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Walking activity after multilevel orthopedic surgery in children with cerebral palsy
Chris Church1, Isabel Biermann1, Nancy Lennon1
1Department of Orthopedics, Nemours Children's Hospital, Delaware, Wilmington, DE, USA.
Insights
Surgical burden impacts walking recovery time after multilevel orthopedic surgery (MLS). Higher burden means longer recovery, while younger age and better preoperative mobility improve it.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Biomechanical Engineering
Background:
- Multilevel orthopedic surgery (MLS) is performed in children with cerebral palsy to improve function.
- Understanding factors influencing postoperative recovery is crucial for patient and family expectations.
- Walking activity is a key indicator of functional recovery after orthopedic interventions.
Purpose of the Study:
- To investigate the relationship between surgical burden and preoperative factors on walking activity recovery post-MLS.
- To establish timelines for return to baseline walking activity based on surgery complexity.
- To identify predictors of faster functional recovery in children undergoing MLS.
Main Methods:
- Retrospective study of 178 children with cerebral palsy undergoing MLS.
- Walking activity monitored using StepWatch devices for 12 months pre- and 24 months post-surgery.
- Statistical analysis including regression to evaluate predictors of walking recovery.
Main Results:
- Recovery time to baseline walking activity was longer for high-burden surgeries (1 year 2 months) compared to low-burden surgeries (3 months).
- Younger age at surgery and higher preoperative mobility were associated with faster recovery of walking activity.
- Postoperative walking activity levels were positively influenced by these preoperative factors.
Conclusions:
- The extent of surgical burden in MLS is inversely related to the time required for walking activity recovery.
- Clinicians can utilize these findings to set realistic expectations for functional return after MLS.
- Further research is needed to explore the influence of postoperative factors on recovery trajectories.
Aim:
To determine how surgical burden and preoperative factors affect the recovery of walking activity after multilevel orthopedic surgery (MLS).
Method:
In this retrospective study, inclusion criteria were a diagnosis of cerebral palsy, MLS, and walking activity monitoring using a StepWatch device within 12 months pre-MLS and 24 months post-MLS. The outcome measure was total mean strides per day normalized to age and Gross Motor Function Classification System level. Pre- and postoperative walking activity were compared using unpaired t-tests; the effects of preoperative predictors and surgical burden on the recovery of walking activity were evaluated using regression analysis.
Results:
Participants included 178 children (mean age 12 years 10 months [SD 8 years 7 months; range 4-20 years]; 91 males, 87 females). On average, children returned to baseline walking activity 3 months after low-burden surgery and 1 year 2 months after high-burden surgery. Postoperative walking activity was higher for children who had surgery at a younger age and those with a higher preoperative mobility function.
Interpretation:
The burden of MLS was found to be inversely related to the time to recovery of postoperative walking activity. These findings provide evidence to help clinicians set expectations for return to function post-MLS. Further study is necessary to investigate the impact of postoperative factors on walking activity recovery.
What This Paper Adds:
High-burden surgeries lead to longer recovery than low-burden surgeries. Younger children recover walking activity faster after multilevel orthopedic surgery. Children with high preoperative mobility function recover walking activity faster after surgery.
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