To expand upon previous validation of the Gait Outcomes Assessment List (GOAL) questionnaire in individuals with cerebral palsy (CP), to rank items by importance, and to summarize written-in (free text) goals.METHOD For this cross-sectional study, the parent-version 5.0 of the GOAL was completed by 310 consecutive caregivers of 310 individuals aged 3 to 25 years with CP (189 males, 121 females; mean [SD] age: 10y [4y 2mo]; Gross Motor Function Classification System [GMFCS] levels I-IV) concurrent with a gait analysis. Distribution properties and validity were quantified using questionnaires, kinematics, and oxygen consumption. Items classified as at least 'difficult' to perform and 'very important' to improve were considered caregiver priorities and rank ordered. Free text goals were categorized. Results were summarized for everyone and by GMFCS level. RESULTSMost scores were normally distributed. Validity was acceptable, with concurrent greater than construct validity. Among all 310 caregivers, fatigue was the highest priority, followed by gait pattern and appearance items. The rank of priorities varied by GMFCS level.Common free text goals included toileting independently as well as improved fine motor and ball sport skills. INTERPRETATIONThe GOAL is a valid tool that can help prioritize goals across GMFCS levels I to IV. Identifying the top goals may improve shared decision-making and prioritize research for this sample.
➢ Assessment of the ambulatory patient who has cerebral palsy (CP) involves serial evaluations by orthopaedic surgeons, neurosurgeons, rehabilitation specialists, and therapists as well as 3-dimensional gait analysis (3DGA). The most common subtype of CP in ambulatory patients is diplegia, and the most common severity is Gross Motor Function Classification System (GMFCS) Levels I, II, and III.➢ Increased tone in the skeletal muscle of patients with CP can be managed with focal or generalized, reversible or irreversible means. One method of irreversible tone control in spastic diplegia is selective dorsal rhizotomy. A careful preoperative assessment by a multidisciplinary team guides a patient’s tone-management strategy.➢ Abnormal muscle forces result in abnormal skeletal development. Resultant lever-arm dysfunction of the lower extremities creates gait abnormality. A comprehensive assessment of gait is performed with 3DGA, supplementing the clinical and radiographic examinations for surgical decision-making.➢ Single-event multilevel surgery (SEMLS) involves simultaneous correction of all musculoskeletal deformities of the lower extremities in a single setting. Specialized centers with attendant facilities and expertise are necessary. SEMLS often follows years of medical treatment, therapy, and planning. Some procedures can be performed with the patient in the prone position for technical ease and optimal assessment of transverse-plane alignment.➢ Objective gains in patient function are made until 1 to 2 years after SEMLS. Most ambulatory children with diplegia undergoing SEMLS maintain function at their preoperative GMFCS level but can make quantifiable improvements in walking speed, oxygen consumption, gait quality, and patient-reported functioning.
AimTo report the test–retest reliability of the parent version of the Gait Outcomes Assessment List (GOAL) questionnaire for item, domain, total score, and goal importance in children with cerebral palsy (CP) functioning in Gross Motor Function Classification System (GMFCS) levels I to III.MethodThe GOAL questionnaire was completed twice, 3 to 31 days apart, in a prospective cohort study of 112 caregivers of children aged 4 to 17 years with CP (40% unilateral; GMFCS level I = 53; II = 35; III = 24; 76 males). All had an outpatient visit over a 1‐year period. The standard error of measurement (SEM), minimum detectable change, and agreement were calculated for all responses, including goal importance.ResultsThe SEM for the total score was 3.1 points for the cohort (GMFCS level I = 2.3, GMFCS level II = 3.8, GMFCS level III = 3.6). The standardized domain and item scores were less reliable than the total score and varied according to GMFCS level. The gait function and mobility domain exhibited the best reliability for the cohort (SEM = 4.4), whereas the use of braces and mobility aids domain exhibited the lowest (SEM = 11.9). Goal importance was reliable (cohort average agreement 73%).InterpretationThe parent version of GOAL has acceptable levels of test–retest reliability for most domains and items. Caution is advised when interpreting the least reliable scores. Essential information necessary for accurate interpretation is provided.
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