Assessing Clubfoot Treatment (ACT) Tool
Objective[edit | edit source]
The Assessing Clubfoot Treatment (ACT) score was developed for clubfoot therapists to assess the results of Ponseti treatment in children of walking age in low resource settings, where access to qualified therapists may be limited. In many of these settings treatment is being offered by non-specialised health workers (article 2). It is helpful in predicting the need for referral for further intervention, whether that is a specialist opinion or referral for further manipulation and casting (ref article 1). The use of the ACT score is to accurately inform and predict future management. It answers such questions as: (1) does the child need more treatment? (2) has the child been successfully treated? and (3) will the child’s quality of life be improved? It is suitable for use in children who are of walking age.
Intended Population[edit | edit source]
An evaluation tool for clubfoot therapists (non-specialised health workers) in low resource settings to assess the results of Ponseti treatment of congenital talipes equinovarus (CTEV) in children of walking age. (ref article 1)
Method[edit | edit source]
The ACT tool consists of 4 questions; each scored from 0 to 3, giving a total from 0 to 12 where 12 is the ideal result. The 4 questions consist of one physical assessment and three parent reported outcome measures. It takes 5 minutes to administer and has been observed to have excellent inter-observer agreement.(Ref Dissertation) • The question about the plantigrade position of the foot was answered first by independent physical examination of the child in supine by the physiotherapists, with the knee extended and though the measurement of passive range of dorsiflexion of the hindfoot. • The remaining three questions of the ACT score were answered by the carers about the child’s pain, ability to wear shoes and satisfaction. The child followed verbal instructions to complete the functional performance review. • In addition, data were collected using a self-administered healthcare satisfaction questionnaire (18) and a quality of life questionnaire (19). The questionnaires were available in English and Shona and were cognitively tested. Each measure was recorded by hand on a separate paper. The study protocol was pilot tested for suitability before use. Table 1: ACT questions and score Score Score 1.The foot is plantigrade 2.Does your child complain of pain in their affected foot? 3.Can your child wear shoes of your/their choice? 4.How satisfied are you with your child’s foot? 0 Does not reach plantigrade, with additional adduction, cavus or varus Yes and it often limits their activity Never Very dissatisfied 1 Does not reach plantigrade, no additional deformity Yes and it sometimes limits their activity Sometimes Somewhat dissatisfied 2 Plantigrade achieved Yes but it does not limit their activity Usually Somewhat satisfied 3 More than plantigrade i.e. some dorsiflexion No Always Very Satisfied
A score of 8 or less indicates that the child needs a referral, A score between 9-10 indicates that the child would benefit from a referral of surgical/medical review
whereas a score of 11 or 12 indicated the child had a good outcome. One child with a score of 9 and three children with a score of 10 were judged to need referral for more casting and one child with a score of 10 to need referral for surgical review.
Reference[edit | edit source]
Smythe T, PhD Thesis (link to https://researchonline.lshtm.ac.uk/4649940/1/2018_ITD_PhD_Smythe_TH.pdf)
Evidence[edit | edit source]
T Smythe developed a tool that has good reliability both within and between examiners and is helpful in predicting the need for referral for further intervention (specialist opinion or for further manipulation and casting) (ref article 1). A study by Smythe et al, in 2018, comparing outcome measures after the Ponsetti method had good inter-observer agreement between the two expert physiotherapists. The study found that the ACT score had 79.2% (95%CI: 57.8–92.9%) sensitivity and 100% (95%CI: 92–100%) specificity in predicting the need for referral, with positive and negative predictive values of 100 and 89.8% respectively.
