Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry.
W Austin Davis, Christina K Zigler, Theresa M Crytzer and 3 others
PMID 32209832WHAT IT FOUND
In myelomeningocele, independent walking was more common in younger children and those with motor levels closer to the sacrum.
Additional surgeries were linked with less independent walking, especially in people most likely to walk. These associations changed by age.
Key findings
01Independent ambulation was more likely in younger participants, and the age effect weakened over time.
02Motor level closer to the sacrum was associated with more independent ambulation than lumbar or thoracic levels.
03Additional surgeries were associated with less independent ambulation, and the effect varied by motor level.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The registry mainly includes people seen at large academic clinics, so it may not represent those cared for in community settings. Children under 5 were excluded, so results do not apply to that younger group. Median follow-up was 2 years, so individual change over time could not be observed well. The model describes population patterns and cannot predict how an event will affect one person. Hoffer categories were collapsed into independent versus nonindependent, so home and therapeutic ambulation differences were lost. The study cannot tell whether surgery followed functional decline or contributed to decline. Older adults may reflect survival bias, because some were born before surgical shunting was available and may be clinically exceptional.
Declared interests
The supplied metadata lists research support from the U.S. government Public Health Service. The article text provided does not include an author conflict of interest declaration.
The easy way to misread this
Do not conclude that surgery causes loss of independent walking. The registry model cannot tell whether surgery was performed because walking was already declining, and it describes population patterns rather than an individual patient's likely outcome.