Predicting functional outcomes following surgical intervention and inpatient rehabilitation stay in children with cerebral palsy.

BACKGROUND

The ability to predict functional outcomes in children with cerebral palsy (CP) after surgical procedures and a subsequent inpatient rehabilitation unit (IRU) stay is limited based on current literature.

OBJECTIVE

To determine if length of stay (LOS) and functional outcomes could be predicted in children with CP following a surgical procedure and IRU stay based on the surgical procedure performed, pattern of involvement, etiology, and Gross Motor Function Classification System level.

DESIGN

Retrospective cohort study.

SETTING

Tertiary care pediatrics.

PARTICIPANTS

Pediatric patients with CP (N = 139) who underwent one of three surgical procedures followed by an IRU stay.

INTERVENTIONS: Selective dorsal rhizotomy, single-event multilevel orthopedic surgery, or intrathecal baclofen pump implantation and subsequent IRU stay.

MAIN OUTCOME MEASURES: IRU LOS, Functional Independence Measure for Children (WeeFIM) total score, subscores (mobility, self-care, and cognition), efficiency, and change score.

RESULTS

Surgical procedure and WeeFIM mobility subscore at admission were significantly predictive of LOS (p < .001). Type/pattern of limb involvement, age, etiology, Gross Motor Function Classification System, and admission WeeFIM total were significantly predictive of total WeeFIM score at discharge (p < .001) and explained 86% of the variance. All WeeFIM subscores at admission were significant predictors of subscores at discharge (p < .001). Type/pattern of limb involvement, as an individual predictor, was most associated with WeeFIM efficiency (r = .398) and WeeFIM change (r = .445, p < .001). Cognition was found to be a significant mediator of the relationship between both admission mobility and self-care and the gains attained during an IRU stay (p ≤ .004).

CONCLUSIONS

LOS and functional outcomes could be predicted with a minimal set of factors accounting for 86% of the variance. Cognition at IRU admission has an important influence on functional outcomes during the postoperative rehabilitation period.