Relationships among classifications of impairment and measures of ambulatory function for children with spina bifida.
Susan A Rethlefsen, Melissa A Bent, Nicole M Mueske and 1 others
PMID 32255380WHAT IT FOUND
For children with spina bifida, classifications based on braces, devices, and home or community mobility tracked daily steps better than x-ray lesion level.
Functional classification may be more useful than anatomic level alone.
Key findings
01IMSG neurosegmental level and x-ray vertebral lesion level showed little to no relationship to each other.
02The Dias FCM and FMS ratings had the strongest relationship with average steps per day, while x-ray lesion level showed little to no relationship with average steps per day.
03The Hoffer community ambulation category included 78% of children, and the Dias low lumbar group took less than 1/3 of the average steps per day taken by the Hoffer community group.
STILL TO COME
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What it does not show
Only first-year data from a 3-year prospective study were analyzed, so this is not a follow-up result. The sample came from one geographic area and was relatively small, so it may not represent all children with spina bifida. Only children who could walk at community, household, or non-functional Hoffer levels were included, so non-ambulatory children are not described. Children with prior orthopaedic or neurosurgical procedures were included, which could have changed muscle strength and IMSG classification. Socioeconomic status, access to therapy or recreation, cognition, shunt status, and other comorbidities were not controlled. FMS was based on report rather than direct observation, and the paper does not establish which activity monitor is better.
Declared interests
The authors report no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not use x-ray lesion level alone to describe a child's daily walking activity. The study found little to no relationship between x-ray lesion level and average steps per day.