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Table 9.6Evidence profile for hip adductor lengthening surgery compared with injection of botulinum toxin type A in children under 6 years with bilateral spasticity; functioning assessment

Number of studiesNumber of participantsEffectQuality
Single event multi-level surgery and physical therapyPhysical therapy onlyRelative

(95% CI)
Absolute

(95% CI)
GMFM-66 at 12 months (better indicated by higher values)
1 study (Thomason 2011)11a8b-MD 1.3 higher*Low
GMFM-66 at 24 months(better indicated by higher values)
1 study (Thomason 2011)11c--MD 4.9 higher (0.98 higher to 8.7 higher)*Very low
GGI at 12 months (better indicated by lower values)
1 study (Thomason 2011)11d8e-MD 211 lower*Low
GGI at 24 months (better indicated by lower values)
1 study (Thomason 2011)11f--MD 213 lower (327 lower to 100 lower)*Low

CI confidence interval, GGI Gillette Gait Index, GMFM-66 Gross Motor Function Measure 66-item score, MD mean difference, P probability, SD standard deviation

*

Calculated by the NCC-WCH

a

Baseline mean (SD) = 65.3 (11.1), Score at 12 months mean (SD) = 66.1 (8.9)

b

Baseline mean (SD) = 70.3 (11.3), score at 12 months mean (SD) = 69.8 (11.4)

c

Baseline mean (SD) = 65.3 (11.1), score at 24 months mean (SD) = 70.2 (10.1), difference from baseline reported as P < 0.05

d

Baseline mean (SD) = 353 (211), score at 12 months mean (SD) = 153 (81)

e

Baseline mean (SD) = 370 (194), score at 12 months mean (SD) = 381 (196)

f

Baseline mean (SD) = 353 (211), score at 24 months mean (SD) = 139 (80), difference from baseline reported as P < 0.05

See the complete GRADE Table K.9.6 which accompanies this abbreviated version.

Calculated by the NCC-WCH

Baseline mean (SD) = 65.3 (11.1), Score at 12 months mean (SD) = 66.1 (8.9)

Baseline mean (SD) = 70.3 (11.3), score at 12 months mean (SD) = 69.8 (11.4)

Baseline mean (SD) = 65.3 (11.1), score at 24 months mean (SD) = 70.2 (10.1), difference from baseline reported as P < 0.05

Baseline mean (SD) = 353 (211), score at 12 months mean (SD) = 153 (81)

Baseline mean (SD) = 370 (194), score at 12 months mean (SD) = 381 (196)

Baseline mean (SD) = 353 (211), score at 24 months mean (SD) = 139 (80), difference from baseline reported as P < 0.05

From: 9, Orthopaedic surgery

Cover of Spasticity in Children and Young People with Non-Progressive Brain Disorders
Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications.
NICE Clinical Guidelines, No. 145.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Jul.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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