The impact of socio-economic factors on parental non-adherence to the Ponseti protocol for clubfoot treatment in low- and middle-income countries: A scoping review

Pigeolet, Manon; Vital, Anchelo; Daoud, Hassan; Mita, Carol; Corlew, D. Scott; Alkire, Blake C

doi:10.1016/j.eclinm.2022.101448

Cited by 12 publications

(17 citation statements)

References 46 publications

(76 reference statements)

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“…Our survey was for POSNA membership clubfoot providers only. Therefore, we could not account for patient, family, and socioeconomic factors that may have played a role in the severity of disease from a lack of follow-up [ 27 , 28 , 29 , 30 , 31 ]. Although we captured tenotomy indications and practices, we did not account for who performed the tenotomies in specific institutions.…”

Section: Discussionmentioning

confidence: 99%

Current Clubfoot Practices: POSNA Membership Survey

et al. 2023

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Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years’ experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell–Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications.

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Section: Discussionmentioning

confidence: 99%

Current Clubfoot Practices: POSNA Membership Survey

et al. 2023

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“…The follow-up time was 1.5 years in this study that's why it was impossible to get the analysis for comparison of puberty and outcome. Moreover, there were no pre-operative scores that's why it was difficult to make comparison of the results 23 .…”

Section: Discussionmentioning

confidence: 99%

Neglected Clubfoot; Surgical Treatment Algorithm Evaluation in Tertiary Care Hospital of Pakistan

Arsalan¹,

Kashmiri²,

Khan³

et al. 2022

PJMHS

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Background: The 1 in every 1000 infants are affected by the idiopathic club-foot. It is most commonly observed among the people living in the low middle income countries. Objective: The study was carried out to evaluate the surgical treatment algorithm in case of neglected clubfoot among patients admitted at tertiary care unit. Study design: It is a cohort based retrospective study conducted for the duration of six months from January 2022 to June 2022. Material and Methods: The study was conducted on the 40 patients presented with clubfoot at the tertiary health unit, Khyber Teaching Hospital, Peshawar, were included. The patients mean age was 11 years. The range of patient’s age was from 3 to 25 years. 13 patients went through bilateral intervention. And among these 40 patients there were 15 had received unilateral intervention for each foot. The basic features of the patients were recorded. There were 3 groups made containing operated clubfeet patients, first group included 15 patients, second and third group included 12 patients each. Results: There were 29 patients that received only one follow-up visit. The patients visited their doctors for the first year after surgery but then the visiting attendance became irregular afterwards. The altered ICFSG data was compared for only those patients that completed at least three follow-up visits. The variation between the score of participants between group 1 and 2 was not significant statitically. Conclusion: In case of neglected club-foot condition, PMR has shown excellent to fair results in patients especially children. Therefore, it can be proposed that PMR can be used to lessen the burden of neglected club-foot in the LMICs as it also has no side effects. There is a strong link between age and the surgical outcomes so the treatment must be done as soon as possible. Keywords: Club-foot, PMR, ICFSG data, surgical outcomes.

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“…Benefits of the Hub and Spoke model allowed for geographical accessibility. This allows for reduced disruption in development for babies, 26 diminishes travel costs and time spent, which is a particular burden for families in less affluent areas and LMICs, 27 and is a notable cause of non-compliance 17 and barrier to treatment. 18,19 The model also provides a comparative advantage to the tertiary Hub in that it improves allocation of human and equipment resources to manage complex feet that may require MDT input, which is a substantial challenge faced in LMICs.…”

Section: Complications Related To Castingmentioning

confidence: 99%

“…The most common challenges faced in Ponseti service delivery is providing a service that is both at a high standard 16 and geographically accessible. 17 This is applicable for both the UK and other countries, specifically LMICs, where it is often difficult for families to travel to specialized Ponseti clinics. [17][18][19] Patients may be treated in large centres with a great deal of experience, or may be treated more locally to increase attendance and compliance (as this condition requires continuous long-term follow-up), 5 albeit by a team that may have exposure to fewer cases per year.…”

Section: Introductionmentioning

confidence: 99%

A ‘Hub and Spoke’ Shared Care initiative for CTEV Ponseti service

Hussain,

Russell,

Cavanagh

et al. 2023

Bone Jt Open

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AimsThe Ponseti method is the gold standard treatment for congenital talipes equinovarus (CTEV), with the British Consensus Statement providing a benchmark for standard of care. Meeting these standards and providing expert care while maintaining geographical accessibility can pose a service delivery challenge. A novel ‘Hub and Spoke’ Shared Care model was initiated to deliver Ponseti treatment for CTEV, while addressing standard of care and resource allocation. The aim of this study was to assess feasibility and outcomes of the corrective phase of Ponseti service delivery using this model.MethodsPatients with idiopathic CTEV were seen in their local hospitals (‘Spokes’) for initial diagnosis and casting, followed by referral to the tertiary hospital (‘Hub’) for tenotomy. Non-idiopathic CTEV was managed solely by the Hub. Primary and secondary outcomes were achieving primary correction, and complication rates resulting in early transfer to the Hub, respectively. Consecutive data were prospectively collected and compared between patients allocated to Hub or Spokes. Mann-Whitney U test, Wilcoxon signed-rank test, or chi-squared tests were used for analysis (alpha-priori = 0.05, two-tailed significance).ResultsBetween 1 March 2020 and 31 March 2023, 92 patients (139 feet) were treated at the service (Hub 50%, n = 46; Spokes 50%, n = 46), of whom nine were non-idiopathic. All patients (n = 92), regardless of allocation, ultimately achieved primary correction, with idiopathic patients at the Hub requiring fewer casts than the Spokes (mean 4.0 (SD 1.4) vs 6.9 (SD 4.4); p < 0.001). Overall, 60.9% of Spokes’ patients (n = 28/46) required transfer to the Hub due to complications (cast slips Hub n = 2; Spokes n = 17; p < 0.001). These patients ultimately achieved full correction at the Hub.ConclusionThe Shared Care model was found to be feasible in terms of providing primary correction to all patients, with results comparable to other published services. Complication rates were higher at the Spokes, although these were correctable. Future research is needed to assess long-term outcomes, parents’ satisfaction, and cost-effectiveness.Cite this article: Bone Jt Open 2023;4(11):865–872.

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The impact of socio-economic factors on parental non-adherence to the Ponseti protocol for clubfoot treatment in low- and middle-income countries: A scoping review

Cited by 12 publications

References 46 publications

Current Clubfoot Practices: POSNA Membership Survey

Current Clubfoot Practices: POSNA Membership Survey

Neglected Clubfoot; Surgical Treatment Algorithm Evaluation in Tertiary Care Hospital of Pakistan

A ‘Hub and Spoke’ Shared Care initiative for CTEV Ponseti service

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