Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a...

The Ponseti method, now regarded as the standard of care for congenital clubfoot, is equally effective whether provided by orthopaedic surgeons or orthopaedic paramedics. Therefore, it is particularly suitable for under-resourced nations with lack of surgeons and physicians. At the Sudan Clubfoot Clinic, physiotherapy assistants (3-year diploma nurses with additional physiotherapy experience) are part of the Ponseti clubfoot treatment team, with the role of assessing the degree of deformity by the Pirani score to assist the team in providing treatment. However, the reliability of Pirani scores measured by physiotherapy assistants in this context is unknown. After obtaining informed consent, we measured the interobserver reliability between a physiotherapy assistant and an orthopaedic surgeon in measuring Pirani scores in 91 virgin clubfeet in 54 infants (41 males and 13 females) at the Sudan Clubfoot Clinic. Scores were measured independently before the onset of treatment and analysed by the κ statistic for interobserver reliability. The κ statistic was 0.61 for posterior crease, 0.72 for empty heel, 0.51 for rigid equinus, 0.54 for the hid-foot score, 0.57 for medial crease, 0.54 for curved lateral border, 0.56 for lateral head of talus, 0.50 for the midfoot score and 0.50 for the total score. The mean percentage of agreement of both observers for all Pirani components was 83%. We found moderate to substantial interobserver reliability for the Pirani clubfoot severity score and all its subcomponents. Properly trained physiotherapy assistants are efficient in assessing the degree of severity of clubfoot. This is particularly useful in developing countries, where orthopaedic surgeons are few. Clubfoot treatment can be made more affordable by using paramedical healthcare workers such as physiotherapy assistants.