{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:00:15Z","timestamp":1785470415405,"version":"3.56.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01NS091056"],"award-info":[{"award-number":["R01NS091056"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To estimate the effect of surgery on parent\u2010reported gait outcomes as measured using the Gait Outcomes Assessment List (GOAL) questionnaire in a cohort undergoing surgery guided by instrumented gait analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      This was an observational study (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0146 individuals, 59 females [40%], median age 7\u2009years 10\u2009months [interquartile range 6\u2009years to 10\u2009years 10\u2009months]) classified in Gross Motor Function Classification System levels I\u2013III). The X\u2010Learner was used to estimate the causal treatment effect on treated individuals. The X\u2010Learner is an advanced machine learning framework designed to estimate causal and heterogeneous treatment effects while controlling for confounding and minimizing bias. Changes in parent\u2010reported GOAL domains were compared with objective measures (Gait Deviation Index, walking speed, energy consumption); heterogeneous treatment effects were explored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant positive causal treatment effects were observed in gait pattern and appearance, and use of braces and mobility aids (+10 points). Moderate effects were observed for body image and self\u2010esteem, and pain, discomfort, and fatigue (+5 points). Functional domains (activities of daily living and independence; gait function and mobility; physical activities, sports, and recreation) showed only small positive effects or slightly negative effects. Gait pattern and appearance was positively correlated with the Gait Deviation Index; however, GOAL items related to walking speed and fatigue showed no association with laboratory\u2010measured analogs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Surgery guided by instrumented gait analysis substantially improved gait appearance and comfort. Clinicians should manage expectations regarding improvements in functional mobility. The disconnect between subjective patient\u2010reported outcome measures and objective measures highlights the complexity of quantifying a treatment's full impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dmcn.70389","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:50:00Z","timestamp":1785469800000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Causal treatment effects of gait\u2010analysis\u2010informed surgery on the Gait Outcomes Assessment List in children with cerebral palsy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3388-7413","authenticated-orcid":false,"given":"Michael H.","family":"Schwartz","sequence":"first","affiliation":[{"name":"Orthopedic Surgery, University of Minnesota\u2010Twin Cities  Minneapolis MN USA"},{"name":"Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare  St.\u00a0Paul MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Georgiadis","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, University of Minnesota\u2010Twin Cities  Minneapolis MN USA"},{"name":"Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare  St.\u00a0Paul MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13618"},{"key":"e_1_2_8_3_1","first-page":"29","article-title":"Predicting outcomes of rectus femoris transfer surgery","volume":"57","author":"Narayanan U","journal-title":"Developmental Medicine & Child Neurology"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13722"},{"key":"e_1_2_8_5_1","first-page":"1643","article-title":"Factor analysis of the gait outcomes assessment list's goal questions: A new method to measure goal prioritization in ambulatory individuals with cerebral palsy","volume":"65","author":"Munger ME","year":"2023","journal-title":"Developmental Medicine & Child Neurology"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.15677"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","DOI":"10.2202\/1557-4679.1203","article-title":"An introduction to causal inference. 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