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Angelliaume A, Harper L, Bouty A, Bouteiller C, Deleplanque B, Ravel M, Le Hanneur M, Narayanan UG, Ferdynus C, Pfirrmann C. Validation of the French version of the Caregivers' Priorities and Child Health Index of Life with Disabilities questionnaire. Orthop Traumatol Surg Res 2023:103753. [PMID: 37979675 DOI: 10.1016/j.otsr.2023.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The Caregivers' Priorities and Child Health Index of Life with Disabilities (CPCHILD) is a questionnaire that measures the health-related quality of life (HRQL) of children with cerebral palsy (CP). Though measuring HRQL is challenging in these children, it is a valuable help for medical decision-making. There is no questionnaire to assess HRQL in French-speaking children with severe CP. OBJECTIVE To translate and adapt transculturally the CPCHILD questionnaire into French (CPCHILD-FV). MATERIAL AND METHODS The CPCHILD was translated from English into French by forward and backward translation by independents translators. The questionnaire was then tested on 32 caregivers of patients with CP classified as GMFCS IV or V, remarks of caregivers were analyzed by an expert committee and, if necessary, modifications were performed. Internal consistency of the CPCHILD-FV was assessed using a sample of 32 parents or caregivers and test-retest reliability was assessed on a random sample of 10 patients. RESULTS The translation and transcultural process resulted in a French version of the CPCHILD. Some items of the CPCHILD required careful discussion to ensure that items had the same meaning as in the original. Internal consistencies were over 0.70 for each domain except for health, and 0.97 for the total scores. The ICC for the test-retest reliability of the CHILD-FV total score was 0.98 (95% CI: 0.93-0.99) and ranged from 0.59 to 0.99 for the domains. CONCLUSION The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a French version than can measure the HRQL of children with severe CP. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Audrey Angelliaume
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Luke Harper
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Aurore Bouty
- Department of Pediatric Surgery, The Royal Children's Hospital, 50, Flemington Road, Parkville, Victoria 3052, Australia
| | - Cécile Bouteiller
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Brigitte Deleplanque
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Magaly Ravel
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopaedics, Trousseau University Hospital, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Unni G Narayanan
- Department of Orthopaedic Surgery and Child Health Evaluative Science, Hospital of Sick Children, Toronto, Canada
| | - Cyril Ferdynus
- Methodological Support Unit, University Hospital, allée des Topazes, 97400 Saint-Denis, Reunion Island, France
| | - Clémence Pfirrmann
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Nowak P, Narayanan U, Szmurło M, Krzyżańska A, Głowacki M, Misterska E, Jóźwiak M. Psychometric Evaluation of the Polish Version of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Neuropsychiatr Dis Treat 2022; 18:773-785. [PMID: 35418755 PMCID: PMC8999719 DOI: 10.2147/ndt.s329070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The assessment of the quality of life is an important element of the clinical examination of the patient. The aim of this study was translation and cross-cultural adaptation of the "Caregiver Priorities and Child Health Index of Life with Disabilities" (CPCHILD) questionnaire into Polish language, and testing of reliability and validity of the CPCHILD-PL for children with cerebral palsy (CP). MATERIAL AND METHODS A Polish version of CPCHILD was created according to internationally accepted guidelines. Parents (n=77) of 51 boys/26 girls between 3 and 17 years with CP with Gross Motor Function Classification System I-V (GMFCS I-V) participated. To assess the reliability each domain and the total measure was tested for internal consistency and test-retest reliability. Convergent validity was evaluated by correlating the CPCHILD-PL with the CHAQ (Childhood Health Assessment Questionnaire) questionnaire. RESULTS Test-retest reliability assessed by Spearman correlation coefficient for the final result of CPCHILD-PL and for most of domains were above 0.90. The values of Cronbach's-α coefficient (measuring internal consistency) were high for all domains (except for domain 5: Health) and the entire CPCHILD-PL, with the range 0.88-0.96. The comparison between CPCHILD-PL and the Disability Index (DI) of the CHAQ showed a negative correlation. The higher the DI, the lower the CPCHILD result. The Spearman's rank coefficient was -0.75. CONCLUSION The Polish version for the CPCHILD for children with CP seems to be reliable and valid tool for assessing health-related quality of life from the caregiver perspective. It can be used in research and clinical practice for evaluation and comparison of health-related quality of life in children with CP in different countries.
