title: Does single-event multilevel surgery enhance physical functioning in the real-life environment in children and adolescents with cerebral palsy (CP)?: patient perceptions five years after surgery.
abstract: Orthopedic procedures are a method of treating gait deviations and musculoskeletal pathology that develop with age in cerebral palsy (CP). Recently single-event multilevel surgery (SEMLS) has become common practice. Although there is evidence that SEMLS could improve gait, it is unclear whether it will enhance overall physical functioning and coping strategies in the real-life environment. It is unclear how improved walking capacity affects actual functioning and enables greater independence. The aim of this study was to examine the perceptions of adolescents concerning the results of surgery on personal physical functioning in the environment five or more years after SEMLS. In this study, qualitative data were gathered by open interviews and analyzed using phenomenographic approach, which aims to study variation in human understanding and perceptions of the phenomenon in question. Gait Profile Score (GPS) was used to describe the objective change. The results indicate that SEMLS had a clear positive effect on the participants' physical functioning capacity, particularly experienced as better walking ability. GPS improved by 3.5° five years postoperatively. Surgery could enhance physical activity and the motivation to maintain mobility in the future. The perceptions of the effect of surgery on physical functioning in the real-life environment varied from a challenge-avoiding, support-seeking agency to a highly active, independent agency in daily life. Our rehabilitation practice after multilevel surgery should be more focused on enhancing active agency in collaboration with adolescents with CP and their families.
authors.affiliation: Metropolia University of Applied Sciences, Helsinki, Finland; University of Jyväskylä, Department of Health Sciences, Puoshaankuja 8, 02480 Kirkkonummi, Finland. Electronic address: krista.lehtonen@metropolia.fi.
authors.forename: Krista
authors.initials: K
authors.lastname: Lehtonen
authors.affiliation: Helsinki University Central Hospital, Department of Paediatric and Adolescent Diseases, Finland. Electronic address: Helena.maenpaa@hus.fi.
authors.forename: Helena
authors.initials: H
authors.lastname: Mäenpää
authors.affiliation: University of Jyväskylä, Department of Health Sciences, Finland. Electronic address: arja.piirainen@jyu.fi.
authors.forename: Arja
authors.initials: A
authors.lastname: Piirainen
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D015444:Exercise / Q000502:physiology*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cerebral palsy; Experience; Gait; Perception; Physical functioning; Single-event multilevel surgery