首页> 外文OA文献 >Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy
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Prevalence of Joint Gait Patterns Defined by a Delphi Consensus Study Is Related to Gross Motor Function, Topographical Classification, Weakness, and Spasticity, in Children with Cerebral Palsy

机译:Delphi共识研究定义的关节步态患病率与脑瘫儿童的总运动功能,地形分类,虚弱和痉挛有关

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摘要

During a Delphi consensus study, a new joint gait classification system was developed for children with cerebral palsy (CP). This system, whose reliability and content validity have previously been established, identified 49 distinct joint patterns. The present study aims to provide a first insight toward the construct validity and clinical relevance of this classification system. The retrospective sample of convenience consisted of 286 patients with spastic CP (3–18 years old, GMFCS levels I–III, 166 with bilateral CP). Kinematic and kinetic trials from three-dimensional gait analysis were classified according to the definitions of the Delphi study, and one classified trial was randomly selected for each included limb (n = 446). Muscle weakness and spasticity were assessed for different muscle groups acting around the hip, knee, and ankle. Subsequently, PearsonChi square tests, Cramer’s V, and adjusted standardized residuals were calculated to explore the strength and direction of the associations between the joint patterns, and the different patient-specific characteristics (i.e., age, GMFCS level, and topographical classification) or clinical symptoms (muscle weakness and spasticity). Patient-specific characteristics showed several significant associations with the patterns of different joints, but the strength of most identified associations was weak. Apart from the knee during stance phase and the pelvis in the sagittal plane, the results systematically showed that the patterns with “minor gait deviations” were the most frequently observed. These minor deviations were found significantly more often in limbs with a lower level of spasticity and good muscle strength. Several other pathological joint patterns were moderately associated with weakness or spasticity, including but not limited to “outtoeing” for weakness and “intoeing” for spasticity. For the joints in the sagittal plane, significantly stronger associationswere foundwithmuscleweakness and spasticity, possibly because most of the evaluated muscles in this study mainly perform sagittal plane motions. Remarkably, the hip patterns in the coronal plane did not associate significantly with any of the investigated variables. Although further validaation is warranted, this study contributes to the construct validity of the joint patterns of the Delphi consensus study, by demonstrating their ability to distinguish between clinically relevant subgroups in CP.
机译:在Delphi共识研究中,针对脑瘫(CP)儿童开发了一种新的联合步态分类系统。该系统的可靠性和内容有效性先前已经建立,它确定了49种不同的关节模式。本研究旨在为这种分类系统的构建有效性和临床相关性提供第一见解。便利性的回顾性样本包括286例痉挛性CP(3-18岁,GMFCS I-III级,双侧CP 166例)。根据Delphi研究的定义对来自三维步态分析的运动学和动力学试验进行了分类,并为每个肢体随机选择了一项分类试验(n = 446)。对髋,膝和踝周围不同肌肉群的肌肉无力和痉挛进行了评估。随后,计算了PearsonChi方检验,Cramer V和调整后的标准化残差,以探讨关节模式与不同患者特定特征(即年龄,GMFCS水平和地形分类)或临床之间的关联的强度和方向。症状(肌肉无力和痉挛)。特定于患者的特征显示出与不同关节模式相关的数个显着关联,但大多数已识别关联的强度较弱。除了在站立阶段的膝盖和矢状面的骨盆之外,结果系统地显示出最常观察到“步态偏差较小”的模式。这些较小的偏差在痉挛程度较低和肌肉力量较好的四肢中更为常见。其他几种病理性关节模式与虚弱或痉挛有中度相关性,包括但不限于虚弱的“外出”和痉挛的“输入”。对于矢状面中的关节,发现其与肌无力和痉挛有明显更强的关联,这可能是因为该研究中大多数评估的肌肉主要执行矢状面运动。值得注意的是,冠状面的髋部形态与任何研究变量均无显着相关性。尽管有必要进行进一步的验证,但本研究通过证明其区分CP的临床相关亚组的能力,有助于构建Delphi共识研究的联合模式。

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