The impact of Three-Dimensional Gait Analysis in adults with pathological gait on management recommendations

Michelle McGrath; James Wood; John Walsh; Peter Window

doi:10.1016/j.gaitpost.2023.06.014

The impact of Three-Dimensional Gait Analysis in adults with pathological gait on management recommendations

Gait Posture. 2023 Sep:105:75-80. doi: 10.1016/j.gaitpost.2023.06.014. Epub 2023 Jun 22.

Authors

Michelle McGrath¹, James Wood², John Walsh³, Peter Window⁴

Affiliations

¹ Queensland Motion Analysis Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia. Electronic address: Michelle.McGrath@health.qld.gov.au.
² Queensland Motion Analysis Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
³ The Menzies institute, Griffith university Gold Coast. Australia.
⁴ STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, Metro North Health and University of Queensland, Brisbane, Queensland, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.

PMID: 37490826
DOI: 10.1016/j.gaitpost.2023.06.014

Abstract

Background: Three-Dimensional Gait Analysis (3DGA) is a gold standard tool that can help identify pathological components of walking patterns. It has been well established that this tool influences the treatment decision making of clinicians treating paediatric patients with Cerebral Palsy, but it has not been established whether this tool changes decision making of clinicians treating adults with complex pathological gait.

Research question: To investigate the impact of pre-treatment 3DGA on treatment plans and management of adults with complex pathological gait.

Method: This retrospective audit examined the medical records of 87 patients undergoing pre-treatment 3DGA between 2014 and 2019. The review collected treatment plans from the initial referral, the post-gait analysis multidisciplinary report, and post-intervention progress notes with consistencies and differences noted throughout the care pathway.

Results: Treatment plans of patients were altered in 80 % (N = 32) of patients following 3DGA assessment and recommendations. These treatment plan alterations included a change in surgery or avoidance of surgery, changes in orthosis prescriptions, casting or rehabilitation; and administration or changes in administration of Botulinum Neurotoxin (BoNT-A). In 47 % (N = 15) of cases the change in plans represented a de-escalation in intervention requirements (e.g. BoNT-A in lieu of surgical intervention), and in 31 % (N = 10) the change in plans represented an escalation in intervention requirements (e.g. requirement for surgery). These changes in treatment plans were either fully or partly enacted by the referring consultant in 86 % of cases.

Significance: Pre-treatment 3DGA impacts the management of adult patients with complex pathological gait and facilitates patients potentially avoiding unnecessary interventions. Further investigation is needed to determine the cost effectiveness of 3DGA in this population and the impact of pre-treatment 3DGA on management outcomes.

Keywords: 3-Dimensional Gait Analysis; Adult; Pathological Gait.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cerebral Palsy* / complications
Cerebral Palsy* / surgery
Child
Gait
Gait Analysis*
Humans
Retrospective Studies
Walking