Getting high level of evidence for surgical treatments from routine clinical data. A real-world testing of the SPHN infrastructure - EVIGAITCP

Cerebral palsy is the first cause of disability with a prevalence of about 2.5 in 1000 children born in developed countries, that is about 250 children every year in Switzerland. The primary cause of cerebral palsy is a brain lesion occurring shortly before or after birth. The brain lesion is static and does not progress with time but secondary consequences, such as joint contractures and bony deformities develop during childhood and adolescence. A variety of surgical interventions and orthotics prescriptions may be performed to improve the biomechanical capacity of the musculoskeletal system once the deformities have developed.

However, ethical and practical difficulties to organise randomised controlled trials within the field of surgery have led to low or moderate level of evidence to support the interventions. In addition, different patients may respond markedly differently to the same treatment. In this context, the principles of evidence-based medicine are difficult to apply by clinicians when choosing the most appropriate treatment for a given child, or when discussing their rationale with the families.

Since the 90s, instrumented gait analysis has been utilised to inform the clinical decision-making process, plan the details of surgical interventions when these are deemed necessary, and evaluate the outcome of these interventions. Instrumented gait analysis provides quantitative and objective measures of the walking function. It generates a rich dataset composed of more than 50 scalar values describing the lower limb anatomy and functioning as well as more than 80 waveforms describing the walking pattern of the patients.

In this project, routine clinical data collected in two leading gait analysis centres at the UKBB (Basel) and at the HUG (Geneva) will be connected to the SPHN infrastructure. The objectives of the project are to ensure the SPHN | Swiss Personalized Health Network 2 | 4 interoperability of gait analysis data collected in different clinical centres in Switzerland and internationally, to determine the causal treatment effect of some of the most common orthopaedic treatments to improve walking in children with cerebral palsy, and to quantify the added value of multicentric observational datasets.

This project aims to lay the foundation for national, and international, gait analysis data interoperability as well as support evidence-based clinical decision-making in the field of neuro-orthopaedics for children with cerebral palsy.