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Published on: January 11, 2016
Issues of concern after a single-event multilevel surgery in ambulatory children with cerebral palsy
Moon Seok Park1, Chin Youb Chung, Sang Hyeong Lee
1Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Bundang-Gu, Sungnam, Kyungki, Korea.
Insights
Parents
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Cerebral Palsy Management
Background:
- Investigating parental concerns following single-event multilevel surgery (SEMS) in ambulatory children with cerebral palsy (CP).
- Addressing the gap in understanding parental perspectives on surgical outcomes and limitations.
Purpose of the Study:
- To identify and analyze parental concerns after SEMS in ambulatory patients with hemiplegic and diplegic cerebral palsy.
- To correlate specific parental concerns with overall satisfaction after SEMS.
Main Methods:
- Postal survey of 72 ambulatory patients with hemiplegic CP (group H) and 170 with diplegia (group D), followed for over a year post-SEMS.
- Utilized a 5-point Likert scale to evaluate parental concerns across 33 items.
- Diagnostic level 3 evidence.
Main Results:
- Top concerns included operative scar, limb circumference/length, and recurrence for group H; operative scar, play, and recurrence for group D.
- Group D reported higher overall concerns (P=0.001).
- Insufficient rehabilitation (group H) and improved walking (group D) most strongly correlated with parental satisfaction (r=-0.457 and r=-0.552, respectively).
Conclusions:
- Parental satisfaction is linked to functional outcomes (rehabilitation, walking ability) but also cosmetic issues (scar, limb appearance).
- Enhanced pre-operative counseling is crucial to align parental expectations with surgical capabilities and limitations.
- Clinicians should address treatable concerns like operative scars to improve patient and family satisfaction.
Background:
This study was performed to identify issues of concern to parents after single-event multilevel surgery in ambulatory patients with cerebral palsy.
Methods:
Parents' reports of concern were obtained for 72 ambulatory patients with hemiplegic cerebral palsy (group H; mean age 8.7 y) and 170 ambulatory patients with diplegia (group D; mean age 8.9 y), who had undergone single-event multilevel surgery and were followed for more than 1 year (mean follow-up 5.5 y). Data were acquired using a postal survey. Issues of concern to parents were evaluated using a 5-point Likert scale (1 to 5) for each of 33 items, which was designed for this study.
Results:
The top 3 issues of concern after surgery were unequal limb circumference, the operative scar, and recurrence in group H, and the operative scar, play activity, and recurrence in group D. Overall concerns were greater in group D (P=0.001) whereas group H was more concerned about appearance such as unequal leg length and circumference (P=0.001, <0.001). The issue of concern that showed the best correlation with parental satisfaction was the insufficient rehabilitation in group H (r=-0.457, P<0.001) and the improvement in walking ability in group D (r=-0.552, P<0.001).
Conclusions:
Even though parental concern over insufficient rehabilitation and improvement in walking ability showed the best correlation with parental satisfaction, related issues such as unequal leg circumference and surgical scar scored high, which appear irrelevant to the purpose of the surgical procedures. Parents' understanding should be established regarding surgical outcomes and limitations before single-event multilevel surgery. Clinicians need to pay more attention to potentially treatable issues that cause concern to parents, such as operative scars.
Level Of Evidence:
Diagnostic level 3.
