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Comparing patient-reported outcomes of the Oxford Ankle and Foot Questionnaire in children with clubfoot from two different geographic and cultural environments: a cohort study in India and Canada

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Abstract

Purpose

The purpose of this study is to compare the results of the Oxford Ankle and Foot Questionnaire (OxAFQ) in children with clubfoot in Canada and India to assess its ability to predict outcomes and capture patient experiences in different cultural contexts.

Methods

This is a retrospective study of children with clubfoot in India and Canada who completed the OxAFQ. Statistical analyses were implemented on registry-collected data to test for independent predictors of poor outcomes and compare scores between countries, among children and their parents, and in Canada where relapse data was collected and the effect of a relapse on scores.

Results

A total of 361 children were included. The mean Indian OxAFQ scores were higher (p < 0.001) in all domains. Pirani score, tenotomy, laterality, and age at presentation were found to be predictive of outcomes between the sites (p < 0.05). OxAFQ scores decreased after relapse for children in Canada (p < 0.05). Canadian children were found to generally have lower OxAFQ scores in all domains compared to their parents (n = 95; Z = −3.178, −3.493, −3.353, and −3.635 for physical, school and play, emotion, and footwear, respectively; p < 0.001). Indian parents and children showed no significant differences in their scores.

Conclusions

A difference was observed in scores between both sites, suggesting there may be differences in how these populations assess personal health outcomes. These findings support the need for cultural validity of patient-reported outcome measures.

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Author information

Authors and Affiliations

  1. Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada

    Maryse Bouchard, Maryam Rezakarimi, Marwah Sadat & Mikyla Reesor

  2. Cloud Nine Hospital, Chennai, Tamil Nadu, India

    P. Vigneshwaran

  3. Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India

    Alaric Aroojis

Authors
  1. Maryse Bouchard
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  2. Maryam Rezakarimi
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  3. Marwah Sadat
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  4. Mikyla Reesor
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  5. P. Vigneshwaran
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  6. Alaric Aroojis
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Contributions

MB and AA contributed to the study conception, study design, and overseeing the data analysis and manuscript writing. Material preparation, data collection, and analysis were performed by MR, MS, MR, and VP. The first draft of the manuscript was written by MR, MS, and MR, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alaric Aroojis.

Ethics declarations

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was obtained from the SickKids Research Ethics Board, Canada (REB approval #1000076194) and the Institutional Ethics Committee, Bai Jerbai Wadia Hospital for Children, India (IEC-BJWHC/AP/2020/26-version 02). Informed consent and assent were obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

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Bouchard, M., Rezakarimi, M., Sadat, M. et al. Comparing patient-reported outcomes of the Oxford Ankle and Foot Questionnaire in children with clubfoot from two different geographic and cultural environments: a cohort study in India and Canada. International Orthopaedics (SICOT) (2023). https://doi.org/10.1007/s00264-023-06064-6

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