Factors associated with adherence to bracing in Ponseti management of clubfoot: a systematic scoping review

2024-07-24

Paterson, Kelly

Clough, Alan

Farry, Katheryn

Virgin, James

Taylor, Sean

Barker, Ruth

College of Healthcare Sciences, James Cook University, Cairns, Australia

College of Public Health, Medical and Vet Sciences, James Cook University, Cairns, Australia

College of Medicine and Dentistry, James Cook University, Townsville, Australia

Orthopaedic Department, Division of Surgery and Critical Care, Royal Darwin and Palmerston Hospital, NT Health, Darwin, Australia

Aboriginal Health Directorate, NT Health, Darwin, Australia

The Cairns Institute, James Cook University, Cairns, Australia

Journal Article

Publication

Informa UK Limited

Background: Clubfoot management according to the Ponseti method, including 4–5 years of bilateral foot abduction bracing to prevent relapse, is widely accepted as gold standard. Adherence to bracing is often low, despite non-adherence being associated with poor outcomes. Objectives: This systematic scoping review aimed to identify and synthesize factors associated with brace adherence and non-adherence in the Ponseti method, to identify strategies shown to improve adherence, and to provide a clinically meaningful synthesis of available evidence. Methods: This scoping review utilized systematic search and formal guidance on conduct and reporting. Medline, SCOPUS, Informit, EmCare, CINAHL, and PEDro databases were searched for peer-reviewed primary research reporting factors associated with brace adherence or non-adherence during Ponseti management. Factors were identified, then grouped using inductive then deductive methods and reported in a narrative synthesis. Results: A total of 413 studies were identified and 42 were included in the review: 31 quantitative and 11 qualitative, generally of low quality. Meta-analysis was not feasible. Factors associated with non-adherence were identified more often than with adherence, and findings for both were inconsistent. Fifty-three factors were investigated, with conflicting findings common. No studies evaluating strategies to improve brace adherence were identified. Conclusions: Available evidence does not indicate that any one factor or set of factors is consistently associated with adherence or non-adherence to bracing in Ponseti clubfoot management, and so clinically meaningful factors are proposed. Adequately powered longitudinal studies of adherence to bracing are required. Mixed methods approaches would help to inform and evaluate strategies to improve adherence, particularly those routinely recommended in clinical practice.

link

Paterson, K. J., Clough, A. R., Farry, K., Virgin, J. W., Taylor, S., & Barker, R. N. (2024). Factors associated with adherence to bracing in Ponseti management of clubfoot: a systematic scoping review. Physical Therapy Reviews, 29(4), 134–152. https://doi.org/10.1080/10833196.2024.2382014