Impacto da análise clínica da marcha nos
custos de reabilitação
CGA and rehabilitation costs

Papers:

Efficacy of clinical gait analysis (2011/2020):

• Efficacy of clinical gait analysis: A systematic review - abstract
Wren TA, Gorton GE 3rd, Ounpuu S, Tucker CA.
Gait Posture. 2011;34(2):149-153.
doi:10.1016/j.gaitpost.2011.03.027

"The aim of this systematic review was to evaluate and summarize the current evidence base related to the clinical efficacy of gait analysis. A literature review was conducted to identify references related to human gait analysis published between January 2000 and September 2009 plus relevant older references.

This body of literature provides strong evidence for the technical, diagnostic accuracy, diagnostic thinking and treatment efficacy of gait analysis. The existing evidence also indicates efficacy at the higher levels of patient outcomes and societal cost-effectiveness, but this evidence is more sparse and does not include any randomized controlled trials. Thus, the current evidence supports the clinical efficacy of gait analysis, particularly at the lower levels of efficacy, but additional research is needed to strengthen the evidence base at the higher levels of efficacy."


• Efficacy of clinical gait analysis: A systematic review 2020 Update - abstract
Wren TA, Tucker CA, Rethlefsen SA, Gorton GE 3rd, Õunpuu S
Gait Posture. Available online 23 May 2020
In Press, Journal Pre-proof

"Background
This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA).

Research question
What is the current evidence base pertaining to the clinical efficacy of 3DGA?"

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• Effects of Preoperative Gait Analysis on Costs and Amount of Surgery - abstract
Wren TA, Kalisvaart MM, Ghatan CE, Rethlefsen SA, Hara R, Sheng M, Chan LS, Kay RM
Journal of Pediatric Orthopaedics. 2009;29:558–563
doi:10.1097/BPO.0b013e3181b2f8c2

"BACKGROUND:
The purpose of this study was to determine the efects of clinical gait analysis (GA) on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery these children undergo.

RESULTS:
Patients in the GA group were significantly older and less functionally involved, had their first surgery in later years, and had a shorter follow-up than patients in the NGA group (P<0.001). Adjusting for these differences, patients in the GA group had more procedures (GA: 5.8, NGA: 4.2; P<0.001) and higher cost (GA: $43,006, NGA: $35,215; P<0.001) during index surgery, but less subsequent surgery. A higher proportion of patients went on to additional surgery in the NGA group (NGA: 32%, GA: 11%; P<0.001), with more additional surgeries per person-year (NGA: 0.3/person-year, GA: 0.1/person-year; P<0.001) resulting in higher additional costs (NGA: $3009/person-year, GA: $916/person-year; P<0.001). The total number of procedures (GA: 2.6/person-year, NGA: 2.3/person-year; P=0.22) and cost (GA: $20,448/person-year, NGA: $19,535/person-year; P=0.58) did not differ significantly between the 2 groups.

CONCLUSIONS:
Clinical GA is associated with a lower incidence of additional surgery, resulting in lesser disruption to patients' lives. This finding has not been shown before and may assist patients, physicians, policy makers, and insurance companies in assessing the role of GA in the care of ambulatory children with CP."


• Gait analysis: clinical facts
Baker R, Esquenazi A, Benedetti MG, Desloovere K
European Journal of Physical and Rehabilitation Medicine 2016 August;52(4):560-74

Edizioni Minerva Medica

"Abstract
Gait analysis is a well-established tool for the quantitative assessment of gait disturbances providing functional diagnosis, assessment for treatment planning, and monitoring of disease progress. There is a large volume of literature on the research use of gait analysis, but evidence on practice to improve the management of children with cerebral palsy. However, there is good evidence to extend its use to patients with various upper motor neuron diseases, and to lower limb amputation. Thereby, the methodology for properly conducting and interpreting the exam is of paramount relevance. Appropriateness of gait analysis prescription and reliability of data obtained are required in the clinical environment. This paper provides an overview on guidelines for managing a clinical gait analysis service and on the principal clinical domains of its application: cerebral palsy, stroke, traumatic brain injury and lower limb amputation."


