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PREDICTIVE FACTOR OF OUTCOME SINGLE EVENT MULTILEVEL SURGERY
IN
SPASTIC DIPLEGIC CEREBRAL PALSY AT PROF. DR.dr.R.SOEHARSO
ORTHOPEDIC HOSPITAL
SURAKARTA
dr.Dimas Febriarto *
dr. Anung B Satriadi,Sp. OT (K) **
dr. Agus Priyono, Sp. OT (K) ***
Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret
University-
Prof.Dr.dr.R.Soeharso Orthopaedic Hospital,Solo
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2014
PREDICTIVE FACTOR OF OUTCOME SINGLE EVENT MULTILEVEL SURGERY
IN
SPASTIC DIPLEGIC CEREBRAL PALSY AT PROF. DR.dr.R.SOEHARSO
ORTHOPEDIC HOSPITAL
SURAKARTA
(Final Paper)
Dimas Febriarto*Anung Budi Satriadi**Agus Priyono**
*Resident of Orthopaedic & Traumatology Faculty of
Medicine,
Sebelas Maret University
**Departement of Orthopaedic & Traumatology Faculty of
Medicine,
Sebelas Maret University-Soeharso Orthopaedic Hospital,Solo
Background. Single Event Multi Level Surgery (SEMLS) is commonly
performed to corrected
orthopaedic deformities and improve function in children with
Spastic Diplegic Cerebral Palsy.
Problems in developing such as poverty, poor hospital acces,
poor education and noncompliance
are factors that affect the success outcome of SEMLS. The
purpose of this study was to examine
the patient characteristic and demographic factor related to
predictive of outcome in patient with
SEMLS
Method. This study based on cross sectional of 55 patients (28
male, 22 female) children with
Spastic Diplegic Cerebral Palsy treated by SEMLS at pediatric
clinic department of Soeharso
Orthopaedic Hospital Surakarta at least 6 month follow up, since
January 2012 until Juny 2014.
The patients characteristics at the time of presentation, such
as the initial age and severity of
initiation of operation, educational and economical level of the
parents, access to the hospital and
control compliance, were examined with use of linear regression
analysis modeling in relation to
functional outcome measure with GMFCS Score
Result : Compliance control was significant relationship with
predictive outcome SEMLS. Other
predictive factor, such as initial age and severity of
spasticity, parental or caregiver educational
and economical level, and access to the hospital no significant
relationship was found with
outcome of SEMLS
Conclusion : Compliance control of the patient parent treatment
are the most factor related for
the predictive outcome of SEMLS
Keyword : SEMLS, CP Spastic Diplegic, factor predictive of
outcome
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PREDICTIVE FACTOR OF OUTCOME SINGLE EVENT MULTI LEVEL SURGERY
FOR
CEREBRAL PALSY SPASTIC DIPLEGIC di RS ORTHOPEDI PROF.
DR.dr.R.SOEHARSO SURAKARTA
(Final Paper)
Dimas Febriarto*Anung Budi Satriadi**Agus Priyono**
*Residen Orthopaedi&Traumatologi Fakultas Kedokteran,
Universitas Sebelas Maret
**Fakultas Kedokteran Bagian Orthopaedi & Traumatologi,
Universitas Sebelas Maret, Rumah Sakit Orthopaedi Soeharso
Prof.dr.R.Soeharso,Solo
Latar Belakang. Single Event Multi Level Surgery (SEMLS)
merupakan penanganan yang
paling sering digunakan untuk memperbaiki deformitas dan
fungsional pada anak dengan
Cerebral Palsy Spastik Diplegik. Permasalahan pada Negara
berkembang berupa kemiskinan,
akses ke rumah sakit yang sulit, kurangnya pendidikan dan
ketidakpatuhan, merupakan faktor-
faktor yang berpengaruh terhadap keberhasilan outcome pada
SEMLS. Tujuan penelitian ini
adalah mengetahui hubungan faktor karakter pasien dan demografi
dengan predictive of outcome
pada pasien dengan SEMLS
Metode. Penelitian menggunakan studi cross sectional pada 55 (28
laki-laki, 22 wanita) anak
penderita Cerebral Palsy Spastik Diplegik yang dilakukan SEMLS
pada klinik pediatrik rumah
sakit Ortopaedi Prof.dr.R.Soeharso Surakarta paling sedikit 6
bulan, sejak Januari 2012 hingga
November 2013. Karakteristik pasien saat dilakukan pemeriksaan
adalah usia dan derajat
keparahan saat sebelum dilakukan terapi, tingkat pendidikan dan
ekonomi orang tua, akses ke
rumah sakit dan kepatuhan kontrol ke rumah sakit, kemudian
dilakukan pemeriksaan analisa
dengan model regresi linier untuk mengetahui hubungan functional
outcome SEMLS
menggunakan GMFCS Score
Hasil: Kepatuhan kontrol merupakan faktor yang paling
berpengaruh terhadap outcome SEMLS,
sedangkan faktor-faktor prediksi lainnya seperti faktor usia,
derajat keparahan (spastisitas),
tingkat pendidikan, ekonomi, dan kemudahan akses ke rumah sakit
tidak berpengaruh secara
signifikan terhadap outcome dari SEMLS
Kesimpulan. Kepatuhan kontrol orangtua merupakan faktor yang
paling berpengaruh terhadap
predictive outcome SEMLS.
