Evaluation of a simple tool to assess the results of Ponseti treatment for use by clubfoot therapists: a diagnostic accuracy study

Abstract

Background 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. Method 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. Results 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). Conclusions 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 of evidence Level II, Diagnostic Study. Electronic supplementary material The online version of this article (10.1186/s13047-019-0323-4) contains supplementary material, which is available to authorized users.

A systematic review of reported outcomes following Ponseti correction of idiopathic club foot

“…Most tools were developed in high-income countries with some notable exceptions. 22 , 23 It should be acknowledged that different parameters will be important to the parents and the child at different ages and different outcomes will have different significance in different parts of the world.…”

“…Most recently, assessment tools have been developed and specifically designed for low-income healthcare settings 22 , 23 showing good interobserver repeatability between physiotherapists and Ponseti practitioners. 24 Other classification systems which integrate gait analysis and paedobarography, 25 – 29 or isokinetic muscle strength assessment, 26 , 30 provide additional information but may not be feasible in most settings.…”

Remote monitoring of clubfoot treatment with digital photographs in low resource settings: Is it accurate?

“…The participants were those included in a cohort study to develop the ACT score [8,14]. They were children with a diagnosis of idiopathic CTEV corrected by the Ponseti method at Parirenyatwa Hospital, Harare, who attended follow-up review in January 2017, 3.5-5.0 years from initial casting.…”

“…Elements of the deformity that recur are typically noted under clinical examination and observation of function. The Assessing Clubfoot Treatment (ACT) score has recently been shown to easily and reliably assess the results of CTEV deformity treated with the Ponseti method in patients of walking age [8]. It was developed for clubfoot therapists to assess the results of Ponseti treatment in children of walking age, in low resource settings, where access to qualified therapists may be limited.…”

Avaliação do tratamento precoce do pé torto congênito idiopático pelo método de Ponseti

“…The average age at the beginning of treatment was 42 days, with the minimum being four days, and the maximum being 82 days. The average number of cast changes was 7.41/patient (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), but no statistical correlation was observed with treatment results (p = 0.11). The average follow-up time was 50 months (minimum, 12 months; maximum, 98 months).…”