부산대학교 도서관

The Gait Deviation Index (GDI) summarizes on a 0-100 basis the distance of a patient's kinematic from the normal reference pattern [1]. It has been developed and used to assess the effect of functional surgery (FS) supported by gait analysis (GA) in large cohorts of children with cerebral palsy [2]. The use of GDI and the computation of effect sizes are suggested to allow for the conduction of systematic reviews on the impact of GA on treatment outcomes [3]. Despite of the increasing use of FS in adults with acquired joint deformities consequent to a stroke, there are no studies in literature using the GDI to investigate the effects FS on walking kinematics in these patients. The databases of two laboratories were retrospectively analyzed to extract data from patients with the following inclusion criteria: hemiparesis consequent to ischemic or hemorrhagic stroke, referral to the laboratories for clinical and instrumental assessment – gait analysis (GA) with EMG – preliminary to FS, lower limb FS performed by the same surgeon (author PZ), available GA data before and three months after FS, available informed consent. Gait kinematics was acquired using a commercial system (BTS Smart DX, BTS Bioengineering) and the so-called Conventional Protocol. GDI was computed by the GA system as in [1]. GDI values of the affected side were compared before and three months after surgery using the paired t-test. The Cohen's d (effect size) with its 95% confidence interval was computed. Preliminary results are presented, related to a two-year period. Twenty-nine patients met the inclusion criteria. Of these, 8 needed an orthosis to walk and had a presurgical EMG assessment only. The remaining 21 patients, 56.4(10.3) years, 6/15 M/F, 19/2 L/R affected side, were included in the study. Preoperative walking speed was 0.30(0.18) m/s. Median FAC was 4 (range 2-7), WHS was 4 (2-6), and RMI was 11 (5-14). Three to eight gait trials per session were used for GDI computation. At the three- months mark, GDI significantly increased from 72(11) to 75(11) (p=0.004), with a moderate effect size of 0.71 (95%IC 0.22–1.12). The relationship between pre- and post-operative values is presented in Fig. 1. A subgroup of subjects had an increase in GDI, irrespective of their initial condition, a subgroup of patients had no variations in GDI while a few patients had a worsening in GDI. For the first time in literature, we used the GDI to investigate the effect of FS on gait kinematics in adults with stroke. Our results confirm, on average, the efficacy of FS in improving walking ability. GDI allowed easily merging data from different laboratories. It could be used to identify clusters of improved/not improved patients to further investigate their characteristics. In clinical trials, GDI could be used to compare the efficacy of different of different treatments, e.g. FS v. focal inhibition or of different surgical approaches, e.g. with and without preoperative GA, as in [4]. Positive results would promote the use of GA in the assessment of stroke patients and support its reimbursement by both national health systems and private insurances. [ABSTRACT FROM AUTHOR]