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Follow-up of children with congenital clubfoot. Development of a new evaluation instrument.

Andriesse, Hanneke LU (2007)
Abstract (Swedish)
Popular Abstract in Swedish

Klumpfot är en medfödd fotfelställning, som drabbar 1 av 1000 barn. Behandlingen består initialt av korrektion av felställningen, genom töjning och eventuellt operation. Det finns flera alternativa metoder att genomföra töjningar, och flera alternativa operationsmetoder. När felställningen korrigerats övergår behandlingen till att bibehålla det uppnådda läget med hjälp av ortos (skena). Även här finns flera olika alternativa metoder. Det finns få vetenskapliga studier som utvärderat klumpfotsbehandling med instrument som visats var tillförlitliga och valida, och där man använt kontrollgrupp för jämförelse.



Denna avhandling belyser utvecklingen av ett bedömningsinstrument,... (More)
Popular Abstract in Swedish

Klumpfot är en medfödd fotfelställning, som drabbar 1 av 1000 barn. Behandlingen består initialt av korrektion av felställningen, genom töjning och eventuellt operation. Det finns flera alternativa metoder att genomföra töjningar, och flera alternativa operationsmetoder. När felställningen korrigerats övergår behandlingen till att bibehålla det uppnådda läget med hjälp av ortos (skena). Även här finns flera olika alternativa metoder. Det finns få vetenskapliga studier som utvärderat klumpfotsbehandling med instrument som visats var tillförlitliga och valida, och där man använt kontrollgrupp för jämförelse.



Denna avhandling belyser utvecklingen av ett bedömningsinstrument, Clubfoot Assessment Protocol (CAP), för uppföljning av barn med klumpfot. CAP ger information om flera olika aspekter på klumpfot (morfologi, rörlighet, muskelfunktion, och rörelsekvalitet). Instrumentets reliabilitet, validitet, förmåga att upptäcka förändring och dess kliniska användbarhet studerades prospektivt på 73 konsekutiva barn med klumpfot. Den kliniska användbarheten utvärderades genom att jämföra gipsteknik (enligt Ponseti) med töjningar (enligt Köpenhamnsmetod) och ortosbehandlingen, och genom att studera utvecklingsbetingade motoriska problem hos barn med klumpfot.



Metodstudierna visade att CAP kan användas med tillräcklig reliabilitet och validitet. CAP uppvisade en bättre förmåga att beskriva skillnader i fotens status jämfört med det vanligast förekommande instrumentet (Dimeglio Classification System). CAP var också mer känsligt för förändring jämfört Dimeglio´s system.



Gipsteknik enligt Ponseti gav, enligt CAP, bättre resultat än töjningar enligt Köpenhamnsmetoden vad gäller rörlighet och rörelsekvalitet vid två års ålder. Dessutom krävdes färre kirurgiska ingrepp. Behandlingen med dynamiska Knä Ankel Fot Ortos (KAFO)/ Ankel Fot Ortos (AFO) visade bibehållet eller något förbättrat kliniskt status och god följsamhet.



Utvecklingsbetingade motoriska problem sågs oftare än förväntat hos sjuåriga barnsom behandlats för klumpfot. Detta fynd kunde inte förklaras som en konsekvens av kirurgiska ingrepp eller av fotens funktion. Förmågan att stå på ett ben korrelerade bäst med motoriska problem och skulle kunna vara en screeningmetod i kliniskt arbete med klumpfot.



Sammanfattningsvis visar undersökningar att CAP förefaller vara ett värdefullt instrument vid bedömning och uppföljning av klumpfot (Less)
Abstract
Clubfoot is a congenital disorder, affecting about one of 1000 children. Treatment consists of initial correction of the deformity, followed by prolonged orthosis treatment to maintain the correction obtained. There are several different treatment options. Outcome studies, using reliable and valid instruments are rare.



In this thesis an assessment instrument, Clubfoot Assessment Protocol (CAP) was developed for longitudinal follow up of children with clubfoot. The CAP provides information on the development of different functional domains (mobility, muscle function, morphology and motion quality) over time. The reliability, validity, responsiveness and clinical utility was analysed in a prospective sample of 73... (More)
Clubfoot is a congenital disorder, affecting about one of 1000 children. Treatment consists of initial correction of the deformity, followed by prolonged orthosis treatment to maintain the correction obtained. There are several different treatment options. Outcome studies, using reliable and valid instruments are rare.



In this thesis an assessment instrument, Clubfoot Assessment Protocol (CAP) was developed for longitudinal follow up of children with clubfoot. The CAP provides information on the development of different functional domains (mobility, muscle function, morphology and motion quality) over time. The reliability, validity, responsiveness and clinical utility was analysed in a prospective sample of 73 consecutive children. The clinical utility was analysed by comparing Ponseti casting technique vs Copenhagen stretching method and by studying developmental motor problems in children born with clubfoot.



