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Interobserver Reliability of Pirani Clubfoot Severity Scoring between an Orthopedic Surgeon, a Resident Doctor, and a Nonmedical Counsellor at a Clubfoot Clinic

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Ponseti method is the gold standard treatment for idiopathic congenital clubfoot. Pirani clubfoot severity score is a vital tool in assessing treatment of clubfoot. This study determines whether, after a short training in the Pirani scoring, a nonmedical personnel can be as accurate as a doctor in assessing the degree of deformity in clubfoot.

Materials and Methods

This was a prospective observational study from January to September 2016. Pirani scoring of all children ≤6 months was done by the counsellor, an orthopedic resident, and a consultant separately. All the three members of the team were blinded of the other’s score. The Pirani scoring of the consultant was taken as the most correct. The data were analyzed for interobserver reliability using the kappa statistic and point-by-point interobserver agreements.

Results

One hundred and fifteen clubfeet in 75 children (48 males and 27 females) with an average age of 96 days were included in the study. Differences between the means of scores for each severity component of the deformity including the sum of midfoot scores, hindfoot scores, and total foot scores were <0.1. There was fair-to-substantial interobserver reliability of all the subcomponents when scores from the three independent observers were analyzed.

Conclusion

Our study successfully demonstrates that after a short training, Pirani score can be successfully used in assessing clubfoot severity by a nonmedical counsellor.

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References

  1. Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M, et al. A method for the early evaluation of the ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 2003;12:133–40.

    PubMed  Google Scholar 

  2. Sud A, Tiwari A, Sharma D, Kapoor S. Ponseti’s vs. Kite’s method in the treatment of clubfoot – A prospective randomised study. Int Orthop 2008;32:409–13.

    PubMed  Google Scholar 

  3. Grimes CE, Holmer H, Maraka J, Ayana B, Hansen L, Lavy CBD, et al. Cost-effectiveness of club-foot treatment in low-income and middle-income countries by the ponseti method. BMJ Glob Health 2016;1:e000023.

  4. Dyer PJ, Davis N. The role of the pirani scoring system in the management of club foot by the ponseti method. J Bone Joint Surg Br 2006;88:1082–4.

    Article  CAS  Google Scholar 

  5. Fixsen J. Associate editor, data supplement. J Bone Joint Surg Br 2006;88:1082–4.

    Google Scholar 

  6. Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. J Pediatr Orthop B 2012;21:366–8.

    Article  Google Scholar 

  7. Jillani SA, Aslam MZ, Chinoy MA, Khan MA, Saleem A, Ahmed SK, et al. A comparison between orthopedic surgeon and allied health worker in pirani score. J Pak Med Assoc 2014;64:S127–30.

  8. Pirani S, Outerbridge H, Moran M, Sawatsky BJ. A Method of Evaluating the Virgin Clubfoot with Substantial Interobserver Reliability. Vol. 71. Miami, Florida: POSNA; 1995.

  9. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960;20:37–46.

    Article  Google Scholar 

  10. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg 1963;45-A: 261–344.

  11. Harrold AJ, Walker CJ. Treatment and prognosis in congenital club foot. J Bone Joint Surg Br 1983;65:8–11.

    Article  CAS  Google Scholar 

  12. Catterall A. A method of assessment of the clubfoot deformity. Clin Orthop Relat Res 1991;(264):48–53.

  13. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995;4:129–36.

    Article  Google Scholar 

  14. Ghanem I, Seringe R. Comparison of evaluation methods of the results of congenital clubfoot treatment. Rev Chir Orthop Reparatrice Appar Mot 1995;81:615–21.

    CAS  PubMed  Google Scholar 

  15. Laaveg SJ, Ponseti IV. Long term results of treatment of congenital club foot. J Bone Joint Surg Am 1980;62:23–31.

    Article  CAS  Google Scholar 

  16. McKay DW. New concept of and approach to clubfoot treatment: Section III – Evaluation and results. J Pediatr Orthop 1983;3:141–8.

    Article  CAS  Google Scholar 

  17. Magone JB, Torch MA, Clark RN, Kean JR. Comparative review of surgical treatment of the idiopathic clubfoot by three different procedures at Columbus Children’s Hospital. J Pediatr Orthop 1989;9:49–58.

    Article  CAS  Google Scholar 

  18. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br 2002;84:1020–4.

    Article  Google Scholar 

  19. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am 2002;84-A: 290–308.

  20. Steck H, Robertson A. The inter-observer reliability of the Pirani Score of Clubfoot. Bone Joint J 2014;96-B Suppl 13:21.

  21. Munshi S, Varghese RA, Joseph B. Evaluation of outcome of treatment of congenital clubfoot. J Pediatr Orthop 2006;26:664–72.

    Article  Google Scholar 

  22. Pirani S, Hodges D, Sekeramyi F. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity. J Bone Joint Surg Br 2008;90 (Suppl I): 53.

  23. Awang M, Sulaiman AR, Munajat I, Fazliq ME. Influence of age, weight, and pirani score on the number of castings in the early phase of clubfoot treatment using ponseti method. Malays J Med Sci 2014;21:40–3.

    PubMed  PubMed Central  Google Scholar 

  24. Cosma D, Vasilescu DE. A clinical evaluation of the pirani and dimeglio idiopathic clubfoot classifications. J Foot Ankle Surg 2015;54:582–5.

    Article  Google Scholar 

  25. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 1998;18:323–7.

    CAS  PubMed  Google Scholar 

  26. Jain S, Ajmera A, Solanki M, Verma A. Interobserver variability in pirani clubfoot severity scoring system between the orthopedic surgeons. Indian J Orthop 2017;51:81–5.

    Article  Google Scholar 

  27. Pulak S, Swamy M. Treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiop J Health Sci 2012;22:77–84.

    PubMed  PubMed Central  Google Scholar 

  28. Sharma P, Verma R, Gohiya A, Gaur S. Analysis of the effectiveness of a non-governmental organization in supporting clubfoot clinic at a tertiary care center. SICOT J 2015;1:8.

    Article  Google Scholar 

  29. Karanicolas PJ, Bhandari M, Kreder H, Moroni A, Richardson M, Walter SD, et al. Evaluating agreement: Conducting a reliability study. J Bone Joint Surg Am 2009;91 Suppl 3:99–106.

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Authors and Affiliations

  1. Department of Orthopaedics, Gandhi Medical College, Bhopal, 462 001, Madhya Pradesh, India

    Rahul Verma & Sanjiv Gaur

  2. Department of Orthopaedics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Pulak Sharma

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  1. Pulak Sharma
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  2. Rahul Verma
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  3. Sanjiv Gaur
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Correspondence to Rahul Verma.

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Sharma, P., Verma, R. & Gaur, S. Interobserver Reliability of Pirani Clubfoot Severity Scoring between an Orthopedic Surgeon, a Resident Doctor, and a Nonmedical Counsellor at a Clubfoot Clinic. IJOO 52, 645–650 (2018). https://doi.org/10.4103/ortho.IJOrtho_10_17

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_10_17

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