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Past and current use of walking measures for children with spina bifida: a systematic review
Derek L Bisaro1, Julia Bidonde1, Kyra J Kane1
1School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
Insights
This review found that while walking is measured in children with spina bifida, few established measures are valid, reliable, or responsive. Common methods include rating scales and spatiotemporal measures, with trends in usage identified.
Area of Science:
- Pediatric Rehabilitation
- Movement Science
- Biomedical Engineering
Background:
- Children with spina bifida often experience mobility impairments.
- Accurate measurement of walking is crucial for assessing function and guiding interventions.
- Existing literature lacks a comprehensive overview of walking measurement tools used in this population.
Purpose of the Study:
- To systematically describe the walking measurement methods used in children with spina bifida.
- To identify patterns and trends in the application of these measures.
- To evaluate the psychometric properties of commonly used walking assessments.
Main Methods:
- A comprehensive literature search was conducted across seven medical databases up to March 2014.
- Articles were included if they involved children (1-17 years) with spina bifida and measured walking, excluding purely kinematic/kinetic analyses.
- Data extraction focused on study characteristics, participant details, and walking measure properties, with methodological quality assessed.
Main Results:
- Nineteen distinct walking measures were identified, with ordinal rating scales (e.g., Hoffer Functional Ambulation Scale) being most prevalent (57%).
- Spatiotemporal measures like walking speed were used in 18% of articles.
- Machine learning identified a trend towards using spatiotemporal measures in older children and those with lumbar/sacral lesions, with 77.1% prediction accuracy.
- Most studies employed convenience samples and unblinded assessors, with limited evaluation of measure psychometric properties.
Conclusions:
- A significant need exists for validated, reliable, and responsive walking measures in pediatric spina bifida research.
- Current practices often rely on measures with insufficient psychometric validation for this specific population.
- Further research is needed to develop and establish robust walking assessment tools for children with spina bifida.
Objectives:
To describe walking measurement in children with spina bifida and to identify patterns in the use of walking measures in this population.
Data Sources:
Seven medical databases-Medline, PubMed, Embase, Scopus, Web of Science, CINAHL, and AMED-were searched from the earliest known record until March 11, 2014. Search terms encompassed 3 themes: (1) children; (2) spina bifida; and (3) walking.
Study Selection:
Articles were included if participants were children with spina bifida aged 1 to 17 years and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic, or electromyographic analysis of walking. A total of 1751 abstracts were screened by 2 authors independently, and 109 articles were included in this review.
Data Extraction:
Data were extracted using standardized forms. Extracted data included study and participant characteristics and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used.
Data Synthesis:
Nineteen walking measures were identified. Ordinal-level rating scales (eg, Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such as walking speed (18% of articles). Walking was measured for various reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures used.
Conclusions:
Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable, and responsive measures have been established for this population.
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