The methodological studies showed that the CAP can be used with sufficient reliability and validity. For research purposes, experience of the CAP and data on actual inter observer differences should be described. The CAP showed a stronger ability to discriminate foot status than the Dimeglio Classification system (DCS). The CAP is more sensitive to change especially in the moderate to severe range. Thus, the CAP is an important contribution to clubfoot evaluation in clinical and in research settings.



The casting technique according to Ponseti was superior in clubfoot correction regarding mobility and motion quality according to the CAP at age two years. Furthermore, less surgery was needed. The orthosis management showed maintenance or slight improvement of the clinical status along with good compliance.



Developmental motor ability problems were found more often than expected among seven year old children treated for idiopathic clubfoot. This finding could not be explained by previous surgery or foot function. The ability to stand on one leg correlated strongest to motor problems and could serve as a screening test in clinical settings of clubfoot evaluation. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Haglund-Åkerlind, Yvonne, Astrid Lindgrens Barnsjukhus, Stockholm
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Validity, Assessment instrument, Clubfoot, Reliability, Responsivenss, Treatment evaluation, Developmental motor ability, Skeleton, rheumatology locomotion, muscle system, muskelsystem, Skelett, Surgery, reumatologi, traumatologi, Rehabilitering (medicinsk och social), rehabilitation, revalidation, kinesitherapy, Physical medicine, orthopaedics, traumatology, Kirurgi, ortopedi
pages
100 pages
publisher
Institution for Health Sciences, Division of Physiotherapy, Lund University Department of Orthopaedics, Lund University Hospital
defense location
Segerfalksalen, BMC, Universitetssjukhuset, Lund.
defense date
2007-09-14 09:00
ISSN
1652-8220
ISBN
978-91-85897-01-8
language
English
LU publication?
yes
id
a7d51a0e-f046-49b7-83e7-bf85a9e96f0a (old id 549010)
date added to LUP
2007-09-07 15:59:55
date last changed
2016-09-19 08:44:59
@phdthesis{a7d51a0e-f046-49b7-83e7-bf85a9e96f0a,
  abstract     = {Clubfoot is a congenital disorder, affecting about one of 1000 children. Treatment consists of initial correction of the deformity, followed by prolonged orthosis treatment to maintain the correction obtained. There are several different treatment options. Outcome studies, using reliable and valid instruments are rare.<br/><br>
<br/><br>
In this thesis an assessment instrument, Clubfoot Assessment Protocol (CAP) was developed for longitudinal follow up of children with clubfoot. The CAP provides information on the development of different functional domains (mobility, muscle function, morphology and motion quality) over time. The reliability, validity, responsiveness and clinical utility was analysed in a prospective sample of 73 consecutive children. The clinical utility was analysed by comparing Ponseti casting technique vs Copenhagen stretching method and by studying developmental motor problems in children born with clubfoot.<br/><br>
<br/><br>
The methodological studies showed that the CAP can be used with sufficient reliability and validity. For research purposes, experience of the CAP and data on actual inter observer differences should be described. The CAP showed a stronger ability to discriminate foot status than the Dimeglio Classification system (DCS). The CAP is more sensitive to change especially in the moderate to severe range. Thus, the CAP is an important contribution to clubfoot evaluation in clinical and in research settings.<br/><br>
<br/><br>
The casting technique according to Ponseti was superior in clubfoot correction regarding mobility and motion quality according to the CAP at age two years. Furthermore, less surgery was needed. The orthosis management showed maintenance or slight improvement of the clinical status along with good compliance.<br/><br>
<br/><br>
Developmental motor ability problems were found more often than expected among seven year old children treated for idiopathic clubfoot. This finding could not be explained by previous surgery or foot function. The ability to stand on one leg correlated strongest to motor problems and could serve as a screening test in clinical settings of clubfoot evaluation.},
  author       = {Andriesse, Hanneke},
  isbn         = {978-91-85897-01-8},
  issn         = {1652-8220},
  keyword      = {Validity,Assessment instrument,Clubfoot,Reliability,Responsivenss,Treatment evaluation,Developmental motor ability,Skeleton,rheumatology locomotion,muscle system,muskelsystem,Skelett,Surgery,reumatologi,traumatologi,Rehabilitering (medicinsk och social),rehabilitation,revalidation,kinesitherapy,Physical medicine,orthopaedics,traumatology,Kirurgi,ortopedi},
  language     = {eng},
  pages        = {100},
  publisher    = {Institution for Health Sciences, Division of Physiotherapy, Lund University Department of Orthopaedics, Lund University Hospital},
  school       = {Lund University},
  title        = {Follow-up of children with congenital clubfoot. Development of a new evaluation instrument.},
  year         = {2007},
}