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Attaining a British consensus on managing idiopathic congenital talipes equinovarus up to walking age
Yael Gelfer1,2, Naomi Davis3, Jose Blanco4
1St George's Hospital, London, UK.
Insights
This study established a consensus on managing idiopathic congenital talipes equinovarus (CTEV) in children up to walking age. The findings provide a UK benchmark for consistent, high-quality care for CTEV treatment.
Area of Science:
- Pediatric Orthopedics
- Clinical Consensus Development
Background:
- Idiopathic congenital talipes equinovarus (CTEV) management varies, impacting care quality.
- A need exists for standardized treatment guidelines for children with CTEV up to walking age.
Purpose of the Study:
- To achieve expert agreement on the management of idiopathic CTEV up to walking age.
- To establish a benchmark for practitioners and ensure consistent, high-quality care for children with CTEV.
Main Methods:
- A Delphi approach was employed, involving a steering group and multi-round surveys.
- Participants were members of the British Society of Children's Orthopaedic Surgery (BSCOS).
- Consensus was defined by a predetermined agreement level, with results analyzed using descriptive statistics.
Main Results:
- A total of 57 consensus statements were developed, covering six stages of idiopathic CTEV management.
- Round 1 of the Delphi survey achieved consensus on 43 statements, with 18 reaching no consensus.
- Round 2 refined the statements, resulting in 12 consensus statements, with three discussed and included after the final meeting.
Conclusions:
- A consensus document for idiopathic CTEV management up to walking age has been produced.
- This document serves as a benchmark for standard of care in the UK.
- Implementation and dissemination are crucial for reducing variability in CTEV treatment and outcomes.
Aims:
The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV.
Methods:
The consensus process followed an established Delphi approach with a predetermined degree of agreement. The process included the following steps: establishing a steering group; steering group meetings, generating statements, and checking them against the literature; a two-round Delphi survey; and final consensus meeting. The steering group members and Delphi survey participants were all British Society of Children's Orthopaedic Surgery (BSCOS) members. Descriptive statistics were used for analysis of the Delphi survey results. The Appraisal of Guidelines for Research & Evaluation checklist was followed for reporting of the results.
Results:
The BSCOS-selected steering group, the steering group meetings, the Delphi survey, and the final consensus meeting all followed the pre-agreed protocol. A total of 153/243 members voted in round 1 Delphi (63%) and 132 voted in round 2 (86%). Out of 61 statements presented to round 1 Delphi, 43 reached 'consensus in', no statements reached 'consensus out', and 18 reached 'no consensus'. Four statements were deleted and one new statement added following suggestions from round 1. Out of 15 statements presented to round 2, 12 reached 'consensus in', no statements reached 'consensus out', and three reached 'no consensus' and were discussed and included following the final consensus meeting. Two statements were combined for simplicity. The final consensus document includes 57 statements allocated into six successive stages.
Conclusion:
We have produced a consensus document for the treatment of idiopathic CTEV up to walking age. This will provide a benchmark for standard of care in the UK and will help to reduce geographical variability in treatment and outcomes. Appropriate dissemination and implementation will be key to its success. Cite this article: Bone Joint J 2022;104-B(6):758-764.
