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The Bangla clubfoot tool: a repeatability study
Angela Margaret Evans1, Roksana Perveen2, Vikki A Ford-Powell3
1Department of Podiatry, Lower Extremity and Gait Studies (LEGS) Research Program, La Trobe University, Bundoora, Melbourne 3083, Australia ; Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand ; Clinical Services, Walk For Life, Dhaka, Bangladesh.
Insights
A new Bangla clubfoot tool demonstrates excellent reliability for assessing congenital clubfoot deformity in Bangladesh. This tool is vital for the
Area of Science:
- Orthopedics
- Pediatric Medicine
- Public Health
Background:
- The 'Walk for Life' (WFL) program in Bangladesh treats congenital clubfoot deformity using the Ponseti technique.
- Challenges in implementing the Ponseti technique in a low-resource, high-population country necessitate reliable evaluation methods.
- Over 10,000 children with 16,668 clubfeet have been treated by WFL since 2009, highlighting the need for program evaluation.
Purpose of the Study:
- To develop a robust and contextually practical tool for evaluating the WFL clubfoot program.
- To assess the examiner reliability of the developed Bangla clubfoot tool.
Main Methods:
- The Bangla clubfoot tool was adapted from existing validated measures, incorporating parent satisfaction, gait, and clinical examination.
- A same-subject repeated measures study design was employed to assess intra-rater reliability.
- Inter-rater reliability was also evaluated for broader applicability.
Main Results:
- The study included 37 children (mean age 2.6 years; 28 male: 9 female) treated within two years.
- Intra-rater reliability was high: ICCs of 0.87 (local examiner) and 0.82 (visiting examiner).
- Inter-rater reliability was also very good, with an ICC of 0.92.
Conclusions:
- The Bangla clubfoot tool demonstrates very good intra-rater and inter-rater reliability.
- The tool is suitable for evaluating the WFL clubfoot program in Bangladesh.
- This reliable instrument aids in assessing medium and longer-term outcomes for clubfoot treatment in similar contexts.
Background:
'Walk for Life' (WFL) is the sustainable clubfoot program in Bangladesh, where there are many challenges in implementing the Ponseti technique in a poor and highly populated country. The relapsing tendency of congenital clubfoot deformity means that initial results may well differ from those of the medium and longer term. Over 10000 children with16668 clubfeet have been treated by WFL since its inception in 2009. Such a large project provides both the need to evaluate each individual child's case, and also the opportunity to evaluate the wider WFL program results. Such systematic review requires a measure that is sufficiently robust, yet contextually practical, hence the aim of this work was to develop a tool for this purpose, and to report the examiner reliability.
Methods:
The Bangla clubfoot tool was largely developed from components of existing validated clubfoot assessment measures, and adapted for local use. Three areas of examination are included: parent satisfaction, gait, clinical examination of the clubfoot. A same-subject repeated measures study design was used to assess the intra-rater reliability of a local WFL physiotherapist, and a visiting WFL volunteer. The inter-rater reliability was also assessed, which is relevant for other examiners and other clubfoot projects undertaking evaluation of medium and longer term results.
Results:
The reliability study was conducted in 37 children who had commenced treatment for congenital clubfoot deformity using Ponseti method within the previous two years. The mean age of the children was 2.6 years, with gender 28 male: 9 female. The intra-rater reliability results [ICCs (95% CI)] were: 0.87 (0.76 - 0.93) for the local WFL examiner, and 0.82 (0.64 - 0.91) for the visiting examiner. Inter-rater reliability results [ICCs (95% CI)] were: 0.92 (0.88 - 0.96). Hence the tool showed very good intra-rater and inter-rater reliability, rendering it suitable for use.
Conclusions:
The Bangla clubfoot tool has been developed to suit the context of the large WFL clubfoot program in Bangladesh, and shown to be a very reliable evaluation instrument.
