Background
Methods
The Clubfoot Assessment Protocol (CAP)
Procedure
Patients
Age group I | Age group II | Age group III | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Item | S | n | Kappa (95% CI) | Po % | N | Kappa (95%CI) | Po% | N | Kappa(95%CI) | Po % |
1. Dorsiflexion | 5 | 22 | 0.94 (0.81–1.00) | 95 | 25 | 0.44 (0.16–0.71) | 68 | 22 | 0.73 (0.5–0.96) | 82 |
2. Plantarflexion | 5 | 22 | 0.65 (0.34–0.96) | 82 | 25 | 0.43 (0.14–0.71) | 64 | 20 | 0.77 (0.35–1.00) | 95 |
3. Subtalar | 5 | 22 | 0.74 (0.54–0.95) | 82 | 23 | 0.26 (-0.17–0.69) | 68 | 22 | 0.71 (0.46–0.96) | 82 |
4. Derotation | 5 | 22 | 0.53 (0.30–0.76) | 73 | 25 | 0.65 (0.02–1.00) | 96 | 22 | 0.62 (0.32–0.93) | 82 |
5. Adduktion | 5 | 22 | 1.00 (0.00–0.00) | 100 | 25 | 0.58 (0.23–0.92) | 84 | 22 | 0.53 (0.21–0.84) | 73 |
6. Tightness | 4 | 22 | 0.66 (0.43–0.90) | 77 | 23 | 0.41 (0.10–0.73) | 84 | 21 | 0.85 (0.65–1.00) | 90 |
7. Flx.dig.long | 3 | 13 | 0.00 (0.00–0.00) | 77 | 25 | -0.06(-0.14–0.0)! | 88 | 18 | 0.00 (0.00–0.00) ! | 94 |
8. Flx.dig.hall. | 3 | 13 | 0.00 (0.00–0.00) | 85 | 25 | 0.83 (0.52–1.00) | 96 | 18 | 0.00 (0.00–0.00) ! | 94 |
9. M. Peroneus | 3 | 22 | 0.58 (0.30–0.86) | 73 | 25 | 0.54 (0.24–0.85) | 76 | 22 | 0.57 (0.26–0.88) | 72 |
10. M. ext.dig.ln | 3 | 22 | 0.21 (0.02–0.40) | 64 | 24 | 0.60 (0.21–0.99) | 84 | 22 | 0.26 (-0.15–0.66) | 72 |
11. M. sol/gastr. | 3 | 20 | 0.52 (0.12–0.93) | 80 | 21 | 0.00 (0.00–0.00) ! | 81 | 22 | 0.00 (0.00–0.00)! | 91 |
12. Tib.rotation | 3 | 22 | 0.74 (0.40–1.00) | 91 | 25 | 0.71 (0.41–1.00) | 88 | 22 | 0.62 (0.16–1.00)! | 91 |
13. Calc.pos. | 3 | 22 | 0.78 (0.56–1.00) | 86 | 21 | -0.07(-0.2–0.04)! | 84 | 22 | 0.43 (0.00–0.98) | 86 |
14. Forefootpos. | 3 | 22 | 0.82 (0.60–1.00) | 82 | 21 | 0.63 (0.26–1.00) | 86 | 19 | 0.41 (0.06–0.75) | 68 |
15. Foot arch | 3 | 22 | 1.00 | 100 | 21 | 0.00 (0.00–0.00) | 95 | 21 | 0.43 (0.10–0.75) | 81 |
16. Walking | 4 | n.a | 24 | 0.71 (0.45–0.97) | 83 | 22 | 0.64 (0.37–0.92) | 77 | ||
17. Toe walking | 4 | n.a | 12 | 0.60 (0.15–1.00) | 83 | 22 | 0.38 (0.02–0.74) | 68 | ||
18. Heelwalking | 4 | n.a | 12 | 0.37 (0.06–0.68) | 58 | 22 | 0.52 (0.23–0.81) | 68 | ||
19. Squatting | 4 | n.a | 18 | 0.50 (0.08–0.92) | 78 | n.a | ||||
20. Running | 4 | n.a | 18 | 0.67 (0.35–0.98) | 83 | 22 | 0.13 (-0.21–0.47) | 45 | ||
21. One legstand | 4 | n.a | n.a | 22 | 0.66 (0.41–0.91) | 77 | ||||
22. Hop 1 leg | 4 | n.a | n.a | 22 | 0.94 (0.82–1.00) | 95 |
Statistics
Results
Inter- rater reliability and age influence
Inter-rater | Intra-rater | ||||||
---|---|---|---|---|---|---|---|
Item | S | n | Kappa (95% CI)) | Po (%) | n | Kappa (95% CI) | Po (%) |
1. Dorsiflexion | 5 | 69 | 0.73 (0.60–0.86) | 85 | 32 | 0.72 (0.50–0.94) | 84 |
2. Plantarflexion | 5 | 67 | 0.62 (0.45–0.79) | 79 | 32 | 0.66 (0.41–0.91) | 66 |
3. Subtalar | 5 | 67 | 0.65 (0.49–0.79) | 79 | 32 | 0.83 (0.66–1.00) | 91 |
4. Derotation | 5 | 69 | 0.62 (0.45–0.79) | 84 | 32 | 0.93 (0.76–1.10) | 97 |
5. Adduktion | 5 | 69 | 0.71 (0.54–0.88) | 85 | 32 | 0.94 (0.83–1.05) | 97 |
6. Tightness | 4 | 66 | 0.68 (0.53–0.83) | 80 | 32 | 0.61 (0.35–0.87) | 78 |
