Sahdi Haniza, Prabaharan Ravin, Cheah Whye Lian, Rasit Ahmad Hata, Sultan Abdul Kader Mohamed Ameenudeen B A, Bujang Mohamad Adam, Nur Alyana Benjamin Abdullah
MD, MS Ortho, Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Jalan Datuk Mohammad Musa, Kota Samarahan, Sarawak, Malaysia. Email:
MD, MS Ortho, Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah (UMS), Jalan UMS, Kota Kinabalu, Sabah, Malaysia, Malaysia.
Malays Fam Physician. 2024 Nov 29;19:68. doi: 10.51866/oa.697. eCollection 2024.
Non-orthopaedic-trained healthcare professionals face challenges in identifying postnatal clubfoot deformities due to the lack of suitable assessment tools, resulting in misdiagnosis. Therefore, this study aimed to develop and validate the Neonatal Clubfoot Screening Checklist (NCSC) to assist non-orthopaedic-trained healthcare professionals in postnatal clubfoot assessment.
The NCSC development involved five phases: conceptual understanding of deformity components, creation of pictorial representations, tool structure design, content and face validation, pilot study and field study. A cross-sectional prospective study was conducted in Sarawak General Hospital from January to June 2021. Non-orthopaedic-trained healthcare professionals were randomly assigned to two groups: one utilising the NCSC for newborn screening and another without it. Results were compared with assessments by the paediatric orthopaedic team. Kappa agreement tests and sensitivity and specificity analyses were performed to evaluate the tool's reliability and validity, respectively.
The content and face validity were satisfactory. Six hundred twelve feet were screened using the NCSC, and 596 feet were checked without the tool. The kappa agreement tests showed strong concordance (kappa coefficient=0.725-1.000, P<0.001) between the non-orthopaedic-trained personnel and paediatric orthopaedic team for all NCSC items. The NCSC exhibited 100% sensitivity, specificity and positive and negative predictive values.
The NCSC is a reliable tool for postnatal clubfoot screening, offering high sensitivity and specificity. It facilitates accurate differentiation of true-positive congenital talipes equinovarus from other foot conditions, reducing misdiagnoses and unnecessary referrals. The NCSC is valuable in resource-constrained settings and for healthcare professionals lacking specialised orthopaedic training.
由于缺乏合适的评估工具，未接受过骨科培训的医护人员在识别产后马蹄内翻足畸形方面面临挑战，这可能导致误诊。因此，本研究旨在开发并验证新生儿马蹄内翻足筛查清单（NCSC），以协助未接受过骨科培训的医护人员进行产后马蹄内翻足评估。
NCSC的开发涉及五个阶段：对畸形组成部分的概念理解、创建图片展示、工具结构设计、内容和表面效度验证、试点研究和实地研究。2021年1月至6月在砂拉越总医院进行了一项横断面前瞻性研究。未接受过骨科培训的医护人员被随机分为两组：一组使用NCSC进行新生儿筛查，另一组不使用。将结果与小儿骨科团队的评估进行比较。分别进行Kappa一致性检验以及敏感性和特异性分析，以评估该工具的可靠性和有效性。
内容和表面效度令人满意。使用NCSC筛查了612只脚，未使用该工具检查了596只脚。对于所有NCSC项目，未接受过骨科培训的人员与小儿骨科团队之间的Kappa一致性检验显示出高度一致性（Kappa系数=0.725 - 1.000，P<0.001）。NCSC的敏感性、特异性、阳性预测值和阴性预测值均为100%。
NCSC是一种可靠的产后马蹄内翻足筛查工具，具有高敏感性和特异性。它有助于准确区分真正的先天性马蹄内翻足与其他足部疾病，减少误诊和不必要的转诊。NCSC在资源有限的环境中以及对于缺乏专业骨科培训的医护人员具有重要价值。
