Positive Communication Paradigm Decreases Early Recurrence in Clubfoot Treatment

NewsBot · Aug 24, 2013

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Positive Communication Paradigm Decreases Early Recurrence in Clubfoot Treatment.
Morin ML, Hoopes DM, Szalay EA.
J Pediatr Orthop. 2013 Aug 20.

BACKGROUND::
The Ponseti method has become the treatment standard for idiopathic clubfoot. Deformity recurrence is most commonly attributed to premature abandonment of the requisite abduction orthosis. A study in 2009 from our center revealed a high rate of deformity recurrence in our patient population. It was surmised that the importance of bracing to maintain correction had not been adequately communicated to some families, especially Native Americans. As a result, the principal investigator developed a different communication protocol for parents of infants.
METHODS::
All children treated for clubfoot at the University of New Mexico Carrie Tingley Hospital, Albuquerque, NM, from 2008 to 2010 were reviewed. They were compared with a historical control group from this institution, the subjects of the 2009 study, and were analyzed for the rate of recurrence and Pirani score improvement.
RESULTS::
Our study cohort comprised 69 infants (104 clubfeet), all of whom were treated with the new communication style. The recurrence rate for the new communication paradigm was 2.88% compared with 18.2% in the control group (P<0.001). The Pirani score improvement was 4.0 in the treatment group compared with 3.5 in the control group (P=0.001). Native American recurrence was zero in the treatment group and 41% in the control group (P=0.011).
CONCLUSIONS::
A positive, rather than a negative communication style, emphasis on the brace as the most important aspect of treatment, and a more culturally sensitive family education paradigm, resulted in a lower rate of deformity recurrence when treating children with clubfeet using the Ponseti method.
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Admin2 · Aug 24, 2013

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wdd · Aug 25, 2013

Does this open the door for research into the effects of positive communication on every single disease and condition under the sun?

Isn't it axiomatic that showing people respect and ensuring that they understand the how, why, where and when of their contribution to the treatment will improve the outcome?

Is the implication of this research that some, if not all other conditions are likely to have a better outcome if a negative communication style is adopted?

"Positive Communication Paradigm". Pardon? The application of a plain English communication 'paradigm' might aid the intended outcome here.

Bill

NewsBot · Feb 17, 2019

Factors affecting compliance to hospital visit among clubfoot patients: A cross-sectional study from a tertiary referral clubfoot clinic in the developing country
Rishi R Poudel, Venkatesan S Kumar, Vivek Tiwari, ...
Journal of Orthopaedic Surgery February 11, 2019

Purpose:
Ensuring compliance to treatment protocol, especially regular visit to treating facility, is an important aspect of clubfoot management. However, the factors affecting compliance to follow-up schedule are myriad.

Methods:
A cross-sectional study was undertaken among caregivers of clubfoot patients from a tertiary referral clubfoot clinic in a developing country. Hospital records were reviewed to collect demographic data and subjects were classified as either “regular” or “irregular” if they missed ≤3 and >3 scheduled hospital visits, respectively. Various factors that could affect compliance such as family size, number of children, literacy of caregiver, occupation of breadwinner, and time taken to travel to hospital were studied. Caregivers were probed regarding the reason for their irregularity.

Results:
A total of 238 patients were included, of which 138 formed the “regular” group and the rest 100 formed the “irregular” group. Patients in the regular group were significantly younger (mean age 43.8 months) compared to the irregular group (59.8 months; p = 0.001). The mean follow-up period in the regular group was 28.1 months and in the irregular group was 33.8 months. On univariate analysis, age, duration of follow-up, and transport duration were found to be significant between the two groups. However, multivariate analysis revealed that female children with clubfoot are more likely to be irregular as compared to males (p = 0.038).

Conclusion:
In a developing country setting, higher age and being a female child are associated with irregularity to hospital visit protocol. At clubfoot clinics, identifying these children and counseling their caregivers might improve compliance.
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