Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis

The results of spinal fusion in patients with paralytic deformities are usu ally presented as the correction of the deformity. When evaluating the surg ical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activ ities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. A total of 94 patients with p aralytic scoliosis and 18 different diagnoses were evaluated 1 year after s urgery. The patients were classified according to whether or not they could understand verbal instructions. The patients were also grouped according t o the Scoliosis Research Society classification of diagnoses. A set of inst ruments was used with the variables classified according to WHO's Internati onal Classification of Impairments, Disabilities, and Handicaps (ICIDH). Th is consists of the patient's/relative's motives for surgery, persistent ski n discoloration, ambulating or use of wheelchair, use of a brace, sitting b alance, weight distribution on a sitting surface, angle of scoliosis, reach ing, pain estimation, activities of daily living (ADL) Klein and Bell, care given, time spent resting, and seating supports. The set of instrument als o included a follow-up questionnaire comprising 12 different areas, where t he patients/relatives assessed the results of surgery. The study showed tha t spinal fusion in paralytic scoliosis led to showed improvements in the wh ole group of patients at the Impariment level in the angle of scoliosis, si tting balance, weight distribution, and reduced number of patients with per sistent skin discoloration, and at the Handicap level in reduced time for r esting during the day, reduced number of seating supports in the wheelchair , and in the use of a brace. Most of the parameters were unchanged. The res ults in the subgroups were almost the same as in the whole group, although pain and reaching at the Impairment level, and ADL at the Disability level, could not be measured in the patients who were unable to understand verbal instructions. The subjectively assessed results showed that seating postur e was ranked positively irrespective of the motive for surgery. The study s howed that the patients with paralytic scoliosis maintained or improved the ir function and level of independence in terms of Impairment and Handicap I year postoperatively. The subjective results assessed by the patients/rela tives also showed a positive outcome of surgery. Weight distribution on a s eating surface was improved, bur still uneven, and with respect to better s itting balance and increasing time sitting in a wheelchair, this can involv e a risk for pressure sores and needs further investigation. When introduci ng outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.