1International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT UK.
2University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.
J Foot Ankle Res. 2019 Mar 4;12:14. doi: 10.1186/s13047-019-0323-4. eCollection 2019.
We aimed to develop and evaluate a tool for clubfoot therapists in low resource settings to assess the results of Ponseti treatment of congenital talipes equinovarus, or clubfoot, in children of walking age.
A literature review and a Delphi process based on the opinions of 35 Ponseti trainers in Africa were used to develop the Assessing Clubfoot Treatment (ACT) tool and score. We followed up children with clubfoot from a cohort treated between 2011 and 2013, in 2017. A full clinical assessment was conducted to decide if treatment was successful or if further treatment was required. The ACT score was then calculated for each child. Inter-observer variation for the ACT tool was assessed. Sensitivity, specificity, positive and negative predictive values were calculated for the ACT score compared to full clinical assessment (gold standard). Predictors of a successful outcome were explored.
The follow up rate was 31.2% (68 children). The ACT tool consisted of 4 questions; each scored from 0 to 3, giving a total from 0 to 12 where 12 is the ideal result. The 4 questions included one physical assessment and three parent reported outcome measures. It took 5 min to administer and had excellent inter-observer agreement.An ACT score of 8 or less demonstrated 79% sensitivity and 100% specificity in identifying children that required further intervention, with a positive predictive value of 100% and negative predictive value of 90%. Children who completed two or more years of bracing were four times more likely to achieve an ACT score of 9 or more compared to those who did not (OR: 4.08, 95% CI: 1.31-12.65, = 0.02).
The ACT tool is simple to administer, had excellent observer agreement, and good sensitivity and specificity in identifying children who need further intervention. The score can be used to identify those children who definitely need referral and further treatment (score 8 or less) and those with a definite successful outcome (score 11 or more), however further discrimination is needed to decide how to manage children with a borderline ACT score of 9 or 10.
Level II, Diagnostic Study.
我们旨在为资源匮乏环境中的足踝畸形矫治治疗师开发并评估一种工具，以评估 Ponseti 技术治疗先天性马蹄内翻足（即足踝畸形）的疗效，该工具适用于学步期儿童。
我们通过文献回顾和基于 35 位非洲 Ponseti 培训师意见的 Delphi 流程，开发了 Assessing Clubfoot Treatment（ACT）工具和评分系统。我们对 2011 年至 2013 年期间接受治疗的患儿队列进行了随访，随访时间为 2017 年。对所有患儿进行全面的临床评估，以确定治疗是否成功或是否需要进一步治疗。然后为每个患儿计算 ACT 评分。评估 ACT 工具的观察者间变异性。与全面临床评估（金标准）相比，计算 ACT 评分的敏感性、特异性、阳性预测值和阴性预测值。探索了预测治疗结果的因素。
随访率为 31.2%（68 例患儿）。ACT 工具由 4 个问题组成；每个问题的评分范围为 0 至 3 分，总分 0 至 12 分，分数越高表示结果越理想。这 4 个问题包括一项体格检查和三项家长报告的结局测量指标。该工具的实施时间为 5 分钟，观察者间的一致性极好。ACT 评分≤8 分的患儿，其需要进一步干预的比例为 79%，特异性为 100%，阳性预测值为 100%，阴性预测值为 90%。与未完成 2 年以上支具治疗的患儿相比，完成 2 年以上支具治疗的患儿获得 ACT 评分≥9 分的可能性高出 4 倍（比值比：4.08，95%置信区间：1.31-12.65， = 0.02）。
ACT 工具易于实施，观察者间的一致性极好，在识别需要进一步干预的患儿方面具有良好的敏感性和特异性。评分可用于确定那些肯定需要转介和进一步治疗的患儿（评分≤8 分）和那些有明确良好结局的患儿（评分≥11 分），然而，需要进一步区分以决定如何管理 ACT 评分为 9 分或 10 分的患儿。
二级，诊断研究。
