A 16-year follow-up of walking function, fatigue, and pain in adults aged 34-65 years with spastic cerebral palsy.
Sandra L Klund-Hansen, Arve Opheim, Terje Gjøvaag and 3 others
PMID 40947883WHAT IT FOUND
Over 16 years, adults with spastic cerebral palsy walked with more gait deviations and slower speed.
Walking distance did not change. Fatigue stayed high, pain improved overall, especially in unilateral CP.
Key findings
01Over 16 years, the whole group had increased gait pattern deviations (mean difference -5.6 GDI points) and lower walking speed (mean difference -0.08 m/s).
02Walking capacity was maintained (mean difference -37 m), and fatigue scores were unchanged from baseline to follow-up.
03In bilateral CP, walking speed fell by a mean 0.13 m/s and walking capacity fell by a mean 84 m; in unilateral CP, speed and capacity were maintained.
STILL TO COME
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What it does not show
Only 29 of 66 original participants were followed up, and only 12 of 29 participants at follow-up had bilateral CP, compared with 36 of 66 at baseline. Only 19 of 48 participants at GMFCS level II from the baseline study were included. The study followed the same people over time and did not test a treatment, so it cannot show that any therapy, surgery, or exercise caused the changes. Subgroup findings are based on small numbers, so the bilateral and unilateral patterns need cautious interpretation. The paper notes that the minimal clinically important difference for GDI in adults with CP is not established. Fatigue and pain were self-reported, and the paper notes large individual differences in fatigue and pain. People who did not respond may have had more pain or lower function, which could make the follow-up sample look better than the original group.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that all adults with spastic CP lose walking distance over time. The whole-group 6-minute walk change was a mean difference of minus 37 m and did not reach significance, and the unilateral group maintained walking speed and distance. Do not read the pain decrease as a treatment effect. This was a follow-up study, and people with more pain may have opted out.
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