Reliability of physiotherapists using the Pirani scoring system for clubfoot

Harvey, Nicole J.; Daley, Deborah; Mudge, Anita; Sims, Susan; Adams, Roger

doi:10.12968/ijtr.2012.19.8.439

Cited by 4 publications

(14 citation statements)

References 11 publications

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“…All children underwent treatment using the Ponseti method [15] at the dedicated clubfoot clinic at The Children's Hospital at Westmead. Baseline severity was established by the treating orthopaedic surgeon (PG) or senior physiotherapists using the valid and reliable Pirani score [8,12,17]. This score comprises six items, summed together to describe severity of the clubfoot deformity.…”

Section: Methodsmentioning

confidence: 99%

Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Gray

Gibbons

Little

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Congenital talipes equinovarus, or clubfoot, is a common pediatric orthopaedic condition of unknown origin. In many clubfoot clinical trials, interventions are assigned to a patient, but response to treatment is assessed separately in each foot. Trials commonly report x patients with y feet where y is greater than x (eg, 35 patients with 56 feet). However, common statistical tests assume that each data point is independent. Although data from unilateral cases of clubfoot are independent, it is unknown if each foot of patients with bilateral clubfeet are correlated. Questions/purposes The purpose of this study was to assess the correlation in the feet of patients with bilateral clubfeet by (1) evaluating the degree of severity between lower limbs of each patient with bilateral clubfeet at baseline; (2) determining if right and left feet of each patient responded to intervention in the same way; (3) determining the proportion of bilateral relapse; and (4) determining the proportion of right and left feet which required the same intervention to correct bilateral relapse. Methods We performed a chart review of the records of 33 patients with bilateral clubfeet (66 feet). Baseline severity was assessed using the Pirani score. The number of Ponseti serial casts to correct the deformity, the proportion of patients who underwent bilateral Achilles tenotomy, the proportion of bilateral relapse, and the treatment to correct bilateral relapse were examined. Results The degree of severity between right (Pirani score mean, 5.2; SD, 0.8) and left (Pirani score mean, 5.2; SD, 0.5) feet for each patient at baseline was highly correlated (r = 0.76, p \ 0.001). Response to intervention between lower limbs was highly correlated for the number of Ponseti casts required for initial correction (right mean, 5.2, SD, 1.1; left mean, 5.2, SD, 1.3) (r = 0.89, p \ 0.001) and the proportion of patients who underwent bilateral Achilles tenotomy (right, 17/18; left, 16/18) (r = 0.94, p \ 0.001). In the nine patients who experienced relapse, eight experienced bilateral involvement. In all cases of bilateral relapse, the right and left foot of each patient required the same intervention to correct the relapse. Conclusions In patients with bilateral clubfeet, baseline severity, response to initial Ponseti treatment, Achilles tenotomy, and relapse outcomes were highly correlated in

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Section: Methodsmentioning

confidence: 99%

Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Gray

Gibbons

Little

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Therefore, Harvey et al . added a certainty measure score (0 or 1) to each sign to make a five-point severity scoring system, but there was no significant difference in reliability between the three-point and five-point severity scales 9 , 20 . Just by assessing the clubfoot from photographs, the inter-rater reliability of Pirani scores between 25 physiotherapists was fairly good regardless of their clinical experience 20 .…”

Section: Discussionmentioning

confidence: 99%

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

Fan

Liu

Zhao

et al. 2017

Sci Rep

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The Pirani and Dimeglio scoring systems both have excellent inter-observer and intra-observer reliability, but no research has been conducted to determine their inter-observer reliability and their relationship at different levels of deformity. A total of 173 idiopathic clubfoot cases were reviewed using Pirani and Dimeglio scoring systems, and the number of casts needed was also recorded. For clubfeet with a cast number equal to 2 or 7 and 8, the inter-observer reliability of the two scoring systems was poor or moderate, and there was no correlation between the two scoring systems. There was also no correlation between the Dimeglio scoring score with the number of casts for grade II or IV clubfeet. A binary regression of the number of casts on initial Pirani or Dimeglio scores showed that there was a Quadratic or Cubic relation between the scores and the cast numbers. In conclusion, in the case of mild and very severe clubfoot deformity, the interobserver reliability and its ability to predict the number of casts needed for clubfoot deformity correction was poor. A more objective evaluation system may be required.

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“…A score (or item) with low reliability compromises every further consideration or correlation. Both Diméglio (DimS) and Pirani (PirS) scores have been considered to have high interrater reliability in terms of total score, 2,5,7,[10][11][12][13][14][15][16][17] but reliability of their subcomponents has been evaluated by very few studies. 5,[13][14][15][16][17] The purpose of the present study was to assess the reliability of PirS and DimS and of their items on the same sample of clubfeet and to suggest features and criteria that might be improved in future score systems.…”

Section: Introductionmentioning

confidence: 99%

Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: A need for improved scoring systems

Bettuzzi

Abati

Salvatori

et al. 2019

Journal of Children's Orthopaedics

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Purpose Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. Methods Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. Results For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved. For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. Conclusions In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. Level of Evidence Level I – Diagnostic studies

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Reliability of physiotherapists using the Pirani scoring system for clubfoot

Cited by 4 publications

References 11 publications

Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: A need for improved scoring systems

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