title: Differences in implementation of gait analysis recommendations based on affiliation with a gait laboratory.
abstract: This study examined the extent to which gait analysis recommendations are followed by orthopedic surgeons with varying degrees of affiliation with the gait laboratory. Surgical data were retrospectively examined for 95 patients with cerebral palsy who underwent lower extremity orthopedic surgery following gait analysis. Thirty-three patients were referred by two surgeons directly affiliated with the gait laboratory (direct affiliation), 44 were referred by five surgeons from the same institution but not directly affiliated with the gait laboratory (institutional affiliation), and 18 were referred by 10 surgeons from other institutions (no affiliation). Data on specific surgeries were collected from the gait analysis referral, gait analysis report, and operative notes. Adherence to the gait analysis recommendations was calculated by dividing the number of procedures where the surgery followed the gait analysis recommendation (numerator) by the total number of procedures initially planned, recommended by gait analysis, or done (denominator). Adherence with the gait analysis recommendations was 97%, 94%, and 77% for the direct, institutional, and no affiliation groups, respectively. Procedures recommended for additions to the surgical plan were added 98%, 87%, and 77% of the time. Procedures recommended for elimination were dropped 100%, 89%, and 88% of the time. Of 81 patients who had specific surgical plans prior to gait analysis, changes were implemented in 84% (68/81) following gait analysis recommendations. Gait analysis influences the treatment decisions of surgeons regardless of affiliation with the gait laboratory, although the influence is stronger for surgeons who practice within the same institution as the gait laboratory.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, United States. twren@chla.usc.edu
authors.forename: Tishya A L
authors.initials: TA
authors.lastname: Wren
authors.forename: Koorosh J
authors.initials: KJ
authors.lastname: Elihu
authors.forename: Shaun
authors.initials: S
authors.lastname: Mansour
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rethlefsen
authors.forename: Deirdre D
authors.initials: DD
authors.lastname: Ryan
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Smith
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000503:physiopathology*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009985:Orthopedics; D012189:Retrospective Studies