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Affiliation(s)
- Paulina Nowak
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
| | - Unni Narayanan
- Division of Orthopaedic Surgery Department, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Anna Krzyżańska
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
| | - Maciej Głowacki
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
| | - Ewa Misterska
- Department of Pedagogy and Psychology, University of Security, Poznan, Poland
| | - Marek Jóźwiak
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
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Effect of Botulinum Toxin Injection on the Progression of Hip Dislocation in Patients with Spastic Cerebral Palsy: A Pilot Study. Toxins (Basel) 2021; 13:toxins13120872. [PMID: 34941710 PMCID: PMC8707328 DOI: 10.3390/toxins13120872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
Hip adductor spasticity is a contributing factor to hip dislocation in patients with cerebral palsy (CP). We hypothesized that botulinum toxin injected into the hip adductor muscles would reduce spasticity and help prevent hip dislocation. Twenty patients with bilateral spastic CP aged 2 to 10 years with gross motor function classification system level IV or V were included. Botulinum toxin was injected into the hip adductor muscles at baseline and at 6-month follow-up. Muscle tone was measured with an eight-channel surface electromyography (EMG) recorder. A hip X-ray was performed, and Reimer’s hip migration index (MI) was measured. The Wilcoxon signed-rank test was used to compare the surface EMG values of the hip muscles at baseline and follow-up. The mean root mean square surface EMG value of the hip adductor muscles was significantly reduced at 1, 2, 3, and 7 months after the first injection, up to approximately 53% of the baseline. The 1-year progression of the hip MI was −0.04%. Repeated sessions of botulinum toxin injections at the hip adductor muscles significantly reduced muscle tone and hip displacement. A botulinum toxin injection may be used as an adjunctive treatment in the prevention of hip dislocation.
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Sung KH, Kwon SS, Cho GH, Chung CY, Encisa C, Menal H, Narayanan UG, Park MS. Differences in responses to English and Korean versions of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD). Health Qual Life Outcomes 2020; 18:282. [PMID: 32807199 PMCID: PMC7433359 DOI: 10.1186/s12955-020-01528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to identify differences in caregiver responses to Korean-language and English-language versions of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Methods Patient data were acquired from the Cerebral Palsy Hip Outcomes Project database, which was established to run a large international multicenter prospective cohort study of the outcomes of hip interventions in cerebral palsy. Thirty-three children whose caregivers had completed the Korean version of CPCHILD were matched by propensity scoring with 33 children whose parents completed the English version. Matching was performed on the basis of 12 covariates: age, gender, gross motor function classification system level, migration percentage of right and hip, seizure status, feeding method, tracheostomy status, pelvic obliquity, spinal deformity, parental report of hip pain and contracture interfering with care. Results There were no significant differences in CPCHILD scores for section 4 (Communication and Social Interaction), and section 5 (Health) between two groups. Korean-language CPCHILD scores were significantly lower than English-language CPCHILD scores for section 1 (Personal Care/Activities of Daily Living), section 2 (Positioning, Transferring and Mobility), section 3 (Comfort and Emotions) and section 6 (Overall Quality of Life) as well as in terms of total score. Conclusions Cultural influences, and the community or social environment may impact the caregivers’ perception of the health-related quality of life of their children. Therefore, physicians should consider these differences when interpreting the study outcomes across different countries.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, South Korea
| | - Gyeong Hee Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Clarissa Encisa
- Division of Orthopaedics & Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, S-107, Toronto, Ontario, M5G 1X8, Canada
| | - Huroy Menal
- Division of Orthopaedics & Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, S-107, Toronto, Ontario, M5G 1X8, Canada
| | - Unni G Narayanan
- Division of Orthopaedics & Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, S-107, Toronto, Ontario, M5G 1X8, Canada.
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea.
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Kwon KB, Choi Y, Sung KH, Chung CY, Lee KM, Kwon SS, Cho GH, Park MS. Correlation between Accelerometer and Questionnaire-Based Assessment of Physical Activity in Patients with Cerebral Palsy. Clin Orthop Surg 2020; 12:107-112. [PMID: 32117546 PMCID: PMC7031426 DOI: 10.4055/cios.2020.12.1.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/23/2019] [Indexed: 12/01/2022] Open
Abstract
Background Precise measuring and monitoring of physical activity (PA) in patients with cerebral palsy (CP) are critical for assessing their PA participation and its potential health benefits. Accelerometer-based assessment of PA has been considered valid, reliable, and practical in children with CP. Therefore, we investigated the correlation between accelerometer- and questionnaire-based assessment of PA in CP patients. Methods Nineteen patients with CP who were classified as Gross Motor Function Classification System level I–III and 84 normally developed participants were included in the study. Study participants wore an accelerometer for seven days, after which they visited the hospital and completed the International Physical Activity Questionnaire (IPAQ). CP patients and their caregivers completed the Pediatric Outcomes Data Collection Instrument (PODCI) and the Caregiver Priorities and Child Health Index of Life with Disabilities, respectively. The concurrent validity of the questionnaires was assessed. Results In the accelerometer-based assessment, time spent in PA was significantly shorter at every intensity level in CP patients than in normally developed participants. However, PA assessed by the IPAQ was significantly higher in patients with CP, indicating that they tend to exaggerate their participation in PA. On the correlation of the assessment by the accelerometer and by the PODCI, transfer/basic mobility, sports/physical function, and happiness increased significantly as the number of steps taken and the distance travelled increased. Conclusions In patients with CP, happiness and quality of life are associated with higher levels of PA. Thus, programs for patients with CP should focus on improving their PA.
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Affiliation(s)
- Ki Bum Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Choi
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chin Youb Chung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Suwon, Korea
| | - Gyeong Hee Cho
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Validation of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) in a sample of Turkish non-ambulatory children with cerebral palsy. Turk Arch Pediatr 2019; 54:13-27. [PMID: 31217705 PMCID: PMC6559974 DOI: 10.14744/turkpediatriars.2019.57778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 01/15/2019] [Indexed: 12/04/2022]
Abstract
Aim: The aim of this study was to translate and transculturally adapt the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire into the Turkish language and test the reliability and validity. Material and Methods: Eighty-two children with cerebral palsy and their parents were included in the study. The majority of children had spastic cerebral palsy. According to the Gross Motor Function Classification System, 26 children were level III, 30 children were level IV, and 26 children were level V. International accepted guidelines were used in the transcultural adaptation and validation process. Reliability was assessed through statistical analysis of the test results for test-retest and internal consistency. To assess construct validity, Caregiver Priorities and Child Health Index of Life with Disabilities was compared with the Child Health Questionnaire Parent Form. Concurrent validity was assessed by examining how Caregiver Priorities and Child Health Index of Life with Disabilities scores changed according to Gross Motor Function Classification System levels. Results: The mean total score of Caregiver Priorities and Child Health Index of Life with Disabilities was 58.34±26.39. The intraclass correlation coefficient for the total questionnaire score was 0.75, ranging from 0.43 to 0.89 for six domains. Cronbach’s alpha was above 0.80 in all domains of Caregiver Priorities and Child Health Index of Life with Disabilities, except the health domain. The construct validity was good because there was a positive correlation between total Child Health Questionnaire Parent Form and Caregiver Priorities and Child Health Index of Life with Disabilities scores (r=0.58, p<0.01) according to the Pearson correlation analysis. Caregiver Priorities and Child Health Index of Life with Disabilities scores were found to be different between Gross Motor Function Classification System levels (p<0.05). Conclusion: This study showed that the Caregiver Priorities and Child Health Index of Life with Disabilities appears to be easy to administer, seems to have significant validity and reliability, and may be useful in the evaluation of health-related quality of life of children with cerebral palsy.
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Jung KJ, Kwon SS, Chung CY, Lee KM, Sung KH, Cho BC, Chung MK, Moon SJ, Kim J, Park MS. Association of Gross Motor Function Classification System Level and School Attendance with Bone Mineral Density in Patients With Cerebral Palsy. J Clin Densitom 2018; 21:501-506. [PMID: 27742529 DOI: 10.1016/j.jocd.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022]
Abstract
The present study aimed to evaluate bone mineral density (BMD) in children and adolescents with cerebral palsy (CP) and to critically analyze the effects of a variety of factors, particularly the Gross Motor Function Classification System (GMFCS) level, the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire, and the Pediatric Outcomes Data Collection Instrument (PODCI), on BMD. Fifty patients with CP who underwent dual-energy X-ray absorptiometry were included. Collected data included the extent of involvement, muscle tone, demographic data, factors determined through chart review, and laboratory results. Factors associated with BMD in this group were analyzed by performing multiple regression analysis. The mean Z-scores in male and female patients were -3.252 ± 1.822 and -3.789 ± 1.764, respectively, in the proximal part of the femur and -2.219 ± 1.323 and -2.451 ± 1.434, respectively, in the lumbar spine. In multiple regression analysis, the GMFCS level and the average frequency of missed school in the PODCI were significant factors associated with both femur and lumbar spine BMD. Both the GMFCS level and school attendance were independently associated with BMD and should be considered for the prevention and management of osteoporosis in patients with CP.
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Affiliation(s)
- Ki Jin Jung
- Department of Orthopedic Surgery, Soonchunhyang University Hospital, Cheonan, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Science, Ajou University, Suwon, South Korea
| | - Chin Youb Chung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea
| | - Byung Chae Cho
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea
| | - Myoung Ki Chung
- Department of Orthopedic Surgery, Gangwon National University Hospital, Gangwon, South Korea
| | - Seung Jun Moon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea
| | - Jaeyoung Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea.
