Association of Socioeconomic Status With Relapse After Ponseti Method Treatment of Idiopathic Clubfeet

Correlation Between Socioeconomic Status and Brace Compliance in Idiopathic Clubfoot Deformities

BACKGROUND

Congenital talipes equinovarus (CTEV), or clubfoot, is one of the most common foot deformities seen at birth. The Ponseti technique is the most common method to treat clubfoot and consists of gentle manipulation with serial casting, a percutaneous Achilles tendon tenotomy, and bracing for the first few years of life. The purpose of this study was to determine whether socioeconomic factors influence compliance with clubfoot bracing for families with infants who have idiopathic clubfoot treated by the Ponseti method.

METHODOLOGY

All patients with clubfoot deformity who began primary treatment at our pediatric orthopedic clinic between February 2018 and May 2021 were included in a retrospective chart review. Compliance was defined as strict adherence to the initial casting and tenotomy appointments, in addition to the caregiver's reported compliance with brace wear, and no mention of non-compliance in the patient's medical record. Recurrence was defined as relapse of the deformity after at least one year of follow-up and/or the need for additional casting or tenotomy.

RESULTS

Forty-three patients were included in the final analysis of compliance with bracing. No significant correlations were seen between the rate of compliance with bracing and any of the socioeconomic factors assessed in this study. The odds of noncompliance were 7.0 times higher in patients who had one or more missed clinic appointments, compared to those who attended all appointments (P = 0.01). Forty-one patients were analyzed at a minimum one-year follow-up for recurrence of deformity. The odds ratio for recurrence of deformity in patients who were noncompliant with bracing was 74.8 compared to those who were compliant (P =< 0.001).

CONCLUSIONS

Socioeconomic factors, including household income, education level, zip code, employment status of caregivers, and insurance status, were not associated with bracing compliance or recurrence of the clubfoot deformity. This was a level 2 observational study.

Ready for Discharge, but Are They Ready to Go Home? Examining Neighborhood-Level Disadvantage as a Marker of the Social Exposome and the Swallowing Care Process in a Retrospective Cohort of Inpatients With Dementia

PURPOSE

Socioeconomically disadvantaged areas are more resource poor, impacting adherence to swallowing care recommendations. Neighborhood-level disadvantage metrics, such as the Area Deprivation Index (ADI), allow for examination of social determinants of health (SDOH) in a precise region. We examined ADI in a cohort of persons living with dementia (PLWD) to determine representation of those residing in areas of socioeconomic disadvantage (high ADI), distribution of swallowing care provided, and frequency of SDOH-related counseling or resource linking prior to discharge.

METHOD

A retrospective chart abstraction was performed for all inpatients with a diagnosis of dementia (N = 204) seen by the Swallow Service at a large academic hospital in 2014. State ADI Deciles 1 (least) to 10 (most socioeconomic disadvantage) and decile groups (1-3, 4-7, and 8-10) were compared with the surrounding county. Frequency of videofluoroscopic swallowing evaluations (VFSEs) based on ADI deciles was recorded. To determine whether SDOH-related counseling or resource linking occurred for those in high ADI (8-10) neighborhoods, speech-language pathology notes, and discharge summaries were reviewed. Descriptive statistics, independent samples t tests, and one-way analysis of variance were calculated.

RESULTS

ADI was significantly higher in this cohort (M = 3.84, SD = 2.58) than in the surrounding county (M = 2.79, SD = 1.88, p = .000). There was no significant difference in utilization of swallowing services across decile groups (p = .88). Although the majority (85%) in high ADI areas was recommended diet modifications or alternative nutrition likely requiring extra resources, there was no documentation indicating that additional SDOH resource linking or counseling was provided.

CONCLUSIONS

These findings raise important questions about the role and responsibility of speech-language pathologists in tailoring swallowing services to challenges posed by the lived environment, particularly in socioeconomically disadvantaged areas. This underscores the need for further research to understand and address gaps in postdischarge support for PLWD in high-ADI regions and advocate for more equitable provision of swallowing care.