Why was this done? Isn't it completely obvious that if you don't do objective damage diagnosis you can never assign protocols to recovery? Not doing gait analysis means your therapist and doctor are just guessing on what to do. ARE YOU OK WITH THAT CRAPOLA MEDICAL TREATMENT?
Does gait analysis change clinical decision-making in post-stroke patients? Results from a pragmatic prospective observational study
chronic poststroke patients. Further work should be done to better translate GA results into indications for specific physiotherapy.
Clinical Rehabilitation Impact.
The use of GA as a tool to better define the rehabilitation planning in post-stroke patients should be fostered, particularly when surgery or botulinum toxin are considered and/ or the prescription of orthoses is hypothesised.
K
EY
WORDS
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Gait - Stroke - Decision making - Rehabilitation - Technology assessment, biomedical.
Computerized gait analysis (GA), performed in a laboratory equipped with instruments for kin-ematic, kinetic and EMG data collection, is unanimously recognized as the most effective approach for an objective and comprehensive analysis of human locomotion.1Conversely, the role of GA in clinical decision-making is still controversial,2, 3except for the application in the pre-surgical planning of children with cerebral palsy (CP), where it was ascertained that the percentage of CP patients whose surgical plan was changed after GA ranges between 52% 4 to 89%,5 with a more recent study reporting a value of 70%.6 A systematic review of Wren et al 7found 11 articles related to “diagnostic thinking and treatment” of GA, among a total of 240 articles about the clinical efficacy of GA, and concluded that there is strong evidence of an effect of GA on treatment decision-
Background.
Gait analysis (GA) was demonstrated to change presurgical planning and improve gait outcomes in children with Cerebral Palsy. GA is often used also to assess walking capability of post stroke subjects, although its influence in the clinical management of these patients has not yet been established.
Objective.
To assess the impact of GA on clinical deci-assess the impact of GA on clinical decision-making in adult chronic post stroke patients.
Design.
Pragmatic prospective observational study.
Setting.
Rehabilitation hospital, both outpatients and inpatients.
Population.
Forty-nine patients (age: 53.3±14.5 years) who had had a cerebrovascular accident 35.2±26.4 months before and were referred to the gait analysis service.
Methods.
Recommendations of therapeutic treatments before and after the analysis of GA data were com-pared, together with the confidence level of recommendations on a 10-point scale. Frequency of changes of post-GA vs pre-GA recommendations were computed for each recommendation type: surgery, botulinum toxin (BT), orthotic management and physiotherapy.
Results.
Based on the analysis of GA data, 71% of post-stroke subjects had their treatment planning changed in some components. Indeed, 73% of patients with indications for surgery had their surgical planning changed; 81%, 37% and 32% had, respectively, their BT, orthotic and physiotherapy planning changed. Confidence level of recommendations increased significantly after GA, in both the whole group of patients (from 6.7±1.4 to 8.7±0.6, P<0.01) and the subgroup whose recommendations had not changed (7.0±1.5vs. 8.8±0.4, P<0.01).
Conclusion.
GA significantly influences the therapeutic planning and reinforces decision-making for
Corresponding author: M. Ferrarin, IRCCS S. Maria Nascente, Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy. E-mail: mferrarin@dongnocchi.it
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