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Pettersson K, Bjerke KM, Jahnsen R, Öhrvik J, Rodby-Bousquet E. Psychometric evaluation of the Scandinavian version of the caregiver priorities and child health index of life with disabilities. Disabil Rehabil 2017; 41:212-218. [PMID: 28927310 DOI: 10.1080/09638288.2017.1378930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine test-retest reliability and construct validity of the Scandinavian version of the caregiver priorities and child health index of life with disabilities (CPCHILD) questionnaire for children with cerebral palsy (CP). METHODS Families were recruited in Sweden and Norway and stratified according to the gross motor function classification system levels I-V for children born 2000-2011, mean age 7.9 (SD 3.2). Construct validity based on the first questionnaire (n = 106) was evaluated for known groups, using linear regression analysis. Intraclass correlation coefficient was used to estimate test-retest reliability (n = 64), and Cronbach's alpha was calculated as an indicator of internal consistency. RESULTS The questionnaire showed construct validity and the ability to discriminate between levels of gross motor function for the total score and all domain scores (p < 0.05). Test-retest reliability was high with intraclass correlation coefficient of 0.92 for the total score and of 0.72-0.92 for the domain scores. Cronbach's alpha was 0.96 for the total score and 0.83-0.96 for the domain scores. CONCLUSIONS The Scandinavian version of the CPCHILD for children with CP seems to be a valid and reliable proxy measure for health related quality of life. Implications for rehabilitation Valid and reliable outcome measures are needed to evaluate whether follow-up programs enhance health related quality of life in different countries. The Scandinavian version of the caregiver priorities and child health index of life with disabilities (CPCHILD) was evaluated for known-groups validity and test-retest reliability. The Scandinavian version of the CPCHILD is a sound and valid measurement for evaluation and comparison of health related quality of life of children with cerebral palsy in different countries.
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Affiliation(s)
- Katina Pettersson
- a Department of Clinical Sciences Lund, Orthopaedics , Lund University , Lund , Sweden.,b Centre for Clinical Research Västerås , Uppsala University , Västerås , Sweden
| | - Kari Marte Bjerke
- c Department of Clinical Neurosciences for Children , Oslo University Hospital , Oslo , Norway.,d Oslo Municipality , Oslo , Norway
| | - Reidun Jahnsen
- e Department of Clinical Neurosciences for Children , The Cerebral Palsy Follow-Up Program (CPOP), Oslo University Hospital , Oslo , Norway
| | - John Öhrvik
- b Centre for Clinical Research Västerås , Uppsala University , Västerås , Sweden.,f Department of Medicine , Karolinska Institutet , Solna , Sweden
| | - Elisabet Rodby-Bousquet
- a Department of Clinical Sciences Lund, Orthopaedics , Lund University , Lund , Sweden.,b Centre for Clinical Research Västerås , Uppsala University , Västerås , Sweden
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Abstract
BACKGROUND Patients with neuromuscular scoliosis (NMS) can pose treatment challenges related to medical comorbidities and altered spinopelvic anatomy. We reviewed the recent literature regarding evaluation and management of NMS patients and explored areas where further research is needed. METHODS We searched the PubMed database for all papers related to the treatment of NMS published from January 1, 2011 through July 31, 2014, yielding 70 papers. RESULTS A total of 39 papers contributed compelling new findings. Steroid treatment has been most promising in patients with Duchenne muscular dystrophy, leading to a significantly lower death rate, better pulmonary function, and longer independent ambulation. Growing rods in early-onset NMS were shown to result in significant improvements in major Cobb angles and pelvic obliquity, with low complication rates in patients with spinal muscular atrophy but high infection rates in those with cerebral palsy. Early reports of magnetic growing rods in NMS patients are favorable. Intraoperative neural monitoring is variable in this patient population; however, use of transcranial motor-evoked potentials in NMS patients seems to be safe. Blood loss is the highest in NMS patients when compared with all other diagnostic categories. However, tranexamic acid seems to significantly lower intraoperative blood loss. In a multicenter study, patients diagnosed with NMS had the highest surgical-site infection rate at 13.1%. Best-practice guidelines have been created regarding prevention of infection in NMS patients. Preoperative nutritional optimization and postoperative nutritional supplementation seem to help with lowering the infection rate in these patients. CONCLUSIONS There have been major advances in the management of NMS patients, but many challenges remain. Further multicenter studies and randomized clinical trials are needed, particularly in the areas of infection prophylaxis, nutritional optimization, improvement in intraoperative neural monitoring, and prevention of proximal junctional kyphosis. LEVEL OF EVIDENCE Level 4-literature review.
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