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Patient-Reported Outcomes in Children With Idiopathic Clubfoot Deformity Treated With Ponseti Casting: Does
Claire Schaibley1, Beltran Torres-Izquierdo, Pooya Hosseinzadeh
1From the Department of Orthopaedics, Washington University School of Medicine, St. Louis, MO.
Insights
Recurrence of idiopathic clubfoot after Ponseti casting does not significantly impact patient-reported outcomes (PROs) in mobility, pain, or peer relationships. This study highlights the resilience of children
Area of Science:
- Pediatric Orthopedics
- Patient-Reported Outcomes
- Clubfoot Treatment
Background:
- Idiopathic clubfoot is effectively treated with Ponseti casting, but patient-reported outcomes (PROs) require further investigation.
- Limited research exists on the long-term impact of clubfoot recurrence on children's quality of life.
Purpose of the Study:
- To evaluate PROs in children with Ponseti-treated clubfoot using the Patient-Reported Outcomes Measurement Information System (PROMIS).
- To assess the effect of recurrence on PROs in this patient population.
Main Methods:
- Retrospective review of 50 patients (ages 5-18) treated for idiopathic clubfoot between 2002-2023.
- Collected PROMIS data on mobility, pain interference, and peer relationships.
- Defined recurrence as requiring further casting or surgery after initial correction.
Main Results:
- Average PROMIS scores: 51.1 (mobility), 44.2 (pain interference), 51.9 (peer relationships).
- Patients with recurrence showed similar PROMIS scores compared to nonrecurrent patients across all domains (P > 0.05).
- No significant difference in mobility, pain, or peer relationships based on recurrence status.
Conclusions:
- This is the first study to use PROMIS to assess recurrence impact in Ponseti-treated clubfoot.
- Recurrence of clubfoot appears to have a limited effect on patient-reported outcomes at an average 5-year follow-up.
- Children with recurrent clubfoot demonstrate comparable PROMIS scores to those without recurrence.
Introduction:
Despite the high effectiveness of Ponseti casting in treating idiopathic clubfoot, patient-reported outcomes (PROs) are not studied well in the literature, necessitating further investigation into PROs to evaluate the effect on patients' lives. We used the Patient-Reported Outcomes Measurement Information System (PROMIS) to evaluate PROs in children with Ponseti-treated clubfoot and assess the effect of recurrence on these PROs.
Methods:
This study retrospectively reviewed medical records from patients ages 5 to 18 years treated for idiopathic clubfoot at a single institution from 2002 to 2023 with available PROMIS data for mobility, pain, and peer relationships. Exclusion criteria included initial treatment other than Ponseti casting, presentation to our institution after age 2 years, and PROMIS scores taken less than 6 months postsurgery. Recurrence was defined as patients who required further treatment with casting or surgery after initial correction.
Results:
Among 50 patients eligible for this study, 78% (39) were male and 34% (17) had bilateral clubfoot. Average age when the most recent PROMIS data were collected was 6.1 years. Average PROMIS scores were 51.1 mobility, 44.2 pain interference, and 51.9 peer relationships. Notably, patients with recurrence showed similar PROMIS scores across all domains when compared with nonrecurrent patients: 50.7 ± 8.1 vs. 51.5 ± 9.8 ( P = 0.753) mobility, 45.5 ± 8.9 vs. 43.1 ± 8.7 ( P = 0.334) pain interference, and 52.5 ± 9.7 vs. 51.3 ± 9.1 ( P = 0.634) peer relationships.
Conclusion:
To our knowledge, this is the first study to use PROMIS scores to evaluate the effect of recurrence on PROs in children with Ponseti-treated clubfoot. The findings of this study suggest that children who sustained recurrence did not have markedly different PROMIS outcomes compared with nonrecurrent children, regardless of treatment modality for recurrence, indicating limited effect of recurrence on PROs at an average 5-year follow-up.
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