title: Literature Review and Comparison of Two Statistical Methods to Evaluate the Effect of Botulinum Toxin Treatment on Gait in Children with Cerebral Palsy.
abstract: OBJECTIVE
  This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A) treatment on gait in children with a diagnosis of spastic cerebral palsy (CP), based on three-dimensional gait analysis (3DGA) data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in children with CP is summarized.
  
  
  METHODS
  Part 1--Intervention studies on BTX-A treatment in children with CP between 4-18 years that used 3DGA data as an outcome measure and were written in English, were identified through a broad systematic literature search. Reported kinematic and kinetic gait features were extracted from the identified studies. Part 2--A retrospective sample of 53 children with CP (6.1 ± 2.3years, GMFCS I-III) received 3DGA before and after multilevel BTX-A injections. The effect of BTX-A on gait was interpreted by comparing the results of paired samples t-tests on the kinematic gait features that were identified from literature to the results of statistical parametric mapping analysis on the kinematic waveforms of the lower limb joints.
  
  
  RESULTS
  Part 1-53 kinematic and 33 kinetic features were described in literature. Overall, there is no consensus on which features should be evaluated after BTX-A treatment as 49 features were reported only once or twice. Part 2--Post-BTX-A, both statistical approaches found increased ankle dorsiflexion throughout the gait cycle. Statistical parametric mapping analyses additionally found increased knee extension during terminal stance. In turn, feature analyses found increased outtoeing during stance after BTX-A.
  
  
  CONCLUSIONS
  This study confirms that BTX-A injections are a valuable treatment option to improve gait function in children with CP. However, different statistical approaches may lead to different interpretations of treatment outcome. We suggest that a clear, definite hypothesis should be stated a priori and a commensurate statistical approach should accompany this hypothesis.
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Nieuwenhuys
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Eirini
authors.initials: E
authors.lastname: Papageorgiou
authors.affiliation: Department of Bioengineering, Shinshu University, Ueda, Japan.
authors.forename: Todd
authors.initials: T
authors.lastname: Pataky
authors.affiliation: Faculty of Engineering Science, KU Leuven, Leuven, Belgium.
authors.forename: Tinne
authors.initials: T
authors.lastname: De Laet
authors.affiliation: Department of Development and Regeneration, KU Leuven, Leuven, Belgium.|Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Molenaers
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.|Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
mesh_terms: D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D019274:Botulinum Toxins, Type A