Andriesse Hanneke, Roos Ewa M, Hägglund Gunnar, Jarnlo Gun-Britt
Department of Orthopedics, Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden.
BMC Musculoskelet Disord. 2006 Mar 15;7:28. doi: 10.1186/1471-2474-7-28.
The Clubfoot Assessment Protocol (CAP) is a multi dimensional instrument designed for longitudinal follow up of the clubfoot deformity during growth. Item reliability has shown to be sufficient. In this article the CAP's validity and responsiveness is studied using the Dimeglio classification scoring as a gold standard.
Thirty-two children with 45 congenital clubfeet were assessed prospectively and consecutively at ages of new-born, one, two, four months and two years of age. For convergent/divergent construct validity the Spearman's correlation coefficients were calculated. Discriminate validity was evaluated by studying the scores in bilateral clubfeet. The floor-ceiling effects at baseline (untreated clubfeet) and at two years of age (treated clubfeet) were evaluated. Responsiveness was evaluated by using effect sizes (ES) and by calculating if significant changes (Wilcoxons signed test) had occurred between the different measurement occasions.
High to moderate significant correlation were found between CAP mobility I and morphology and the Dimeglio scores (rs = 0.77 and 0.44 respectively). Low correlation was found between CAP muscle function, mobility II and motion quality and the Dimeglio scoring system (rs = 0.20, 0.09 and 0.06 respectively). Of 13 children with bilateral clubfeet, 11 showed different CAP mobility I scores between right and left foot at baseline (untreated) compared with 5 with the Dimeglio score. At the other assessment occasions the CAP mobility I continued to show higher discrimination ability than the Dimeglio. No floor effects and low ceiling effects were found in the untreated clubfeet for both instruments. High ceiling effects were found in the CAP for the treated children and low for the Dimeglio. Responsiveness was good. ES from untreated to treated ranged from 0.80 to 4.35 for the CAP subgroups and was 4.68 for the Dimeglio. The first four treatment months, the CAP mobility I had generally higher ES compared with the Dimeglio.
The Clubfoot Assessment Protocol shows in this study good validity and responsiveness. The CAP is more responsive when severity ranges between mild-moderate to severe, while the Dimeglio focuses more on the extremes. The ability to discriminate between different mobility status of the right and left foot in bilaterally affected children in this population was higher compared with the Dimeglio score implicating a better sensitivity for the CAP.
马蹄内翻足评估方案（CAP）是一种多维度工具，用于对马蹄内翻足畸形在生长过程中的纵向随访。项目可靠性已被证明是足够的。在本文中，以迪梅廖分类评分作为金标准，研究了CAP的有效性和反应性。
对32例患有45只先天性马蹄内翻足的儿童进行前瞻性连续评估，评估时间点为新生儿期、1个月、2个月、4个月和2岁。对于收敛/发散结构效度，计算了斯皮尔曼相关系数。通过研究双侧马蹄内翻足的评分来评估区分效度。评估了基线（未治疗的马蹄内翻足）和2岁时（治疗后的马蹄内翻足）的地板效应和天花板效应。通过使用效应量（ES）并计算不同测量时间点之间是否发生了显著变化（威尔科克森符号秩检验）来评估反应性。
发现CAP活动度I和形态与迪梅廖评分之间存在高度到中度的显著相关性（rs分别为0.77和0.44）。CAP肌肉功能、活动度II和运动质量与迪梅廖评分系统之间的相关性较低（rs分别为0.20、0.09和0.06）。在13例双侧马蹄内翻足患儿中，11例在基线（未治疗）时左右脚的CAP活动度I评分不同，而迪梅廖评分不同的有5例。在其他评估时间点，CAP活动度I继续显示出比迪梅廖更高的区分能力。两种工具在未治疗的马蹄内翻足中均未发现地板效应，天花板效应较低。在接受治疗的儿童中，CAP发现有较高的天花板效应，而迪梅廖评分的天花板效应较低。反应性良好。CAP亚组从未治疗到治疗的ES范围为0.80至4.35，迪梅廖评分为4.68。在治疗的前四个月，CAP活动度I的ES通常高于迪梅廖评分。
本研究表明马蹄内翻足评估方案具有良好的有效性和反应性。当严重程度在轻度-中度至重度之间时，CAP的反应性更强，而迪梅廖评分更关注极端情况。与迪梅廖评分相比，该方案在该人群中双侧受累儿童左右脚不同活动状态的区分能力更高，这意味着CAP具有更好的敏感性。
