Trajectory of functional recovery and health-related quality of life following multilevel soft-tissue surgery in children with spastic diplegic cerebral palsy: a prospective longitudinal observational study.

Abstract

This prospective longitudinal observational study characterized 3-year functional mobility and health-related quality-of-life trajectories following single-event multilevel soft-tissue surgery in 32 children with spastic diplegic cerebral palsy, Gross Motor Function Classification System levels II-IV. Functional Mobility Scale (FMS) scores at 5, 50, and 500 m and parent-proxy Pediatric Quality of Life Inventory (PedsQL) Cerebral Palsy Module scores were assessed preoperatively and at 3, 6, 9 months, 1 year, and 3 years. FMS varied over time at all distances (Friedman P < 0.001). Median 5-m and 50-m FMS fell from 4.5 preoperatively to 2.0 at 3 months and returned to 4.5 by 3 years; baseline-to-3-year shifts were favorable (5 m: Bonferroni-adjusted P = 0.0087, r = 0.608; 50 m: adjusted P = 0.0158, r = 0.579). At 500 m, the median increased from 0 to 4.5 (adjusted P = 0.0191, r = 0.570), while N (does not apply; distance not completed) decreased from 19/32 to 8/32; 4.5 is an interpolated median between categories 4 and 5. Mean PedsQL increased from 68.2 ± 14.7 to 74.3 ± 14.5 (change +6.13, 95% confidence interval = 4.30-7.96; P < 0.001) without early decline. No FMS distance changed significantly from 1 to 3 years. Short- and intermediate-distance mobility showed early deterioration followed by recovery to baseline medians, whereas community mobility and caregiver-reported quality of life showed favorable long-term shifts. These observational changes cannot be attributed solely to surgery.