Davids Jon R, Shilt Jeff, Kay Robert, Dreher Thomas, Shore Benjamin J, McCarthy James, Shrader Wade, Graham Kerr, Veerkamp Matthew, Narayanan Unni, Chambers Hank, Novacheck Tom, Rhodes Jason, Van Campenhout Anja, Pierz Kristan, Theologis Tim, Rutz Erich
Shriners Children's Northern California, Sacramento, CA, USA.
Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA.
J Child Orthop. 2022 Apr;16(2):111-120. doi: 10.1177/18632521221084183. Epub 2022 Apr 30.
The purpose of this study was to establish consensus for the assessment of foot alignment and function in ambulatory children with cerebral palsy, using expert surgeon's opinion through a modified Delphi technique.
The panel used a five-level Likert-type scale to record agreement or disagreement with 33 statements regarding the assessment of foot alignment and function. Consensus was defined as at least 80% of responses being in the highest or lowest of two of the five Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.
Consensus was achieved for 25 (76%) statements, general agreement for 4 (12%) statements, and lack of consensus for 4 (12%) of the statements. There was consensus that the functional anatomy of the foot is best understood by dividing the foot into three segments and two columns. Consensus was achieved concerning descriptors of foot segmental alignment for both static and dynamic assessment. There was consensus that radiographs of the foot should be weight-bearing. There was general agreement that foot deformity in children with cerebral palsy can be classified into three levels based on soft tissue imbalance and skeletal malalignment.
The practices identified in this study can be used to establish best care guidelines, and the format used will be a template for future Delphi technique studies on clinical decision-making for the management of specific foot segmental malalignment patterns commonly seen in children with cerebral palsy.
V.
本研究的目的是通过改良的德尔菲技术，利用外科专家的意见，就评估脑瘫患儿步行时足部对线和功能达成共识。
专家小组使用五级李克特量表记录对33条关于足部对线和功能评估陈述的同意或不同意程度。共识定义为至少80%的回答处于五级李克特评级中最高或最低的两个等级。总体同意定义为60%-79%的回答属于最高或最低的两个等级。如果未达到任何一个阈值，则表示未达成一致。
25条（76%）陈述达成了共识，4条（12%）陈述达成了总体同意，4条（12%）陈述未达成共识。大家一致认为，将足部分为三个节段和两个柱来理解足部的功能解剖最为合适。在静态和动态评估中，关于足部节段对线的描述符达成了共识。大家一致认为足部X线片应负重拍摄。普遍同意，基于软组织失衡和骨骼排列不齐，脑瘫患儿的足部畸形可分为三个等级。
本研究确定的做法可用于制定最佳护理指南，所采用的形式将成为未来关于脑瘫患儿常见特定足部节段排列不齐模式临床决策的德尔菲技术研究的模板。
V级。
