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Evidence-Based Orthopaedics   |    
Commentary
Michael J. Goldberg, M.D.
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Department of OrthopaedicsTufts-New England Medical Center Boston, Massachusetts

J Bone Joint Surg Am, 2000 Jun 01;82(6):874-a-874
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Extract

The goal of treatment for children with cerebral palsy is to improve their function. To patients and parents, improvement in function is an improvement in motor skill performance (e.g., running and playing). The outcomes literature separates improvements in physiological or technical parameters (e.g., joint range of motion and degrees of scoliosis) from improvements in functional health status (e.g., sports and feeding)1. In this study, intramuscular BTX (botulinum toxin type A) led to an improved "gait pattern" and an increased ankle range of motion, both of which are technical outcomes. The inference is that technical improvements will improve functional performance, but the proof for this is lacking. Just as goniometers measure range of motion, patient and parent-based functional health questionnaires (e.g., the Pediatric Orthopaedic Society of North America instrument3 and the Landgraf Child Health Questionnaire) measure physical performance. Only when functional health measures are included can we state that an improved PRS composite score and 3° more ankle motion improves the child's real-world performance. Such functional data will refute the contention that an equinus gait is more than just a cosmetic deformity.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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