Kata Kunci : SEMLS, CP Spastik Diplegik, factor predictive of
outcome
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Introduction
Cerebral Palsy is a group of non-progressive disorder that
occurs in early
childhood where the brain abnormality causing disturbances in
the movement and
postural function.1
In developing countries the prevalence of Cerebral Palsy (CP)
was 2 to 2.5 per
1,000 births. CP spastic type is the most common sub-type, which
is nearly 70% - 80% of
the whole population of CP. Patients experiencing spasticity
involving the lower
extremities with minor motoric disorders in the upper
extremities, but most of them still
able to walk, either usingc tools or not.2
In the 1980s, orthopedic therapy in children with Cerebral Palsy
performed
surgical procedures on an annual basis, which is often referred
to Happy birthday
syndrome. Rang probably was the first to propose methods of
intervention operations at
some level anatomy at one stage. Single-event multilevel surgery
(SEMLS) is a
corrective methode in the form of operation of the soft tissue
and bone, with two or more
different anatomical locations at the same time with the aim of
rehabilitation can be done
in one time.4
Research conducted by Bleck and Rang, Silver and Dela Garza
showed that the
surgical therapy to correct joints with different anatomical
locations in a single step
(Single Event Multi level Surgery) showed effective results than
multi stages surgery.
Previous studies have shown that walking ability in children
peaked at the age of seven
years. So the ideal time for surgery is the age of seven years
old.4
Some problematic in the poor and developing countries such as
poverty, lack of
education and limitation of the healthcare facilities, lack of
compliance for control and
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rehabilitation, lack of adequate medical attention causing
delayed treatment to Cerebral
Palsy patients, thus greatly affect the outcome of the CP
therapy.5
This study aimed to investigate the characteristics of patients
with Spastic
Diplegic Cerebral Palsy and to evaluate the predictive outcome
in patients with Spastic
diplegic Cerebral Palsy who came to the Paediatric Clinic RSO
Prof. Dr. dr. R. Soeharso
Surakarta after Single Event Multilevel Surgery method performed
in Paediatrics clinic at
RSO Prof. Dr. dr. R. Soeharso Surakarta.
Methods
This is observational study with cross-sectional design. This
study was held at
pediatrics clinic at RSO Prof.Dr.dr.R.Soeharso Surakarta on
January 1st – November 1st
2013. Population and sample of this study was all Cerebral Palsy
Spastic Diplegic
patients who came to pediatrics clinic at RSO
Prof.Dr.dr.R.Soeharso Surakarta, with
inclusion criteria patients with Cerebral Palsy Spastic Diplegic
who had perfomed
SEMLS method, Patients who had peformed SEMLS operation after
minimal 6 month.
Exclusion criteria . Drop out during the therapy, Uncompleted
criteria, Patients refuse to
became sample of the study. This study based on cross sectional
of 55 patients (28 male,
22 female) children with Spastic Diplegic Cerebral Palsy treated
by SEMLS at pediatric
clinic department of Soeharso Orthopaedic Hospital Surakarta at
least 6 month follow up,
since January 2012 until Juny 2014. The patients characteristics
at the time of
presentation, such as the initial age and severity of initiation
of operation, educational and
economical level of the parents, access to the hospital and
control compliance, were
-
examined with use of linear regression analysis modeling in
relation to functional
outcome measure with GMFCS Score
Results
From our study that being held at pediatric clinic of RSO
Prof.Dr. dr. R.Soeharso
Surakarta, between January 1st – November 1st 2013, we obtained
50 patients with
distribution as followings:
28 male patients (56%) and 22 female patients (44%).
0
20
40
male female
28 (56%)22 (44%)
Sex Distribution Percentage
male
female
21
22
23
24
25
26
27
under 7 yearsold
over 7 years old
23 (46%)
27 (54%)
Age Distribution
under 7 years old
over 7 years old
-
0
5
10
15
20
25
30
0 1 2 3 4
0
2426
0 0
Severity Level Distribution
0
10
20
30
40
50
comply not comply
48 (96%)
2 (4%)
patients Distribution based on compliance
comply
not comply
0
5
10
15
20
25
30
easy uneasy
30 (60%)
20 (40%)
Easiness acces to hospital
easy
uneasy
-
0
5
10
15
20
25
30
35
highschool andabove
under highschool
19 (38%)
31 (62%)
Parents level of education Distribution
highschool and above
under highschool
0
10
20
30
well off needy
20 (40%)
30 (60%)
Parents’s economic level
well off
needy
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5
0
9
41
0 0
Patients Distribution based on Outcomes
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Discussion
Table 1. Results analysis of the Partial (Individual) predictive
factors influence Against Outcome
(GMFCS Score).
Model Beta Sig.
Age -0.61 0.714
Severity 0.072 0..638
Compliance control -0.200 0.020*
Acces easiness to hospital 0.204 0.199
Parents education -0.308 0.161
Parents economic status 0.091 0.678
Note : Sig > 0.05, there’s significancy between variables
According to the table number 2 shows that the effect of
compliance in control for the
rehabilitation to the outcomes using multiple linear regression
analysis showed
significance 0.02 (less than 0.05) These results indicate that
the compliance control for
rehabilitation significantly influence the outcome. Beta
constant value is -0.200. The
negative sign indicates that the more frequent the control was,
the better outcome will be
obtained. The magnitude of the effect of compliance controls for
the rehabilitation of the
outcome was 20%. According to Biwott (2014), the compliance of
the patients to control
would make them remain consistent to exercise regularly as
recommended by the doctor
so that will affect the outcome.
Table 2. result of data analysis on the influence of control
compliance to the Outcome
Model B Sig.
Control compliance -0.200 0.020
Note : Sig > 0.05, there’s significancy between variables
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Based on Table 3 showed that the odds ratio value indicated by
the value "Estimate" is
0.200 mean: patients who had good compliance had more risk to
have 0.20 times better
outcomes than patients who didn’t have good compliance control.
Asymp value. Sig (2-
Sided) shows the p value or significance of the value of the
odds ratio. When
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