Chang FM, Seidl AJ, Muthusamy M, et al. Effectiveness of instrumented gait analysis in children with cerebral palsy: comparison of outcomes. J Pediatr Orthop 2006; 26:612-616. Twenty children with ambulatory CP were recommended orthopaedic surgery after undergoing gait analysis. Ten children did not follow through with these recommendations and underwent unspecified alternative non-operative treatments, while the other 10 completed the surgical procedures recommended. The surgical group experienced 'a higher percentage' of positive (44%) gait outcomes compared with the group that did not follow the gait analysis-based surgical recommendations (26%). The data are insufficient to support the authors' conclusion that 'gait performance can be significantly improved when gait analysis is used to determine the appropriate surgical intervention'. Little information exists about the comparability of the two groups at baseline other than the similarity of the surgical recommendations based on gait analysis. The 'outcomes' are based on desired or expected changes in the gait kinematics, but we have no knowledge of how these changes relate to physical function. In this retrospective case-control study, patients treated with surgery did better than patients treated by the nonoperative methods based on the authors' definition of gait outcomes. The actual contribution of gait analysis to these outcomes is speculative.
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