Use of PROMIS in Assessment of Children With Ponseti-treated Idiopathic Clubfoot: Better Scores With Greater Than 3 Years of Brace Use

Abstract

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) is a well-validated tool used to measure health-related quality of life for children and adolescents with chronic medical conditions. The current study evaluates PROMIS scores in 3 domains for children with Ponseti-treated idiopathic clubfoot. Methods: This is a retrospective cohort study of 77 children, ages 5 to 16 years, treated by Ponseti protocol for idiopathic clubfoot. Three pediatric PROMIS domains (Mobility, Pain Interference, and Peer Relationships) were administered between April 2017 and June 2018. One-way analysis of variance with Bonferroni post hoc and independent sample t tests were performed to explore differences across PROMIS domain scores by sex, age, initial Dimeglio score, laterality, bracing duration, and whether the child underwent tibialis anterior transfer. Results: In the self-reported group (ages 8 to 16), mean T-scores for all 3 domains in both unilaterally and bilaterally affected groups were within the normal range, with respect to the general reference pediatric population. However, children with unilateral clubfoot had a significantly higher mean Mobility T-score (54.77) than children with bilateral clubfoot (47.81, P=0.005). Children with unilateral clubfoot also had significantly lower mean pain scores (39.16) than their bilateral counterparts (46.56, P=0.005). Children who had braced >36 months had a significantly higher mean Mobility T-score (53.68) than children who braced ≤36 months (46.28, P=0.004). In the proxy group (ages 5 to 7), mean T-scores for all 3 domains in both laterality groups were within the normal range, with respect to the reference population. Children who had braced >36 months had a significantly higher mean Mobility T-score (52.75 vs. 49.15, P=0.014) and lower Pain Interference score (43.04 vs. 49.15, P=0.020) than children who braced ≤36 months. Conclusions: Children treated by Ponseti protocol for idiopathic clubfoot yielded PROMIS scores for Mobility, Pain Interference, and Peer Relationships domains similar to the reference population. Bracing duration >36 months and unilaterality were associated with less mobility impairment than their counterparts. These findings may help guide parent recommendations. Level of Evidence: Level III.

What is New in Pediatric Orthopaedic Foot and Ankle

“…Aulie et al3 found that 96% of school aged children treated for idiopathic clubfoot with the Ponseti method have normal function when compared with age-matched controls in the same population. Several other studies similarly demonstrated comparable activity levels and have similar patient reported outcome scores when compared with the general pediatric population 4–6. For patients diagnosed in utero, Mahan et al7 found that prenatal counseling of families by an orthopaedic surgeon did not decrease parental anxiety; however, anxiety decreased as treatment progressed.…”

“…Several other studies similarly demonstrated comparable activity levels and have similar patient reported outcome scores when compared with the general pediatric population. [4][5][6] For patients diagnosed in utero, Mahan et al 7 found that prenatal counseling of families by an orthopaedic surgeon did not decrease parental anxiety; however, anxiety decreased as treatment progressed.…”

Patient-Reported Outcome Measurement Information System (PROMIS) Scores in Pediatric Idiopathic Toe Walkers

“…14 The MCID is reported to be 2 to 3 points for pain and mobility and 3 points for peer relationships. [15][16][17][18][19] Utilizing PROMIS data from children with ITW may be beneficial in understanding the patient perspective and priorities regarding this diagnosis. Our null hypothesis is that PROMIS metrics in children with ITW do not differ significantly from those of healthy children.…”

Untreated congenital vertical talus deformity in walking age: minimally invasive method works

“…Consistent with previous studies, we defined recurrence of talonavicular deformity as lateral TAMBA measuring >30 degrees in a previously corrected foot and radiographic pes valgus as an AP talocalcaneal angle >40 degrees [20,23]. Additionally, all patients who were seen after 2015 completed questionnaires on the pain interference and peer relationship domains of the Patient-Reported Outcomes Measurement Information System (PROMIS) platform as several past studies have highlighted the advantages of using this technology [28–31]. This information system uses a score of 50 points to represent a reference population and 10 points represents one SD from the reference population.…”