This clinical practice guideline provides physical therapists, physicians, and related clinicians involved in the care of children with CP, with seven action statements on when and how 3D-IGA can inform clinical assessments and potential interventions. It links the action statement grades with specific levels of evidence based on a critical appraisal of the literature.
A critical appraisal of evidence was conducted for each of seven action statements, following guidance from a needs assessment survey and a scoping review focused on this topic. Grades of evidence for each action statement were determined through critical appraisal of research literature and clinical guidance from a Guideline Development Group composed of experts in use of 3D-IGA for management of gait dysfunction among children with CP. Citations from 2179 publications were screened for inclusion and 969 were included as relevant to the action statements. Critical appraisal was conducted using the CAT-EI and AXIS tools. BridgeWiz was used to assure editorial consistency and comprehensiveness of the action statements. A 17-member advisory board including PTs, surgeons, and former patients, reviewed the action statements and they were made available for public review through the Academy of Pediatric Physical Therapy.
A review of the literature resulted in seven graded action statements with varying levels of obligation that describe the role of 3D-IGA in the clinical management of ambulatory children with CP who present with gait dysfunction. These statements address whether for surgical and non-surgical interventions assessment that includes 3D-IGA changes treatment decisions and produces better outcomes compared with a plan of care that does not include 3D-IGA. These statements also address what information 3D-IGA provides independent from typical clinical evaluations, how it can identify/quantify gait deviations among segments/joints and planes (sagittal, coronal, and transverse), and if 3D-IGA can be an appropriate tool to evaluate the biomechanical effects of interventions aimed at improving walking function. Finally, recommendations for the equipment, staffing, and reporting for 3D-IGA are described.
These guidelines show that 3D-IGA provides a comprehensive analysis and assessment of typical and pathological walking. 3D-IGA can be used to identify specific gait deviations and possible causes of atypical gait patterns, analyze how specific gait deviations influence function, guide decision making about orthopaedic surgical intervention strategies, and evaluate the effectiveness of rehabilitation outcomes. Best practice statements provide guidance to clinicians about the preferred characteristics of 3D-IGA laboratories including instrumentation, staffing, and reporting practices.
Pediatric physical therapists and associated clinicians now have guidance on when assessment with 3D-IGA is appropriate for children with cerebral palsy based on evidence that has been rated on quality and summarized.
Instrumented Gait Analysis
Gait Analysis
