Background

This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA).

Research question

What is the current evidence base pertaining to the clinical efficacy of 3DGA?

Methods

We identified English language articles published from September 2009 to October 2019 reporting primary research that used typical motion analysis laboratory methods to study human walking. Five gait laboratory experts classified articles according to the highest type of efficacy they addressed: type 1 (technical), 2 (diagnostic accuracy), 2b (outcome prediction), 3−4 (diagnostic thinking and treatment), 5 (patient outcome), 6 (societal). Articles classified into type 3−4 and higher were rated for quality using LEGEND.

Results

Of 2712 articles related to the efficacy of 3DGA, over 99% addressed technical (n = 313), diagnostic (n = 1466), or outcome prediction (n = 927) efficacy. Six type 3−4 studies showed that 3DGA changes treatment plans, increases clinicians’ confidence in their treatment decisions, and increases agreement among clinicians. Two type 5 articles based on a randomized controlled trial demonstrated that patient outcomes improved only when 3DGA data were available and its recommendations were followed. A population-based type 5 study found that the incidence of severe crouch gait dropped from 25% to 4% following practice changes including the addition of 3DGA. The strength of evidence was mainly 3b (lesser quality prospective cohort studies) but also included stronger studies (three level 2 controlled clinical trials).

Significance

Literature related to the clinical efficacy of 3DGA has grown substantially over the last decade. Thousands of articles contribute to continued improvement of data collection and interpretation, as well as understanding of gait pathology and treatment. A smaller number of studies clearly demonstrate the efficacy of 3DGA in changing and reinforcing treatment decisions, increasing clinicians’ confidence in treatment planning, and increasing agreement among clinicians, as well as the potential to improve patient outcomes.

中文翻译：

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仪器化步态分析的临床功效：系统评价2020更新。

背景

本文更新了我们对三维仪器步态分析（3DGA）的临床疗效的2011年系统综述。

研究问题

目前有关3DGA临床疗效的证据基础是什么？

方法

我们确定了2009年9月至2019年10月发表的英语文章，这些文章报道了使用典型的运动分析实验室方法研究人类步行的基础研究。五名步态实验室专家根据他们所解决的最高功效类型对文章进行了分类：类型1（技术），类型2（诊断准确度），类型2b（结果预测），3-4（诊断思想和治疗），5（患者预后）， 6（社交）。使用LEGEND对分类为3−4和更高类型的文章进行质量评定。

结果

在与3DGA功效相关的2712篇文章中，超过99％的涉及技术（n = 313），诊断（n = 1466）或结果预测（n = 927）功效。六项3-4型研究表明3DGA改变了治疗计划，增加了临床医生对其治疗决策的信心，并增加了临床医生之间的共识。两项基于随机对照试验的5类文章证明，只有在3DGA数据可用并遵循其建议的情况下，患者的预后才有所改善。一项基于人群的5型研究发现，在实践改变（包括添加3DGA）后，严重蹲下步态的发生率从25％降至4％。有力的证据主要是3b（前瞻性队列研究质量较差），但也包括更强的研究（3项2级对照临床试验）。

意义

在过去的十年中，与3DGA的临床功效相关的文献已大大增加。成千上万的文章有助于持续改进数据收集和解释，以及对步态病理学和治疗的理解。少数研究清楚地表明了3DGA在更改和加强治疗决策，增强临床医生对治疗计划的信心以及增加临床医生之间的共识以及提高患者预后的潜力方面的功效。