• Gait and Posture Virtual Special Issue "Clinical Impact of Instrumented Motion Analysis"
Wren TAL, Chou LS, Dreher T.
Gait Posture. 2020 Aug 12;82:108-109.
doi: 10.1016/j.gaitpost.2020.08.102.
Epub ahead of print. PMID: 32911094.

"We are pleased to present this virtual special issue focused on the clinical impact of instrumented motion analysis. In this issue, you will find both recent articles prepared specifically for this issue along with previous papers from Gait and Posture relevant to the topic. Understanding the clinical impact of motion analysis is important to establish its evidence base, optimize its clinical application, and ultimately to expand its usage to further improve clinical care. We hope the articles in this special issue will be informative to motion analysis practitioners, users, and the broader clinical community and will inspire further research and continued advancement of the field."


• Impact of instrumental analysis of stiff knee gait and associated costs
Impact of instrumental analysis of stiff knee gait on treatment appropriateness and
associated costs in stroke patients (abstract)
Merlo A, Campanini I
Gait Posture. 2019 Jun 13;72:195-201
doi:10.1016/j.gaitpost.2019.06.009

"BACKGROUND:
Stiff Knee Gait (SKG) in stroke patients is typically treated by the inhibition of the rectus femoris (RF) with botulinum toxin (BoNT) after clinical evaluation, obtaining an average pooled recovery in knee flexion (KF) of 7 degrees.

RESULTS:
160 patients, age 20-87 years, gait speed 9-77%height/s, KF peak -4-44 degrees, were included. Of these, in 119 cases poor APO was the main cause of SKG, thus leading to PITkin =74%. In 48 out of 107 non-obese subjects, RF spasticity was not involved in SKG, resulting in PITEmg=45%. Finally, patients with a braking activity as the main cause and concurrent RF activity were 20/107=19%, resulting in PITga=81%

SIGNIFICANCE:
When treating SKG, proper use of GA can reduce the percentage of inappropriate treatments by BoNT at the RF up to 81%. Savings are in the order of €100k/year when considering centers treating 100 or more patients/year."


• Counter reply: Impact of instrumental analysis of stiff knee gait and associated costs - open access
Counter reply: Impact of instrumental analysis of stiff knee gait on treatment appropriateness and associated costs in stroke patients
Merlo A, Campanini I
Gait Posture. 2020 Nov 5;83:230-231
doi: 10.1016/j.gaitpost.2020.11.003
Epub ahead of print. PMID: 33186885.

Teses/Thesis:

• Economic Evaluation of Clinical Gait Analysis: A Cost-Benefit Approach

ABSTRACT

This research is concerned exclusively with children who are suffering from gait related abnormalities. The purpose of this thesis was to conduct an economic evaluation of alternative means of treating gait. More specifically, the answer to the following was sought: “which method of treating cerebral palsy (clinical gait analysis or the current method of clinical observation) maximises the difference between social benefits and social costs?” The technique of cost-benefit analysis was employed to answer this question.

In order to conduct an economic evaluation, information on the marginal costs and benefits of conducting gait analyses was estimated using data obtained from the Royal Children’s Hospital in Brisbane. Of the 15 patients identified for the study, 10 responses were obtained. Three of six physicians who were approached for the study responded to the questionnaire. Of the ten respondents, six either had their treatment options changed or deferred, three had no changes but wanted confirmation and one had CGA to assure family of the initial diagnosis by the physician. Results of the analysis of the raw data suggest that the marginal benefits of conducting clinical gait analysis are greater than its marginal costs. The bootstrapping technique used also used to simulate a larger sample (of 2000 iterations) and the results also confirmed the initial finding.