Impact of single-event multilevel surgery on gait efficiency in children with cerebral palsy: a retrospective study.
Corrado Borghi, Daniela Pandarese, Debora Formisano and 7 others
PMID 41364021WHAT IT FOUND
Children with cerebral palsy who had single-event multilevel surgery improved their walking efficiency and overall gait quality.
They walked with better knee extension and stronger ankle push-off, though their speed did not increase. These changes were seen in a retrospective study without a true control group.
Key findings
01Surgery significantly improved maximum knee extension by 6.1 degrees and ankle push-off power by 0.274 W/kg, indicating better gait efficiency.
02Overall gait quality improved significantly, with the Gait Profile Score decreasing by 2.8 degrees, a change exceeding the minimal clinically important difference.
03Spatiotemporal parameters like walking speed and stride length did not change significantly, although stance duration and double support time increased slightly.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was retrospective and exploratory, meaning it was not designed to test a specific hypothesis with a control group. The p-values should be viewed as trends rather than definitive proof of effect. The non-surgical group was small and heterogeneous, so it could not serve as a valid control. It is impossible to know how much of the surgical group's improvement was due to natural growth or other factors. Energy expenditure was not measured directly (e.g., via oxygen consumption). Gait efficiency was inferred from kinematic and dynamic proxies, which may not perfectly reflect metabolic cost. Follow-up was relatively short (mean 18 months), so the durability of these improvements over time, particularly during adolescence, is unknown. The study was conducted in a high-income setting with routine access to multidisciplinary care and advanced treatments, which may limit generalizability to other healthcare contexts.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the lack of change in the non-surgical group as evidence that surgery is superior to no surgery. The non-surgical group was too small and varied to be a valid control, and the study was not designed for this comparison.
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