Comparison of outcomes following surgical intervention and inpatient rehabilitation stays in children with cerebral palsy

Christian Niedzwecki; Amy Barbuto; Katy Mitchell; Steven Wirt; Michelle Seymour; Sruthi Thomas; Aloysia Schwabe

doi:10.1002/pmrj.13075

Comparison of outcomes following surgical intervention and inpatient rehabilitation stays in children with cerebral palsy

PM R. 2023 Oct 6. doi: 10.1002/pmrj.13075. Online ahead of print.

Authors

Christian Niedzwecki¹, Amy Barbuto², Katy Mitchell³, Steven Wirt⁴, Michelle Seymour¹, Sruthi Thomas⁵, Aloysia Schwabe¹

Affiliations

¹ Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.
² Department of Physical and Occupational Therapy, Texas Children's Hospital-The Woodlands, The Woodlands, Texas, USA.
³ Department of Physical Therapy, Texas Woman's University-Houston, Houston, Texas, USA.
⁴ Department of Physical and Occupational Therapy, Texas Children's Hospital-Main Campus, Houston, Texas, USA.
⁵ Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

PMID: 37801614
DOI: 10.1002/pmrj.13075

Abstract

Introduction: Literature is limited on functional outcomes in children with cerebral palsy (CP) following surgical procedures and a subsequent inpatient rehabilitation unit (IRU) stay.

Objective: To compare functional outcomes and length of stay (LOS) in children with CP following a surgical procedure and IRU stay based on the surgical procedure performed, pattern of involvement, etiology, and Gross Motor Function Classification System (GMFCS) level.

Design: Retrospective cohort study.

Setting: Tertiary care pediatrics.

Participants: Pediatric patients with CP who underwent one of three surgical procedures followed by an IRU stay.

Interventions: Selective dorsal rhizotomy (SDR), single-event multilevel orthopedic surgery (SEMLS), or intrathecal baclofen (ITB) pump implantation and subsequent IRU stay.

Main outcome measures: IRU LOS, Functional Independence Measure for Children (WeeFIM) total score, sub-scores, and efficiency.

Results: Children undergoing SDR had a longer LOS (p ≤ .015). Children with spastic diplegia, GMFCS level II, and prematurity-based CP had higher WeeFIM efficiency scores (p ≤ .046, ≤.021, and .034 respectively). Greater changes in WeeFIM™ scores were associated with spastic diplegia, SDR, GMFCS level II, longer LOS, and higher admission scores (p ≤ .045).

Conclusions: Although statistically and functionally significant improvements in children with CP following surgical interventions and an IRU stay were seen, those with higher WeeFIM change scores tended to have spastic diplegia, to have undergone SDR, GMFCS level II, longer LOS, and higher admission scores.