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Evaluation of a disease-specific instrument for idiopathic clubfoot outcome
Frederick R Dietz1, Margaret C Tyler, Kecia S Leary
1Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. Frederick-dietz@uiowa.edu
Insights
The Roye disease-specific instrument (DSI) effectively measures clubfoot treatment outcomes. It shows joint-sparing techniques yield better results than surgery, supporting its use in pediatric care.
Area of Science:
- Pediatric Orthopedics
- Clinical Outcome Measurement
Background:
- The Roye disease-specific instrument (DSI) was developed in 2001 to assess clubfoot treatment outcomes.
- Idiopathic clubfoot treatment varies, including joint-invasive surgery and joint-sparing techniques.
Purpose of the Study:
- To validate the Roye DSI's reliability and sensitivity in a cohort of pediatric idiopathic clubfoot patients.
- To compare DSI scores between different treatment modalities for clubfoot.
Main Methods:
- A cohort of 62 idiopathic clubfoot patients (ages 5-12) treated with various methods were assessed using the DSI.
- Patients were categorized into joint-invasive surgery and joint-sparing treatment groups.
- Internal consistency reliability was calculated using Cronbach's alpha.
Main Results:
- The DSI demonstrated good internal consistency reliability (0.74-0.85).
- Higher DSI scores correlated with better general health and quality of life.
- Patients treated with joint-sparing techniques (e.g., Ponseti) had significantly higher DSI scores than those undergoing joint-invasive surgery.
Conclusions:
- The Roye DSI is a reliable and sensitive measure for assessing idiopathic clubfoot outcomes in children.
- The instrument can differentiate between treatment techniques and disease severity.
- Findings support the use of the Roye DSI for evaluating pediatric clubfoot treatment efficacy.
Unlabelled:
In 2001, Roye et al. developed a disease-specific instrument (DSI) to measure outcomes of treatment for clubfoot. We assessed this instrument using a cohort of 62 patients, ages 5 through 12 years (mean, 8.6 years), with idiopathic clubfoot who were treated as infants by various methods. Treatment groups were defined by whether the patient received joint-invasive surgery (posterior or posteromedial release surgery) or joint-sparing treatment only (manipulation and casting with or without tendo-Achilles lengthening or anterior tibial tendon transfer). The DSI scales demonstrated internal consistency reliability of 0.74 to 0.85 using Cronbach's alpha. Higher (better) DSI scores were associated with "excellent" general health ratings and better health-related quality of life; lower DSI score were related to special healthcare needs. Patients treated using joint-sparing techniques only (eg, Ponseti technique) had higher DSI scores than those who had received joint-invasive surgery. DSI scores for patients who had received posterior or posterior medial release surgery were very similar to those reported by Roye et al. in New York for a comparable group of patients. Our findings suggest the DSI is sensitive to differences in treatment technique or underlying severity of disease. These data support the use of the Roye DSI as an outcome measure for idiopathic clubfoot in children.
Level Of Evidence:
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.