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What did the project achieve?
The first-ever national study of orthopaedic surgery for children with cerebral palsy, has found that it is better for children to undergo a type of surgery called ‘Single Event Multi-Level Surgery’ (SEMLS) than not.
“Children with cerebral palsy who undergo this procedure should expect to see improvements in their walking patterns, although it may not necessarily mean they will be able to walk faster or further than if they hadn’t had the surgery,” says Mr Tim Theologis at the Oxford University Hospitals NHS Foundation Trust.
“Our findings will provide doctors and families with a clear picture of the results that can be expected after this surgery, which will help guide them when making decisions about whether or not to go ahead with the procedure.”
Cerebral palsy, the most common serious physical disability in childhood, often affects mobility due to bone, muscle and joint deformities. SEMLS is widely used across the UK to address these issues, but there has been limited data about its effectiveness or which children benefit most from this surgery.
Mr Theologis and researchers in Oxford and around the UK collected information on 203 children with cerebral palsy who were offered SEMLS at 22 centres across the UK. They followed up on how the children were doing for two years by talking to the surgeons and families of the children – focussing on what mattered most to them.
“We showed, through computerised gait analysis and parental feedback, that SEMLS significantly improved the way children walked,” says Mr Theologis. “However, there were no substantial gains in their overall physical ability, in terms of how far or fast they could walk, compared to those who did not have the surgery.”
Compared to children who had undergone SEMLS, those who had not had the procedure experienced a decline in their walking abilities over time – and parents also noticed a worsening in how they viewed their child’s walking.
“In children with cerebral palsy, walking ability tends to naturally decline over time, so the outcomes of any treatment should be evaluated with this in mind,” says Mr Theologis. “This is an important factor to consider when discussing SEMLS with families.”
The study also revealed considerable variations in clinical practice among centres undertaking SEMLS across the UK, particularly in how children are selected for this surgery and how their outcomes are measured.
“This study has established the first national benchmark for the expected outcomes from SEMLS in the UK,” says Mr Theologis. “We also identified areas for further research, particularly to address the geographical variations in clinical practice and help improve outcomes for all children with cerebral palsy, regardless of where they live.”
The results of the study are set to be shared widely, with benchmarking standards to be made available both nationally and internationally within the next 12 months.
This research was completed on
Cerebral palsy is the most common serious physical disability in children, affecting more than 1,500 babies born in the UK each year.1,2 Many children with symptoms in both legs will undergo a type of surgery called ‘Single Event Multi-Level Surgery’ (SEMLS) which aims to correct their muscle, bone and joint deformities. But it is unclear how effective this operation is, and which children benefit the most. Mr Tim Theologis and his team at the Oxford University Hospitals NHS Foundation Trust are carrying out a national study of SEMLS. He hopes his results will ensure that children receive the best treatment to improve their walking, helping them to live as normal and independent a life as possible.
How are children’s lives affected now?
Cerebral palsy is usually caused by damage to a baby’s brain before, during or soon after birth. A lifelong condition, children develop stiff muscles, and bone and joint deformities that affect their muscle control and movement.
One common type of cerebral palsy is called ‘bilateral cerebral palsy’, or diplegia, which affects both sides of a child’s body – especially their legs. Their leg muscles tend to be extremely tight and over time, this causes joints to stiffen, reducing the range of motion.
“This can make it difficult for a child to walk – and in the most severe cases, impossible,” says Mr Theologis.
SEMLS is a widely-used approach for treating children with this type of cerebral palsy, with surgeons aiming to correct their bone, joint and muscle deformities in a single operation. However, its effectiveness is unclear – and there are differences in how it is carried out between hospitals across the UK.
How could this research help?
“We aim to improve our understanding of how effective SEMLS is and better define which children will benefit most, which we hope will lead to future improvements,” says Mr Theologis.
The researchers will carry out a national study of SEMLS, collecting information from all children put forward for the operation across the UK over a one-year period – including families who decide not to pursue the treatment.
“We will talk to surgeons and the children’s families to find out how children are doing one and two years after their operation, focussing on what matters for patients and their families,” says Mr Theologis.
By analysing these data, the team hopes to understand which children are most likely to have a good result from SEMLS.
“Our results will help surgeons to improve how SEMLS is performed and select the best type of surgery and rehabilitation for individual children,” says Mr Theologis. “In the longer term, this project will guide future research to help children with cerebral palsy get the best possible treatment.”
References
1. Wimalasundera, N. & Stevenson, V.L., Cerebral palsy. BMJ Practical Neurology 2016; 16:184-194.
2. Office for National Statistics. Overview of the UK population: July 2017 https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/july2017#toc [website accessed 04 Sep 2018]
| Project Leader | Mr Tim Theologis, MSc PhD FRCS |
| Project Team | Dr Nicky Thompson, MSc PhD MCSP, Dr Julie A Stebbins, DPhil SRCS CSci, Professor Dan C Perry, MB ChB FRCS(Orth) PhD, Professor James G Wright, CM MD MPH FRCSC FRCSEd, Professor David J Beard, GDPhys MCSP MSc MA DPhil FRCS and Mrs Jacqueline S Birks, MA MSc |
| Project Location | Nuffield Orthopaedic Centre, Oxford University Hospital NHS Foundation Trust |
| Project Location Other | Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford |
| Project duration | 3 years |
| Date awarded | 15 August 2018 |
| Project start date | 1 June 2019 |
| Project end date | 31 March 2024 |
| Grant amount | £199,889 |
| Grant code | GN2721 |
| Acknowledgements | Supported by a generous grant from The Linder Foundation |
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