7. Flx.dig.long | 3 | 56 | -0.03 (-0.09–0.03) ! | 87 | 32 | 0.72 (0.36–1.08) | 94 |
8. Flx.dig.hall. | 3 | 56 | 0.57 (0.20–0.94) ! | 93 | 32 | 0.54 (0.27–0.81) | 81 |
9. M. Peroneus | 3 | 69 | 0.60 (0.44–0.76) | 75 | 26 | 0.63 (0.34–9.92) | 94 |
10. M. ext.dig.lgn | 3 | 68 | 0.36 (0.16–0.56) | 75 | 28 | 1.00 | 100 |
11. M. sol/gastr. | 3 | 63 | 0.35 (0.05–0.60) | 84 | 24 | 1.00 | 100 |
12. Tib.rotation | 3 | 69 | 0.70 (0.50–0.90) | 90 | 31 | 0.84 (0.63–1.00) | 94 |
13. Calc.pos. | 3 | 65 | 0.63 (0.43–0.83) | 85 | 32 | 0.80 (0.53–1.00) | 94 |
14. Forefootpos. | 3 | 62 | 0.63 (0.44–0.82) | 82 | 32 | 0.82 (0.63–1.00) | 91 |
15. Foot arch | 3 | 64 | 0.5 (0.30–0.86) ! | 92 | 31 | 1.00 | 100 |
16. Walking | 4 | 46 | 0.68 (0.50–0.86) | 80 | 27 | 0.81 (0.63–0.99) | 89 |
17. Toe walking | 4 | 34 | 0.49 (0.21–0.77) | 73 | 15 | 0.61 (0.27–0.95) | 80 |
18. Heelwalking | 4 | 34 | 0.47 (0.23–0.71) | 65 | 15 | 0.79 (0.52–1.00) | 87 |
19. Squatting | 4 | 19 | 0.56 (0.18–0.94) | 79 | 19 | 0.80 (0.54–1.00) | 89 |
20. Running | 4 | 40 | 0.38 (0.14–0.62) | 62 | 27 | 0.78 (0.59–0.97) | 85 |
21. One legstand | 4 | 22 | 0.70 (0.45–0.95) | 77 | 9 | 0.68 (0.28–1.00) | 77 |
22. Hop 1 leg | 4 | 22 | 0.94 (0.82–1.06) | 95 | 9 | 0.70 (0.33–1.07) | 77 |
Intra – rater reliability
Discussion
Methodological issues
Statistics
Results
Future research
Conclusion
Name: | Date of birth: | ||||
---|---|---|---|---|---|
Date of assessment: | Assessment number: | ||||
Side: | O Left | O Right | |||
Rating | 0 | 1 | 2 | 3 | 4 |
Passive mobility
| |||||
1. Dorsiflexion | < -10° | -10°-< 0° | 0°- < +10° | +10°- +20° | >+20° |
2. Plantar flexion | 0°- < 10° | 10°- < 20° | 20°-< 30° | 30°- 40° | >40° |
3. Varus/valgus | >20°var | 20°-< 10°var | 10° -< 0°var | 0°- neutral | >0°vlg |
4. Derotation | >20°inv | 20°-< 10°inv | 10°- < 0°inv | 0°- 10°evr | >10°evr |
5. Add/abd | >20°add | 20°-< 10°add | 10°- < 0°add | 0°- neutral | >0°abd |
6. Tightness | + tight | tight | soft-tight | soft | |
7. Flx.dig.long. | + reduced | reduced | normal | ||
8. Flx.dig.hall. | + reduced | reduced | normal | ||
Muscle function (strength)
| |||||
9. M. peroneus | absent/poor | reduced | normal | ||
10. M. ext.dig.long | absent/poor | reduced | normal | ||
11. M. sol./gastr. | absent/poor | reduced | normal | ||
Morphology
| |||||
12. Tibial rotation | + inw. | inw. | normal | ||
13. Calcaneus position | >10 varus | >0 varus <10 | neutral/vlg | ||
14. Forefoot position | >20° add. | >10 add. <20° | add<10° | ||
15. Foot arch | + cavus | cavus | normal | ||
Motion quality
| |||||
I
| |||||
16. Walking | + deviant | deviant | slightly deviant | normal | |
17. Toe walking | cannot | deviant | slightly deviant | normal | |
18. Heel walking | cannot | deviant | slightly deviant | normal | |
19. Squatting | cannot | deviant | slightly deviant | normal | |
20. Running | + deviant | deviant | slightly deviant | normal | |
II
| |||||
21. One legstand | cannot | deviant | slightly deviant | normal | |
22. Hop1leg | cannot | deviant | slightly deviant | normal |