Exploring health professionals' understanding of evidence‐based treatment for idiopathic toe walking

Abstract

Background Idiopathic toe walking (ITW) is an exclusionary diagnosis resulting in a child walking on the balls of their feet. Preferred treatment options may be due to the severity of the toe or the health professional preference There are limited guidelines supporting consistent treatment recommendations for this condition. This research aimed to understand agreement between health professionals' knowledge of evidence for common treatment strategies for ITW and if health professionals supported these strategies being used in clinical practice. Methods An international online survey was opened to registered health professionals who treat children with ITW between July 2017 and March 2018. The survey had two components: (a) demographic variables and variables relating to knowledge of evidence about ITW treatments and (b) support for common treatment strategies. Additional data on strategy use, referrals, and preference were collected. Kappa statistics described intra‐rater agreement between evidence knowledge and support. Multivariable regression analyses identified factors associated with the 10 most commonly preferred treatments. Results There were 908 international responses. Kappa agreement for paired correct responses determined a fair agreement for evidence support knowledge for four strategies including watch and wait (Kappa = 0.24), stretching (Kappa = 0.30), sensory integration strategies (Kappa = 0.40), and motor control strategies (Kappa = 0.24) and moderate responses for 13 others. No strategies had greater than moderate agreement between correct knowledge of evidence and strategy support. Profession, location, number of children seen in practice, and not correctly identifying the evidence factored into many of the most commonly used strategies for ITW (p < .05). Conclusions The results from this study, which confirm a variety of interventions, are utilized in the management of ITW around the world. Furthermore, there remains a disconnection between paediatric health professionals' understanding of the evidence of common treatment strategies of ITW and a consensus for the treatment of this condition.

A Retrospective Analysis of Nonoperative Treatment Techniques for Idiopathic Toe Walking in Children: Outcomes and Predictors of Success

“…With limited literature guiding treatment approaches and resources, these differing backgrounds likely affected what treatment was offered. 10 For example, a physical therapist may be more apt to consider the use of AFOs, sensory integration strategies, stretching, and casting as they are expertly trained in these modalities. 10 Surgeons may be more apt to abandon nonoperative modalities earlier if success is not achieved and consider surgery.…”

“…10 For example, a physical therapist may be more apt to consider the use of AFOs, sensory integration strategies, stretching, and casting as they are expertly trained in these modalities. 10 Surgeons may be more apt to abandon nonoperative modalities earlier if success is not achieved and consider surgery. Additionally, surgeons may be seeing the most severely affected children.…”

“…9 There is no consensus regarding the optimal approach for nonoperative management of ITW, resulting in wide variations in treatment across providers and institutions. 3,10 Surgical correction with gastrocnemius recession or tendo-achilles lengthening is typically recommended for children 7 years and older when the equinus contractures are more severe and fail to resolve with nonoperative management. 6,9 Both nonoperative and surgical treatments have high recurrence rates reported between 8% and 88% and 17% and 63%, respectively.…”

American and Australian family experiences while receiving a diagnosis or having treatment for idiopathic toe walking: a qualitative study

“…Similarly, described in a recent international health professional's survey. 11 Without international uniformity of treatment pathways, parents and children may continue to receive disparate care. It should be a priority for healthcare providers and researchers to provide information consistent with evidence.…”

“…A recent survey of treatment options for ITW found that healthcare professionals preferred up to 10 different treatments and these varied depending on the healthcare professional. 11 For parents, varied treatment options may result in a misinterpretation of an ITW diagnosis, its natural history or why their child received a different treatment to those offered to other children with the same diagnosis.…”