Prospective evaluation of parental anxiety related to newborn foot disorder.

PURPOSE: The presence of a clubfoot is often found prenatally and some families seek counselling with a specialist. The purpose of this study was to compare the parental anxiety levels in families that: a) knew prenatally and had prenatal counselling; b) knew prenatally but did not seek prenatal counselling; and c) did not know until after delivery. METHODS: This prospective cohort study evaluated the anxiety of parents as they presented to the paediatric orthopaedic clinic with their newborn with a foot disorder (prior to the diagnostic confirmation of clubfoot). Each family filled out the 'Pre-visit orthopaedic surgeon questionnaire' and then after the initial visit with the orthopaedic surgeon (confirming the clubfoot diagnosis) the family filled out the 'Immediately post-visit orthopaedic surgeon questionnaire'. Through these questionnaires, anxiety level was assessed prior to meeting postnatally with the paediatric orthopaedic specialist, as well as after the meeting and compared across groups. RESULTS: A total of 121 parents completed questionnaires: 71% (86/121) confirmed clubfoot; 69% of families (59/86) received prenatal counselling (Group A); 16% (14/86) knew prenatally but had no counselling (Group B); and 15% (13/86) found out at birth (Group C). There was no difference in anxiety levels across groups before (p = 0.78) or after (p = 0.57) meeting with the paediatric orthopaedic surgeon; however, overall anxiety reduced significantly (p < 0.001). CONCLUSION: We found no difference in the anxiety levels of across the three groups. Prenatal counselling for parents of children with likely clubfoot may not decrease parental anxiety, but nonetheless is very appreciated by the families who receive it. LEVEL OF EVIDENCE: Prognostic Level II.

Clubfoot relapse: does presentation differ based on age at initial relapse?

PURPOSE: Treatment of idiopathic clubfoot with the Ponseti method is now standard, but predicting relapse can be difficult. Most experts recommend bracing to the age of four years, but this can be challenging for families, and may not be necessary in all patients. The purpose of this study is to compare patterns of bracing and age of relapse to help determine if predictable patterns exist. METHODS: The 70 patients with idiopathic clubfoot treated initially with the Ponseti technique who had relapse of their clubfoot were identified. Relapse was defined as a return to casting or surgery due to recurrent deformity. Data collected included demographics, treatment and brace adherence. Patients who sustained initial relapse before the age of two years were compared with those who sustained initial relapse after the age of two years. RESULTS: In total 56% (39/70) had their initial relapse prior to age two years while 44% (31/70) were after age two years. Of the patients who relapsed prior to the age of two years, 28% (11/39) were adherent with bracing while 72% were non--adherent. For patients who initially relapsed after age two, 74% (23/31) were adherent with bracing while 26% were non-adherent (p < 0.001). Of those who had initial -relapse -prior to age two, a subsequent relapse was seen in 69% (27/39). CONCLUSION: Patients with idiopathic clubfoot who experienced recurrence prior to age two years are significantly more likely to be non-adherent with bracing than those who sustain recurrence after age two. After initial relapse prior to age two, bracing adherence does not affect likelihood of subsequent recurrence.

A simple and reliable method to calibrate respiratory magnetometers and Respitrace.

We present a simple and reliable method to calibrate respiratory magnetometers and Respitrace to infer respiratory volume changes. As in earlier methods, we assume two degrees of freedom in the chest wall and that volume displacement depends linearly on surface motion at the rib cage and abdomen. Because the area of the rib cage is larger, a given motion of its surface produces a greater lung volume change; therefore, the rib cage motion signal is given a larger gain before the two signals are added to estimate volume. In contrast to earlier methods, we use a "standard ratio" to weight relative gains of the rib cage and abdominal signals for all subjects rather than determining a gain ratio for each individual subject. Our procedure does not require subjects to perform the sometimes difficult isovolume maneuvers used in the calibration method of Konno and Mead (J. Appl. Physiol. 22: 407-422, 1967), does not require statistical computation used in the multiple-breath linear regression method, and does not produce the occasional substantial errors in gain ratio that may occur with the other methods. When magnetometers are used, the standard ratio is 4:1 (rib cage-to-abdomen); when Respitrace is used, the standard ratio is 2:1. In 11 subjects, calibration with standard ratios was as accurate as the isovolume and linear regression techniques. Accuracy during normal breathing was nearly always within 10% (median 2%), but occasional large errors occurred with both instruments.