Functional outcomes after upper extremity surgery for cerebral palsy: comparison of high and low manual ability classification system levels.
OBJECTIVE
The heterogeneity of cerebral palsy makes interpretation and prediction of outcome after upper extremity surgery difficult. We hypothesized that the outcome of upper extremity surgery for cerebral palsy is related to the Manual Ability Classification System (MACS) level.


METHODS
We reviewed 27 patients with a mean age of 22 years, who underwent upper extremity surgery for spastic cerebral palsy at a mean follow-up of 29 months. Patients were classified into 5 MACS levels using a standardized questionnaire completed by their primary caregivers. Preoperatively and at most recent follow-up visits, patients were assessed using the House scale and patient-reported functional outcomes on a 5-point scale. We compared the outcomes of patients with high (I-II, independence in daily activities) and low (III-V, dependence in daily activities) MACS levels.


RESULTS
The overall mean House scale improved from 2.9 to 4.6 postoperatively (p<.001), dressing ability from 3.7 to 4.2 (p=.005), hygiene from 4.2 to 4.9 (p=.005), and appearance from 2.4 to 4.2 (p<.001). A total of 13 patients had a high MACS level (7 had I and 6 had II) and 14 had a low MACS level (8 had III, 6 had IV, and none had V). The high-MACS group had a greater improvement according to the House scale (p=.009) and the low-MACS group had a larger improvement in hygiene status (p=.043). There were no differences in the amount of improvement in dressing ability (p=.169) and appearance (p=.765). Overall satisfaction with surgery was higher for the high-MACS group (p=.038).


CONCLUSIONS
The high-MACS group had a greater improvement in rating according to the House scale and higher satisfaction than the low-MACS group after upper extremity surgery for cerebral palsy in our small number of patients. This study suggests that the MACS level can be used to predict upper extremity surgery outcomes for cerebral palsy.


METHODS
Prognostic II.
Department of Orthopaedics and Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea. hsgong@snu.ac.kr
Hyun Sik
HS
Gong
Chin Youb
CY
Chung
Moon Seok
MS
Park
Hyung-Ik
HI
Shin
Moon Sang
MS
Chung
Goo Hyun
GH
Baek
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000145:classification* / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009128:Muscle Spasticity / Q000175:diagnosis / Q000534:rehabilitation; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult