Abstract
While adoption of the Ponseti method has continued gradually, its use to manage patients with congenital talipes equinovarus (CTEV) has been limited in low- and middle-income countries (LMICs) for a number of reasons including a lack of clinical training on technique and lack of appropriate clinical equipment. There are a frequent number of emerging studies that report on the role of clubfoot training programmes; however, little is known in regard to cumulative benefits.A systematic review was undertaken through Medline, the Cochrane Library and Web of Science for studies analysing clubfoot training programmes. There were no limitations on time, up until the review was commenced on January 2020. The systematic review was registered with PROSPERO as 165657. Ten articles complied with the inclusion criteria and were deemed fit for analysis. Training programmes lasted an average of 2–3 days. There was a reported increase in knowledge of applying the Ponseti method in managing clubfoot by participants (four studies P < 0.05). Skill retention was examined by multiple choice (MCQ) examination style questions before and after the training programme in two studies; both showed an improvement (MCQ answers improved from 59% to 73%). All studies showed an improvement in participants' self-reported understanding of the Ponseti method and confidence in its use in future practice (P < 0.05). There were improved benefits of knowledge and clinical application of the Ponseti method by participants in the programmes in all studies examined. However, there was a significant lack of follow-up and exploration of long-term effects of these programmes. Implementing training programmes based on perceived benefits rather than actual long-term benefits may have a negative impact on healthcare delivery and patient management in LMICs.
Highlights
Congenital talipes equinovarus (CTEV) is one of the most prevalent congenital deformities, estimated to occur in 0.6–1.5 per 1000 live births, with 80% born in low- and middle-income countries (LMICs).[1]
All other studies opted for the use of questionnaires that were given after the training programmes were completed, focusing on confidence and perceived improvement in understanding of the Ponseti method after the training session
On review of the available literature on CTEV training programmes in LMICs, we have identified common themes of improvement in knowledge of management of CTEV and a subsequent increase in the proportion of clinical cases managed by attendees in their own practice (Tables 1 and 2)
Summary
Congenital talipes equinovarus (CTEV) is one of the most prevalent congenital deformities, estimated to occur in 0.6–1.5 per 1000 live births, with 80% born in low- and middle-income countries (LMICs).[1]. Reasons for this may include limited training in the Ponseti method, limited personnel and competing priorities, in sub-Saharan Africa.[10,11] Further, the major challenge for the availability of surgical services for children in LMICs worldwide is lowskilled workforce and infrastructure.[12,13,14] A recent Zambian study, using the World Health Organization (WHO) SAT tool, demonstrated that lack of surgical skill and relevant equipment was the leading factor in limiting availability of 93% of paediatric procedures.[15]
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