BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,but no evidencebased guidelines or assessment tools exist.Yet,surgical indication is left to the surgeon’s experience and preferences.AIM To dev...BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,but no evidencebased guidelines or assessment tools exist.Yet,surgical indication is left to the surgeon’s experience and preferences.AIM To develop a functional clinical score for FFF[Catania flatfoot(CTF)score]and a measure of internal consistency;to evaluate inter-observer and intra-observer reliability of the CTF Score;to provide a strong tool for proper FFF surgical indication.METHODS CTF is a medically compiled score of four main domains for a total of twelve items:Patient features,Pain,Clinical Parameters,and Functionality.Each item refers to a specific rate.Five experienced observers answered 10 case reports according to the CTF.To assess inter-and intra-observer reliability of the CTF score,the intra-class correlation coefficients’(ICCs)statistics test was performed,as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication.Values of 75%were chosen as the score cut-off for surgical indication.Sensitivity,specificity,positive likelihood ratio(PLHR),negative likelihood ratio(NLHR),positive predictive value(PPV),and negative predictive value(NPV).RESULTS Overall interobserver reliability ICC was 0.87[95%confidence interval(CI):0.846-0.892;P<0.001].Overall intra-observer reliability ICC was 0.883(95%CI:0.854-0.909;P<0.001).A direct correlation between the CTF score and surgical treatment indication[Pearson correlation coefficient=0.94(P<0.001)]was found.According to the 75%cut-off,the sensitivity was 100%(95%CI:83.43%-100%),specificity was 85.71%(95%CI:75.29%-92.93%),PLHR was 7(95%CI:3.94-12.43),NLHR was 0(95%CI:0-0),PPV was 75%(95%CI:62.83%-84.19%)and NPV was 100%(95%CI:100%-100%).CONCLUSION CTF represents a useful tool for orthopedic surgeons in the FFF evaluation.The CTF score is a quality questionnaire to reproduce suitable clinical research,survey studies,and clinical practice.Moreover,the 75%cutoff is an important threshold for surgical indication and helps in the decision-making process.展开更多
文摘BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,but no evidencebased guidelines or assessment tools exist.Yet,surgical indication is left to the surgeon’s experience and preferences.AIM To develop a functional clinical score for FFF[Catania flatfoot(CTF)score]and a measure of internal consistency;to evaluate inter-observer and intra-observer reliability of the CTF Score;to provide a strong tool for proper FFF surgical indication.METHODS CTF is a medically compiled score of four main domains for a total of twelve items:Patient features,Pain,Clinical Parameters,and Functionality.Each item refers to a specific rate.Five experienced observers answered 10 case reports according to the CTF.To assess inter-and intra-observer reliability of the CTF score,the intra-class correlation coefficients’(ICCs)statistics test was performed,as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication.Values of 75%were chosen as the score cut-off for surgical indication.Sensitivity,specificity,positive likelihood ratio(PLHR),negative likelihood ratio(NLHR),positive predictive value(PPV),and negative predictive value(NPV).RESULTS Overall interobserver reliability ICC was 0.87[95%confidence interval(CI):0.846-0.892;P<0.001].Overall intra-observer reliability ICC was 0.883(95%CI:0.854-0.909;P<0.001).A direct correlation between the CTF score and surgical treatment indication[Pearson correlation coefficient=0.94(P<0.001)]was found.According to the 75%cut-off,the sensitivity was 100%(95%CI:83.43%-100%),specificity was 85.71%(95%CI:75.29%-92.93%),PLHR was 7(95%CI:3.94-12.43),NLHR was 0(95%CI:0-0),PPV was 75%(95%CI:62.83%-84.19%)and NPV was 100%(95%CI:100%-100%).CONCLUSION CTF represents a useful tool for orthopedic surgeons in the FFF evaluation.The CTF score is a quality questionnaire to reproduce suitable clinical research,survey studies,and clinical practice.Moreover,the 75%cutoff is an important threshold for surgical indication and helps in the decision-making process.
