Effect of Cultural Factors on Outcome of Ponseti Treatment of Clubfeet in Rural America
Effect of Cultural Factors on Outcome of Ponseti Treatment of Clubfeet in Rural America
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DOI：
10.2106/jbjs.h.00580
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发表时间：
2009-03-01
影响因子：
5.3
通讯作者：
Schwend, Richard M.
中科院分区：
文献类型：
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作者：
Avilucea, Frank R.;Szalay, Elizabeth A.;Schwend, Richard M.
背景：Ponseti方法非手术治疗马蹄内翻足已被证明是有效的，它是公认的初始治疗形式。虽然一些研究表明，与支具协议的遵守问题是主要负责复发，没有区别已作出关于是否从护理现场的距离影响早期复发率。我们比较了早期复发后Ponseti治疗的农村和城市种族不同的北美人群之间的距离进行分析是否从护理的网站影响的依从性，以及是否某些患者的人口统计学特征预测recursion.Methods：100个连续的婴儿，共138个马蹄内翻足治疗的Ponseti方法进行了前瞻性随访至少两年的治疗开始。早期复发（定义为需要后续石膏治疗或手术治疗）和依从性（定义为严格遵守Ponseti描述的支具方案）从与护理部位的距离、就诊时的年龄、初始矫正所需的石膏数量、肌腱切开术的需要和家庭人口统计学变量进行分析。结果：在18名来自农村地区的早期复发婴儿中，有14名是美洲原住民。这些孩子的家庭，像所有早期复发的孩子一样，比医生建议的更早停止使用矫形器。在居住在农村地区的患者中，停用矫形器与复发相关，比值比为120（p < 0.0001）。美国原住民种族，未婚父母，公共或无保险，父母教育程度为高中或以下，家庭收入低于20，000美元也是生活在农村地区的患者复发的重要风险因素。马蹄内翻足畸形的内在因素与复发或中止bracing.Conclusions：遵守矫形方案后，石膏治疗是必不可少的Ponseti方法取得成功。与城市美洲原住民患者和其他种族儿童的结局相比，农村美洲原住民患者的结局存在显着差异，这表明在向该亚群的家庭传达支具以维持矫正的重要性方面存在特殊问题。对沟通风格的研究表明，这些沟通失败可能与文化有关。
Background: Nonoperative management of clubfoot with the Ponseti method has proven to be effective, and it is the accepted initial form of treatment. Although several studies have shown that problems with compliance with the brace protocol are principally responsible for recurrence, no distinction has been made with regard to whether the distance from the site of care affects the early recurrence rate. We compared early recurrence after Ponseti treatment between rural and urban ethnically diverse North American populations to analyze whether distance from the site of care affects compliance and whether certain patient demographic characteristics predict recurrence.Methods: One hundred consecutive infants with a total of 138 clubfeet treated with the Ponseti method were followed prospectively for at least two years from the beginning of treatment. Early recurrence, defined as the need for subsequent cast treatment or surgical treatment, and compliance, defined as strict adherence to the brace protocol described by Ponseti, were analyzed with respect to the distance from the site of care, age at presentation, number of casts needed for the initial correction, need for tenotomy, and family demographic variables.Results: Of eighteen infants from a rural area who had early recurrence, fourteen were Native American. The families of these children, like those of all of the children with early recurrence, discontinued orthotic use earlier than was recommended by the physician. Discontinuation of orthotic use was related to recurrence, with an odds ratio of 120 (p < 0.0001), in patients living in a rural area. Native American ethnicity, unmarried parents, public or no insurance, parental education at the high-school level or less, and a family income of less than $20,000 were also significant risk factors for recurrence in patients living in a rural area. Intrinsic factors of the clubfoot deformity were not correlated with recurrence or discontinuation of bracing.Conclusions: Compliance with the orthotic regimen after cast treatment is imperative for the Ponseti method to succeed. The striking difference in outcome in rural Native American patients as compared with the outcomes in urban Native American patients and children of other ethnicities suggests particular problems in communicating to families in this subpopulation the importance of bracing to maintain correction. An examination of communication styles suggested that these communication failures may be culturally related.