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The online version of this article (https://doi.org/10.1186/s13047-019-0323-4) contains supplementary material, which is available to authorized users.
We aimed to develop and evaluate a tool for clubfoot therapists in low resource settings to assess the results of Ponseti treatment of congenital talipes equinovarus, or clubfoot, in children of walking age.
A literature review and a Delphi process based on the opinions of 35 Ponseti trainers in Africa were used to develop the Assessing Clubfoot Treatment (ACT) tool and score. We followed up children with clubfoot from a cohort treated between 2011 and 2013, in 2017. A full clinical assessment was conducted to decide if treatment was successful or if further treatment was required. The ACT score was then calculated for each child. Inter-observer variation for the ACT tool was assessed. Sensitivity, specificity, positive and negative predictive values were calculated for the ACT score compared to full clinical assessment (gold standard). Predictors of a successful outcome were explored.
The follow up rate was 31.2% (68 children). The ACT tool consisted of 4 questions; each scored from 0 to 3, giving a total from 0 to 12 where 12 is the ideal result. The 4 questions included one physical assessment and three parent reported outcome measures. It took 5 min to administer and had excellent inter-observer agreement.
An ACT score of 8 or less demonstrated 79% sensitivity and 100% specificity in identifying children that required further intervention, with a positive predictive value of 100% and negative predictive value of 90%. Children who completed two or more years of bracing were four times more likely to achieve an ACT score of 9 or more compared to those who did not (OR: 4.08, 95% CI: 1.31–12.65, p = 0.02).
The ACT tool is simple to administer, had excellent observer agreement, and good sensitivity and specificity in identifying children who need further intervention. The score can be used to identify those children who definitely need referral and further treatment (score 8 or less) and those with a definite successful outcome (score 11 or more), however further discrimination is needed to decide how to manage children with a borderline ACT score of 9 or 10.
Level II, Diagnostic Study.
Additional file 1: STARD Checklist for Reporting of Studies of Diagnostic Accuracy. (DOCX 21 kb)13047_2019_323_MOESM1_ESM.docx
Additional file 2: Results of ACT score and treatment required. (DOCX 12 kb)13047_2019_323_MOESM2_ESM.docx
Additional file 3: ACT score distribution. (DOCX 13 kb)13047_2019_323_MOESM3_ESM.docx
Additional file 4: Results of Quality of Life Questionnaire. (DOCX 13 kb)13047_2019_323_MOESM4_ESM.docx
Additional file 5: Results of Healthcare Satisfaction Questionnaire. (DOCX 15 kb)13047_2019_323_MOESM5_ESM.docx
Smythe T, Kuper H, Macleod D, Foster A, Lavy C. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Tropical Med Int Health. 2017;22(3):269–85.
Dietz F. The genetics of idiopathic clubfoot. Clin Orthop Relat Res. 2002;401:39–48.
Tindall AJ, Steinlechner CWB, Lavy CBD, Mannion S, Mkandawire N. Results of manipulation of idiopathic clubfoot deformity in Malawi by Orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world? [article]. Journal of Pediatric Orthopaedics September/October. 2005;25(5):627–9.
Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23–31. PubMed
Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129–36. PubMed
Pirani S, Hodges D, Sekeramayi F. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity. Journal of Bone & Joint Surgery, British Volume. 2008(90-B (SUPP I):53).
Roye BD, Vitale MG, Gelijns AC, Roye DP Jr. Patient-based outcomes after clubfoot surgery. J Pediatr Orthop. 2001;21(1):42–9. PubMed
Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6(11).
Portney LG, Watkins MP. Foundations of clinical research. Upper Saddle River, NJ: Pearson Prentice Hall; 2009.
Smythe T, Chandramohan D, Bruce J, Kuper H, Lavy C, Foster A. Results of clubfoot treatment after manipulation and casting using the Ponseti method: experience in Harare, Zimbabwe. Tropical Med Int Health. 2016;21(10):1311–8.
Souza FM, Molina J, Terreri MT, Hilario MO, Len CA. Reliability of the pediatric quality of life inventory - healthcare satisfaction generic module 3.0 version for the assessment of the quality of care of children with chronic diseases. J Pediatr. 2012;88(1):54–60.
Desai AD, Zhou C, Stanford S, Haaland W, Varni JW, Mangione-Smith RM. Validity and responsiveness of the pediatric quality of life inventory (PedsQL) 4.0 generic core scales in the pediatric inpatient setting. JAMA Pediatr. 2014;168(12):1114–21. PubMed
Zionts LE, Jew MH, Bauer KL, Ebramzadeh E, S NS. How many patients who have a clubfoot treated using the Ponseti method are likely to undergo a tendon transfer? J Pediatr Orthop 2016;July.
- Evaluation of a simple tool to assess the results of Ponseti treatment for use by clubfoot therapists: a diagnostic accuracy study
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