Hip flexion contracture and diminished functional outcomes in cerebral palsy.
BACKGROUND
Hip flexion contracture (HFC) in the ambulatory child with cerebral palsy (CP) may impair function and lead to deteriorations in health-related quality of life. Furthermore, increasing HFC may lead to increasing disability. However, the association between passive range of motion and the measures of function and well-being is unclear. This study was designed to determine whether increasing HFC is associated with functional outcome.


METHODS
A total of 181 children, with an average age of 14.0 ± 10.2 years, were evaluated as part of a multicenter prospective data collection of patients with ambulatory CP. Measurements of HFC were recorded, and patients were evaluated using walking score from Gillette Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM), and the Pediatric Outcome Data Collection Instrument (PODCI). Patients were grouped on the basis of severity of HFC: group A, 0 to 14 degrees; group B, 15 to 29 degrees; and group C ≥ 30 degrees. Associations were examined using the Spearman correlation.


RESULTS
There was an inverse association between degree of HFC and FAQ walking score (P<0.01, ρ=-0.25). Similarly, there was an inverse association between the degree of HFC and GMFM parts D (P<0.001, ρ=-0.31) and E (P<0.001, ρ=-0.32). Lastly, the PODCI domains of global function, mobility, and physical function also showed an inverse association with degree of HFC (P<0.001, ρ=-0.24).


CONCLUSIONS
As surgeons treating children with CP, we often rely on joint measurements as an indirect measure of function. This study of children with ambulatory CP suggests that increased HFC from the physician's perspective is associated with deterioration in function from a patient and a therapist's perspective.


METHODS
Level II, prospective study.
Center for Children, NYU Hospital for Joint Diseases, New York, NY 10003, USA.
Joseph Ray
JR
Pinero
Rachel Y
RY
Goldstein
Stephanie
S
Culver
Craig A
CA
Kuhns
David S
DS
Feldman
Norman Y
NY
Otsuka
D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D002792:Cholestyramine Resin; D004185:Disability Evaluation; D006616:Hip Contracture / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D002792:Cholestyramine Resin