The PBS Score – a clinical assessment tool for the ambulatory and recurrent clubfoot

Böhm, Stephanie; Sinclair, Marc

doi:10.1302/1863-2548.13.190077

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…Other outcome tools use clinical examination findings alone. 15 , 18 , 21 Different tools dictate different degrees of detail for clinical examination – ranging from binary ‘yes’ or ‘no’ outcomes (for example, for a plantigrade foot) to quantitative measures of range of movement.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Aims To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot. Methods A systematic review of the literature was performed to identify a list of outcomes and outcome tools reported in the literature. A total of 865 studies were screened following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 124 trials were included in the analysis. Data extraction was completed by two researchers for each trial. Each outcome tool was assigned to one of the five core areas defined by the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT). Bias assessment was not deemed necessary for the purpose of this paper. Results In total, 20 isolated outcomes and 16 outcome tools were identified representing five OMERACT domains. Most outcome tools were appropriately designed for children of walking age but have not been embraced in the literature. The most commonly reported isolated outcomes are subjective and qualitative. The quantitative outcomes most commonly used are ankle range of motion (ROM), foot position in standing, and muscle function. Conclusions There is a diverse range of outcomes reported in studies of Ponseti correction of clubfoot. Until outcomes can be reported unequivocally and consistently, research in this area will be limited. Completing the process of establishing and validating COS is the much-needed next step. Cite this article: Bone Joint Open 2020;1-8:457–464.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…The consensus group agreed that several of the individual OMTs that reached ‘consensus in’ could be grouped together and would then represent part of two established outcome scores. The PBS score, 31 which includes OMTs such as muscle strength, ankle, and subtalar range of motion, foot position and gait, represents the musculoskeletal domain under the core area of pathophysiological manifestations. Five additional clinical OMTs that are not a part of the PBS score have reached ‘consensus in’, of which one is static and four are dynamic.…”

Section: Delphi Surveymentioning

confidence: 99%

The outcomes of idiopathic congenital talipes equinovarus

et al. 2022

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Aims To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV). Methods A list of outcome measurement tools (OMTs) was obtained from the literature through a systematic review. Further outcomes were collected from patients and families through a questionnaire and interview process. The combined list, as well as the appropriate follow-up timepoint, was rated for importance in a two-round Delphi process that included an international group of orthopaedic surgeons, physiotherapists, nurse practitioners, patients, and families. Outcomes that reached no consensus during the Delphi process were further discussed and scored for inclusion/exclusion in a final consensus meeting involving international stakeholder representatives of practitioners, families, and patient charities. Results In total, 39 OMTs were included from the systematic review. Two additional OMTs were identified from the interviews and questionnaires, and four were added after round one Delphi. Overall, 22 OMTs reached ‘consensus in’ during the Delphi and two reached ‘consensus out’; 21 OMTs reached ‘no consensus’ and were included in the final consensus meeting. In all, 21 participants attended the consensus meeting, including a wide diversity of clubfoot practitioners, parent/patient representative, and an independent chair. A total of 21 outcomes were discussed and voted upon; six were voted ‘in’ and 15 were voted ‘out’. The final COS document includes nine OMTs and two existing outcome scores with a total of 31 outcome parameters to be collected after a minimum follow-up of five years. It incorporates static and dynamic clinical findings, patient-reported outcome measures, and a definition of CTEV relapse. Conclusion We have defined a minimum set of outcomes to draw comparisons between centres and studies in the treatment of CTEV. With the use of these outcomes, we hope to allow more meaningful research and a better clinical management of CTEV. Cite this article: Bone Jt Open 2022;3(1):98–106.

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“…Dynamic supination has been attributed to over-active supination by the tibialis anterior muscle 4,7,9,10. Some studies define the observation of supination of the foot in early swing phase of gait with initial contact on the lateral border to be a sign of this relapse 11,12. It is also noted to be a result of muscle imbalance that leads to recurrent clubfoot deformity and a known indication for a tibialis anterior tendon transfer surgery when clinically significant 3,8…”

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confidence: 99%

Dynamic Supination in Congenital Clubfoot: A Modified Delphi Panel Approach to Standardizing Definitions and Indications for Treatment

Baskar

Hosseinzadeh²,

Mosca³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Dynamic supination is a well-recognized cause of congenital clubfoot deformity relapse. However, there is no consensus on how to diagnose it and there are varied approaches in its management. This study aims to define dynamic supination and indications for treatment by presenting consensus from an international panel of experts using a modified Delphi panel approach. Methods: An international panel of 15 pediatric orthopaedic surgeons with clinical and research expertise in childhood foot disorders participated in a modified Delphi panel on dynamic supination in congenital clubfoot. Panelists voted on 51 statements using a 4-point Likert scale on dynamic supination, clinical indications for treatment, operative techniques, and postoperative casting and bracing. All panelists participated in 2 voting rounds with an interim meeting for discussion. Responses were classified as unanimous consensus (100%), consensus (80% or above), near-consensus (70% to 79%), and indeterminate (69% or less). Results: Consensus was achieved for 34 of 51 statements. Panelists agreed dynamic supination is present when the forefoot is supinated during swing phase of gait with initial contact on the lateral border of the foot. There was also agreement that dynamic supination results from muscle imbalance between the tibialis anterior and the peroneus longus and brevis. There was no consensus on observation of hindfoot varus in dynamic supination, operative indications for posterior release of the ankle joint, or incisional approach for tibialis anterior tendon transfer. Reference to the calcaneopedal unit concept, planes of movement, and phases of gait were deemed important factors for consideration when evaluating dynamic supination. Conclusions: Consensus statements from the Delphi panel can guide diagnosis and treatment of dynamic supination in clubfoot deformity relapse, including clinical decision making regarding preoperative casting, surgical approach, and postoperative immobilization. Near-consensus and indeterminate statements may be used to direct future areas of investigation. Level of Evidence: Level V.

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The PBS Score – a clinical assessment tool for the ambulatory and recurrent clubfoot

Cited by 10 publications

References 25 publications

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

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

The outcomes of idiopathic congenital talipes equinovarus

Dynamic Supination in Congenital Clubfoot: A Modified Delphi Panel Approach to Standardizing Definitions and Indications for Treatment

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