Causal treatment effects of gait‐analysis‐informed surgery on the Gait Outcomes Assessment List in children with cerebral palsy

This study investigated how surgery impacts mobility-related goals of children with cerebral palsy (CP). We used a specialized causal inference method called the X-learner to analyze parent-reported data from the Gait Outcomes Assessment List (GOAL) questionnaire. The results showed that surgery guided by instrumented gait analysis (the objective, quantitative measurement of human motion) provides clear benefits in specific areas, but less in others. The largest surgery effects were in Gait Pattern and Appearance and the Use of Braces and Mobility Aids (both increasing by over 10 points). Modest surgery effects were seen in Body Image and Self-Esteem and the reduction of Pain, Discomfort, and Fatigue. Functional areas – such as Activities of Daily Living, General Mobility, and Participation in Sports – did not benefit from surgery. We also observed a lack of alignment between subjective reports of parents and objective laboratory data, suggesting that progress towards goals can be affected by the artificial nature of the gait laboratory, parent expectations and perceptions, or both. We conclude that surgery is effective at improving a child's physical appearance, comfort, and self-confidence. However, clinicians should help families set realistic expectations regarding increased independence or better performance in sports and recreation.