Predictive Factors of Cessation of Ambulation in Patients with Duchenne Muscular Dystrophy

Bakker JPJ, de Groot IJM, Beelen A, Lankhorst GJ: Predictive factors of cessation of ambulation in patients with Duchenne muscular dystrophy. Am J Phys Med Rehabil 2002;81:906–912. Objectives To identify baseline patient and treatment characteristics that can predict wheelchair dependency within 2 yr. Design This prospective cohort study included 44 subjects who met study inclusion criteria. The same investigator examined them at 6-mo intervals. Ambulatory status, anthropometric data, muscle strength, range of motion of weight bearing joints, scoliosis, WeeFIM® instrument, Functional Status II revised, and use of standing and walking aids. Cox proportional hazards regression analysis and the stepwise technique were used to search for prognostic factors of wheelchair dependency within 2 yr. Results Children with impaired hip extension and ankle dorsiflexion strength are 11.5 (95% confidence interval, 3.2–40.5) and 3.7 (95% confidence interval, 1.4–9.7) times, respectively, more likely to stop ambulating within 2 yr. Conclusions This study confirms that strength loss, specifically in hip extension and ankle dorsiflexion, are the primary predictors of loss of ambulation in Duchenne muscular dystrophy. Further research is needed for medical interventions that can improve hip extension or ankle dorsiflexion and actually can improve ambulation.