Smythe Tracey, Gova Maxman, Muzarurwi Rumbidzai, Foster Allen, Lavy Christopher
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, UK.
Department of Surgery, Parirenyatwa Group of Hospitals, Harare, Zimbabwe.
BMC Musculoskelet Disord. 2018 Dec 22;19(1):450. doi: 10.1186/s12891-018-2365-3.
There are various established scoring systems to assess the outcome of clubfoot treatment after correction with the Ponseti method. We used five measures to compare the results in a cohort of children followed up for between 3.5 to 5 years.
In January 2017 two experienced physiotherapists assessed children who had started treatment between 2011 and 2013 in one clinic in Harare, Zimbabwe. The length of time in treatment was documented. The Roye score, Bangla clubfoot assessment tool, the Assessing Clubfoot Treatment (ACT) tool, proportion of relapsed and of plantigrade feet were used to assess the outcome of treatment in the cohort. Inter-observer variation was calculated for the two physiotherapists. A comparative analysis of the entire cohort, the children who had completed casting and the children who completed more than two years of bracing was undertaken. Diagnostic accuracy was calculated for the five measures and compared to full clinical assessment (gold standard) and whether referral for further intervention was required for re-casting or surgical review.
31% (68/218) of the cohort attended for examination and were assessed. Of the children who were assessed, 24 (35%) had attended clinic reviews for 4-5 years, and 30 (44%) for less than 2 years. There was good inter-observer agreement between the two expert physiotherapists on all assessment tools. Overall success of treatment varied between 56 and 93% using the different outcome measures. The relapse assessment had the highest unnecessary referrals (19.1%), and the Roye score the highest proportion of missed referrals (22.7%). The ACT and Bangla score missed the fewest number of referrals (7.4%). The Bangla score demonstrated 79.2% (95%CI: 57.8-92.9%) sensitivity and 79.5% (95%CI: 64.7-90.2%) specificity and the ACT score had 79.2% (95%CI: 57.8-92.9%) sensitivity and 100% (95%CI: 92-100%) specificity in predicting the need for referral.
At three to five years of follow up, the Ponseti method has a good success rate that improves if the child has completed casting and at least two years of bracing. The ACT score demonstrates good diagnostic accuracy for the need for referral for further intervention (specialist opinion or further casting). All tools demonstrated good reliability.
有多种既定的评分系统可用于评估经庞塞蒂方法矫正后的马蹄内翻足治疗效果。我们采用了五项指标来比较一组随访3.5至5年的儿童的治疗结果。
2017年1月，两名经验丰富的物理治疗师对2011年至2013年期间在津巴布韦哈拉雷一家诊所开始接受治疗的儿童进行了评估。记录了治疗时间。使用罗伊评分、孟加拉国马蹄内翻足评估工具、马蹄内翻足治疗评估（ACT）工具、复发比例和足底行走足比例来评估该队列的治疗效果。计算了两名物理治疗师之间的观察者间差异。对整个队列、完成石膏固定的儿童以及完成两年以上支具治疗的儿童进行了比较分析。计算了这五项指标的诊断准确性，并与全面临床评估（金标准）以及是否需要转诊进行进一步干预以重新进行石膏固定或手术复查进行了比较。
该队列中有31%（68/218）的儿童前来接受检查并得到评估。在接受评估的儿童中，24名（35%）接受了4至5年的门诊复查，30名（44%）接受的复查时间不到2年。两位专家物理治疗师在所有评估工具上的观察者间一致性良好。使用不同的评估指标，治疗的总体成功率在56%至93%之间。复发评估的不必要转诊率最高（19.1%），罗伊评分的漏诊转诊比例最高（22.7%）。ACT和孟加拉国评分的漏诊转诊数量最少（7.4%）。孟加拉国评分在预测是否需要转诊方面的敏感性为79.2%（95%CI：57.8 - 92.9%），特异性为79.5%（95%CI：64.7 - 90.2%）；ACT评分的敏感性为79.2%（95%CI：57.8 - 92.9%），特异性为100%（95%CI：92 - 100%）。
在随访三至五年时，庞塞蒂方法的成功率较高，如果儿童完成了石膏固定和至少两年的支具治疗，成功率会更高。ACT评分在预测是否需要转诊进行进一步干预（专家意见或进一步石膏固定）方面具有良好的诊断准确性。所有工具都显示出良好的可靠性。
