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The gross motor function classification system for cerebral palsy and single-event multilevel surgery: is there a relationship between level of function and intervention over time?
Journal of Pediatric Orthopedics 2009 December
BACKGROUND: The purpose of this study was to determine what effect, if any, an intervention such as Single-event multilevel orthopaedic surgery (SEMLS) might have on the relative stability of the gross motor function classification system (GMFCS) for cerebral palsy over a 5-year time period.
METHODS: Eighty-four children with spastic cerebral palsy who underwent SEMLS were included. The patients had an average of 5.45 procedures during surgery. Mean age at the time of surgery was 6 years. Two blinded physical therapists applied the GMFCS to functional descriptions extracted from outpatient clinical records. The patients were rated preoperatively, 1, 2, and 5 years postoperatively.
RESULTS: Interrater reliability was high, Kw=0.90. Friedman's nonparametric repeated measures analysis of variance was conducted comparing the GMFCS classification levels of the patients preoperatively and 1, 2, and 5 years after SEMLS. The patients as a group showed a significant change to a lower GMFCS classification postsurgery (P<0.001). Children classified at levels I and V of the GMFCS preoperatively showed lesser likelihood of changing functional levels postsurgery.
CONCLUSIONS: The results of this investigation support the concept that interventions, especifically SEMLS, can affect the stability of the GMFCS classification. The majority of children in this study showed changes in gross motor function classification as reflected by lower GMFCS scores after SEMLS intervention. We also found that changes were maintained over a period of 5 years. The results of this study suggest that certain interventions, such as SEMLS, might have an effect on the stability of the GMFCS and that effect may be level-dependent.
LEVEL OF EVIDENCE: Retrospective Study by Review of Medical Records. Level III in the Therapeutic Study investigating results of treatment category.
METHODS: Eighty-four children with spastic cerebral palsy who underwent SEMLS were included. The patients had an average of 5.45 procedures during surgery. Mean age at the time of surgery was 6 years. Two blinded physical therapists applied the GMFCS to functional descriptions extracted from outpatient clinical records. The patients were rated preoperatively, 1, 2, and 5 years postoperatively.
RESULTS: Interrater reliability was high, Kw=0.90. Friedman's nonparametric repeated measures analysis of variance was conducted comparing the GMFCS classification levels of the patients preoperatively and 1, 2, and 5 years after SEMLS. The patients as a group showed a significant change to a lower GMFCS classification postsurgery (P<0.001). Children classified at levels I and V of the GMFCS preoperatively showed lesser likelihood of changing functional levels postsurgery.
CONCLUSIONS: The results of this investigation support the concept that interventions, especifically SEMLS, can affect the stability of the GMFCS classification. The majority of children in this study showed changes in gross motor function classification as reflected by lower GMFCS scores after SEMLS intervention. We also found that changes were maintained over a period of 5 years. The results of this study suggest that certain interventions, such as SEMLS, might have an effect on the stability of the GMFCS and that effect may be level-dependent.
LEVEL OF EVIDENCE: Retrospective Study by Review of Medical Records. Level III in the Therapeutic Study investigating results of treatment category.
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