Severe hip displacement reduces health-related quality of life in children with cerebral palsy

Abstract

Background and purposeHip displacement is common in children with severe cerebral palsy (CP) and can cause problems such as pain, contractures, and nursing difficulties. Caregiver priorities and child health index of life with disabilities (CPCHILD) is a recently developed measure of health-related quality of life (HRQL) in children with severe CP. The associations between CPCHILD scores and hip displacement have not been investigated. We explored the effect of hip displacement on HRQL.Patients and methods67 children were recruited from the population-based Norwegian CP register. Mean age was 9 (7–12) years. There were 40 boys. Gross motor function classification system (GMFCS) distribution was 12 level III, 17 level IV, and 38 level V. Hip displacement was assessed by radiographic migration percentage (MP). The criterion for hip displacement was MP of the worst hip of ≥40%. Primary caregivers responded to 5 of the 6 domains of the CPCHILD questionnaire.ResultsHip displacement was found in 18 children and it was significantly associated with lower scores on the CPCHILD domains 3 (Comfort and Emotions) and 5 (Health), but not with domains 1 (Activities of Daily Living/Personal Care), 2 (Positioning, Transfer, and Mobility), and 6 (Overall Quality of Life). GMFCS level V was a significant predictor of low scores in all the domains.InterpretationFor the assessment of HRQL in children with severe CP and hip problems, we propose a modified and simplified version of the CPCHILD consisting of 14 of 37 questions. This would reduce the responders’ burden and probably increase the response rate in clinical studies without losing important information.

Migration percentage and odds of recurrence/subsequent surgery after treatment for hip subluxation in pediatric cerebral palsy: A meta-analysis and systematic review

“…5 Hip displacement is associated with lower Toileting, Clothing, Transfers, Sitting, Lying, and Sleeping scores on the CP CHILD. 6,7…”

Inter-rater and Intrarater Reliabilities of the Identification of a “Gothic Arch” in the Acetabulum of Children With Cerebral Palsy

“… 1 – 3 Left untreated, the hip can dislocate causing pain and decreased quality of life. 4 – 6 Evidence supports the use of systematic hip surveillance to identify children with hip displacement and allow for timely orthopaedic management. 7 , 8 Guidelines for hip surveillance, which provide recommendations for frequency of surveillance and define the criteria for referral to a pediatric orthopaedic surgeon, are readily available.…”

Parents and Caregivers Satisfaction After Palliative Treatment of Spastic Hip Dislocation in Cerebral Palsy

“…Results: In all groups of patients, we observed a decrease in pain complaints. The observed reduction of pain in the first group was from 7.88 (4-10) to 3.08 (0-8) (p = 0.05), but results of injection were observed only for 4 months (2)(3)(4)(5)(6)(7)(8), and it has to be repeated (average: two times). In the second group, level of pain was reduced from 4.93 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) to 0.93 (0-5) (p < 0.001); in the third group, from 6.22 (3)(4)(5)(6)(7)(8)(9)(10) to 0.59 (0-6) (p < 0.001); and in the fourth group, pain reduces from 5.43 (2-10) to 2.13 (0-5) (p < 0.001).…”

“…In the Schanz osteotomy group, parents' evaluation was 5.9 (0-10), and in eight cases, caregivers would not repeat surgery. In the proximal femoral resection group, satisfaction was the highest, 8.3 (3)(4)(5)(6)(7)(8)(9)(10), and only two parents would not decide for surgery again.…”