Multidimensional Outcome Assessment in Cerebral Palsy Is It Feasible and Relevant? Elke Viehweger, MD, PhD,*Þ Thierry Haumont, MD, PhD,þ Capucine de Lattre, MD,§ Ana Presedo, MD,|| Paul Filipetti, MD,¶ Brice Ilharreborde, MD,|| Pierre Lebarbier, MD,# Anderson Loundou, PhD,** Marie<Claude Simeoni, MD, PhD,** and VARAX Study Group Background: To examine feasibility and relevance of a multi- dimensional outcome assessment approach using instrumented 3- dimensional gait analysis, via the Gillette Gait Index (GGI), and a set of validated functional and health-related quality of life tools in diplegic cerebral palsy children, before introduction as a nationwide evaluation set. Methods: A 3-year prospective government-funded multicenter study was conducted, recruiting patients during a 9-month period classified using the Gross Motor Function Classification System and the Rodda et al sagittal walking patterns. The Gross Motor Classification System Dimensions D and E, the 10-level Gillette Functional Assessment Questionnaire, the Energy Expenditure Index (EEI), the GGI out of 3D gait analysis, and health-related quality of life, assessed by self or proxy with the questionnaire BVe `cu et Sante Per0u de l’Adolescent,[ were selected for the study. Results: Cross-sectional data subset at inclusion of 160 spastic diplegic cerebral palsy patients, the largest series in our country, 6 to 18 years old (mean age, 11.0 years), are reported. The GGI correlated significantly (P G 0.001) with the Gross Motor Classification System, the Functional Assessment Questionnaire, and the EEI for all the patients, and all but one (EEI) correlated if grouped according to Gross Motor Function Classification System or Rodda. No systematic correlation was found between the quality of life scores and the other outcome tools. Conclusions: The outcome evaluation instrument set tested in our study helps to adopt common tools, to be integrated in an evidence- based practice and to compare health status and treatment outcome between countries, specifically in different linguistic environments like in European countries. Level of Evidence: Level 1VTesting of previously developed diagnostic criteria in series of consecutive patients. Key Words: cerebral palsy, outcome, gait analysis, function, quality of life (J Pediatr Orthop 2008;28:576Y583) T he decision-making process in cerebral palsy (CP) patients has changed profoundly over the last 2 decades. For exam- ple, the orthopaedic surgeon is now a part of the multi- disciplinary decision-making team. Nevertheless, although evidence-based practice is now required, clinicians have yet to agree on uniform standards when caring for CP children. 1Y8 Currently, therapeutic plans are expressed in terms of fixed objectives for the child and his or her family. Therefore, before surgery is conducted, surgeons need to know the final outcome desired by the child and his or her family, and they need to evaluate whether it will be possible to meet these objectives. The international standard in CP care is to use 4 evaluation levels to measure outcomes: technical evaluation from 3-dimensional (3D) gait analysis, clinical functional evaluation (including daily life activities and social participa- tion), evaluation of integration and quality of life (QL), and cost evaluation. 9 Nevertheless, orthopaedic surgical training in most countries around the world does not include these evaluation techniques. The medical education system should be changed, and practitioners-in-training should be provided with more information for judging the use of various evaluation tools, specifically with respect to cost-intensive 3D gait analysis. This will allow clinicians and governments to develop the most economic practices in medical education and health care and establish the most effective medical recom- mendations and insurance reimbursement policies. Spurred by the need to examine the efficacy and relevance of pediatric orthopaedic practice in our country, a homogeneous multicenter outcome assessment was under- taken with government funding. One of the foci of this study was to evaluate the use of gait analysis in CP treatment. ORIGINAL ARTICLE 576 J Pediatr Orthop & Volume 28, Number 5, July/August 2008 From the *Department of Pediatric Orthopaedics, and †Center of Motion Analysis, Children’s Hospital Timone, Marseille; ‡Department of Pediatric Orthopaedics, Ho ˆpital Brabois-Enfants, Vandoeuvre-le ´s-Nancy; §HCL, L’Escale, Service de Re `e `ducation Pe `diatrique, CHU Lyon-Sud, Pierre< Be `nite; ||Department of Pediatric Orthopaedics, Robert Debre Hospital, Paris; ¶Service de Re `e `ducation neurologique pe `diatrique, Centre de l’Arche-I, Le Mans; #Centre Paul Dottin (ASEI), Ramonville-Sainte- Agne; and **Department of Public Health, Mediterranean University, Marseille, France. None of the authors received financial support for this study. The study was funded by Grant DHOS/OPRC/2003/167, April 4, 2003 BProgramme de soutien des innovations diagnostiques et the `rapeutiques cou ˆ teuses 2003[ from the French Ministry of Health, Family and Disabled Persons. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patient licensing arrange- ments, etc) that might pose a conflict of interest in connection with the submitted article. VARAX Study Group: Carole Be `rard, MD; Je `ro ˆme Be `rard, MD; Anne Berruyer, PT; Christian Beyaert, MD, PhD; Ge `rard Bollini, MD; Ve `ronique Bourg, MD; Vincent Cunin, MD; Yannick Delpierre, PhD; Moustapha ElLaassel, PhD; Isabelle Ferotin, PT; Paul Filipetti, MD; Thierry Haumont, MD, PhD; Michel Jacquemier, MD; Elisabeth Kolanowski, MD; Pierre Lascombes MD, PhD; Pierre Lebarbier, MD; Aure `lie Lucet, MD; Fabrice Megrot, PhD; Georges-Fran0ois Penne0ot, MD, PhD; Vincent Pomero, PhD; Ana Presedo, MD; Ve `ronique Quentin, MD; Marie-Ange Rohon, MD; Marino Scandella, PhD; Elke Viehweger, MD, PhD. Reprints: Elke Viehweger, MD, PhD, Department of Pediatric Orthopaedics, Children’s Hospital Timone, 264, Rue Saint Pierre, 13385 Marseille Cedex 05, France. E-mail: elke.viehweger@mail.ap-hm.fr. Copyright * by 2008 Lippincott Williams & Wilkins Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.