Monday, May 11, 2015

Past and current use of walking measures for children with spina bifida: a systematic review.

Bisaro DL, Bidonde J, Kane KJ, Bergsma SA, Musselman KE. (2015) Past and current use of walking measures for children with spina bifida: a systematic review.
Arch Phys Med Rehabil. 2015 May 2. pii: S0003-9993(15)00384-6. doi: 10.1016/j.apmr.2015.04.014



To describe walking measurement in children with spina bifida, and to identify patterns in the use of walking measures in this population.


Seven medical databases were searched from inception until March 2014. Search terms encompassed three themes: 1) children, 2) spina bifida, and 3) walking.


Articles were included if participants were children aged 1-17 years with spina bifida, and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic or electromyographic analyses of walking. A total of 1,751 abstracts were screened by two authors independently, and 109 articles were included in this review.


Data were extracted using standardized forms. Extracted data included study and participant characteristics, and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used.


Nineteen walking measures were identified. Ordinal-level rating scales (e.g., Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such walking speed (18% of articles). Walking was measured for a variety of reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether or not a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures.


Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable and responsive measures have been established for this population.
Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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