Drew Sarah, Gooberman-Hill Rachael, Lavy Christopher
Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
School of Clinical Sciences, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
BMC Musculoskelet Disord. 2018 Mar 2;19(1):72. doi: 10.1186/s12891-018-1984-z.
Around 100,000 children are born annually with clubfoot worldwide and 80% live in low and middle-income counties (LMICs). Clubfoot is a condition in which children are born with one or both feet twisted inwards and if untreated it can limit participation in everyday life. Clubfoot can be corrected through staged manipulation of the limbs using the Ponseti method. Despite its efficacy and apparent availability, previous research has identified a number of challenges to service implementation. The aim of this study was to synthesise these findings to explore factors that impact on the implementation of clubfoot services in LMICs and strategies to address them. Understanding these may help practitioners in other settings develop more effective services.
Five databases were searched and articles screened using six criteria. Articles were appraised using the Critical Appraisal Skills Programme (CASP) checklist. 11 studies were identified for inclusion. A thematic analysis was conducted.
Thematic analysis of the included studies showed that a lack of access to resources was a challenge including a lack of casting materials and abduction braces. Difficulties within the working environment included limited space and a need to share treatment space with other clinics. A shortage of healthcare professionals was a concern and participants thought that there was a lack of time to deliver treatment. This was exacerbated by the competing demands on clinicians. Lack of training was seen to impact on standards, including the nurses and midwives attending to the child at birth that were failing to diagnose the condition. Financial constraints were seen to underlie many of these problems. Some participants identified failures in communication and cooperation within the healthcare system such as a lack of awareness of clinics. Strategies to address these issues included means of increasing resource availability and the delivery of targeted training. The use of non-governmental organisations to provide financial support and methods to disseminate best practice were discussed.
This study identified factors that impact on the implementation of clubfoot services in LMIC settings.Findings may be used to improve service delivery.
全球每年约有10万名儿童出生时患有马蹄内翻足，其中80%生活在低收入和中等收入国家（LMICs）。马蹄内翻足是一种儿童出生时一只或两只脚向内扭曲的病症，如果不治疗，会限制其日常生活参与度。马蹄内翻足可通过使用庞塞蒂方法对肢体进行分阶段手法治疗来矫正。尽管该方法有效且看似可行，但先前的研究已确定了服务实施方面的一些挑战。本研究的目的是综合这些发现，以探讨影响低收入和中等收入国家马蹄内翻足服务实施的因素以及应对这些因素的策略。了解这些因素可能有助于其他地区的从业者制定更有效的服务。
检索了五个数据库，并使用六项标准筛选文章。使用批判性评估技能计划（CASP）清单对文章进行评估。确定纳入11项研究。进行了主题分析。
对纳入研究的主题分析表明，资源获取不足是一个挑战，包括缺乏石膏材料和外展支具。工作环境方面的困难包括空间有限以及需要与其他诊所共享治疗空间。医疗保健专业人员短缺令人担忧，参与者认为缺乏提供治疗的时间。临床医生面临的相互竞争的需求使这一情况更加恶化。缺乏培训被认为会影响治疗标准，包括分娩时照顾孩子的护士和助产士未能诊断出该病症。财务限制被视为许多这些问题的根源。一些参与者指出医疗保健系统内存在沟通和合作失败的情况，例如诊所之间缺乏了解。解决这些问题的策略包括增加资源可用性的方法以及提供有针对性的培训。讨论了利用非政府组织提供财政支持以及传播最佳实践的方法。
本研究确定了影响低收入和中等收入国家马蹄内翻足服务实施的因素。研究结果可用于改善服务提供。
