Factors Causing Dropout From Treatment During the Ponseti Method of Clubfoot Management: The Caregivers' Perspective

A retrospective comparative study was conducted, aiming to identify factors associated with dropout from clubfoot treatment by Ponseti method in low- and middle-income countries. A prospectively gathered database of patients who received treatment at a high-volume urban clubfoot clinic over 6 years was queried for dropouts. A "dropout" was identified as any child that had not had a visit within 3 weeks of casting, 4 weeks of tenotomy or 6 months of brace follow-up. The second part of the study was a telephonic interview with caregivers of the identified dropouts to ascertain their reasons for discontinuing treatment. Of the 965 patients treated during the study period, there were 155 (16.06%) dropouts-137 (88.38%) during bracing phase and 18 (11.62%) during casting phase. Age at presentation was significantly higher among the dropouts as compared to those who did not dropout (median 9.5 and 7 months for casting and bracing dropouts respectively versus 3.5 months for regular follow-ups, p < .001). No significant correlation was found between patient dropout and sex (p = .061), or laterality (p = .071). Thirty-seven caregivers (23.8%) could be contacted telephonically; including 6 casting and 31 bracing dropouts. The most commonly cited reason for dropout from treatment was lack of family support (75.7%), followed by distance to the clinic (59.5%) and unavailability of transport (54.1%). Sixteen caregivers (43.2%) dropped out on account of migration to another town/state. Maintenance of a meticulous registry with regular update of caregivers' contact details, and interventions to mitigate the identified hurdles can help in reducing treatment dropouts.