Long-term follow-up of children with a surgically treated clubfoot: Assessing the multi-segment-foot motions, dynamic plantar pressures, and functional outcomes

Patient-Reported Outcomes in Children With Idiopathic Clubfoot Deformity Treated With Ponseti Casting: Does Recurrence of the Deformity Play a Role?

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.

Pediatric Outcomes Data Collection Instrument Scores Within Gross Motor Function Classification Scale Levels and Functional Mobility Scale Ratings in Individuals With Cerebral Palsy

BACKGROUND AND OBJECTIVE

The Pediatric Outcomes Data Collection Instrument (PODCI) is a patient/parent-reported outcome measure used in children with cerebral palsy (CP). PODCI score variability has not been widely examined in patients of Gross Motor Function Classification System (GMFCS) level IV or using the Functional Mobility Scale (FMS). The purpose of this study is to examine the distribution of PODCI scores within patients with CP GMFCS levels I-IV and FMS levels 1-6.

METHODS

Retrospectively identified patients with CP whose parent/caregiver had completed the PODCI at their visit were grouped based on GMFCS and FMS level. One-way ANOVA with pairwise Bonferroni-adjusted post hoc tests was performed to compare the effect of GMFCS and FMS levels (1, 2-4, 5, or 6) on PODCI scores.

RESULTS

Three hundred sixty-seven patients were included (128 female, 11.7 years, SD 3.6). Global, Sports, Transfer, and Upper Extremity scores differed among all GMFCS levels ( P ≤0.056) and were significantly lower for GMFCS IV compared with all other levels. Happiness, Expectations, and Pain scores did not differ significantly among GMFCS levels including level IV ( P >0.06). Similar trends were seen at all FMS distances (5, 50, and 500âm). At 50âm, Global, Sports, Transfer, and Upper Extremity scores differed significantly among all FMS levels ( P <0.001) except that Upper Extremity Scores were similar between levels 2-4 and level 5 ( P =1.00). Happiness and Pain scores were not different between FMS levels ( P >0.27). Expectations scores differed only between FMS 1 and FMS 6 with FMS 6 being higher at the 50-m distance only ( P =0.03).

CONCLUSIONS

Parent-reported outcome measures are important for providing patient-centered care. Providers can examine these measures alongside functional classification systems to create a more complete clinical picture of the patient. Providers should be aware of the score trends seen in our results when evaluating the PODCI for individuals with CP to improve shared decision-making and better monitor their need for future care.

LEVEL OF EVIDENCE

Level III-retrospective study.

Translation and Cross-Cultural Adaptation of the Pediatric Outcomes Data Collection Instrument into the Italian Language

(1) Background: The Pediatric Outcomes Data Collection Instrument (PODCI) is an English-language questionnaire specifically designed to assess health-related quality of life in children and adolescents with musculoskeletal disorders. This scoring system has been translated into several languages. Given the lack of an Italian version of the PODCI, this study aimed to translate, cross-culturally adapt, and assess the psychometric properties of the PODCI score in the Italian pediatric population. (2) Methods: The PODCI questionnaire was culturally adapted to Italian patients in accordance with the literature guidelines. The study included 59 participants from a single orthopedic institution who underwent orthopedic surgery for various skeletal conditions. The questionnaire was administered to participants at multiple time-points (T0, T1, T2). Internal consistency was evaluated using Cronbach’s alpha. Reproducibility was assessed using the intraclass correlation coefficient (ICC) between T0 and T1 assessment. Criterion validity was assessed using Spearman’s correlation coefficients between PODCI and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Responsiveness was evaluated by the difference between T0 and T2 using the effect size (ES) and the standardized response mean (SRM) calculation. (3) Results: Cronbach’s alpha was acceptable in both the self- and parent-reported versions with values of 0.78 (0.68–0.90) and 0.84 (0.60–0.92), respectively. The ICC fluctuated between 0.31 and 0.89 for self-reported and 0.49 to 0.87 for pediatrics. The Spearman’s r showed a moderate correlation between HSS Pedi-FABS and the “Sport & Physical Functioning” and “Global Functioning” domains. ES and SRM varied from small to moderate across all the domains. (4) Conclusions: This study demonstrates that the Italian version of the PODCI, translated following the international standardized guidelines, is reliable, valid, and responsive in pediatric patients who underwent orthopedic surgery.