title: The Bangla clubfoot tool: a repeatability study.
abstract: BACKGROUND
  'Walk for Life' (WFL) is the sustainable clubfoot program in Bangladesh, where there are many challenges in implementing the Ponseti technique in a poor and highly populated country. The relapsing tendency of congenital clubfoot deformity means that initial results may well differ from those of the medium and longer term. Over 10000 children with16668 clubfeet have been treated by WFL since its inception in 2009. Such a large project provides both the need to evaluate each individual child's case, and also the opportunity to evaluate the wider WFL program results. Such systematic review requires a measure that is sufficiently robust, yet contextually practical, hence the aim of this work was to develop a tool for this purpose, and to report the examiner reliability.
  
  
  METHODS
  The Bangla clubfoot tool was largely developed from components of existing validated clubfoot assessment measures, and adapted for local use. Three areas of examination are included: parent satisfaction, gait, clinical examination of the clubfoot. A same-subject repeated measures study design was used to assess the intra-rater reliability of a local WFL physiotherapist, and a visiting WFL volunteer. The inter-rater reliability was also assessed, which is relevant for other examiners and other clubfoot projects undertaking evaluation of medium and longer term results.
  
  
  RESULTS
  The reliability study was conducted in 37 children who had commenced treatment for congenital clubfoot deformity using Ponseti method within the previous two years. The mean age of the children was 2.6 years, with gender 28 male: 9 female. The intra-rater reliability results [ICCs (95% CI)] were: 0.87 (0.76 - 0.93) for the local WFL examiner, and 0.82 (0.64 - 0.91) for the visiting examiner. Inter-rater reliability results [ICCs (95% CI)] were: 0.92 (0.88 - 0.96). Hence the tool showed very good intra-rater and inter-rater reliability, rendering it suitable for use.
  
  
  CONCLUSIONS
  The Bangla clubfoot tool has been developed to suit the context of the large WFL clubfoot program in Bangladesh, and shown to be a very reliable evaluation instrument.
authors.affiliation: Department of Podiatry, Lower Extremity and Gait Studies (LEGS) Research Program, La Trobe University, Bundoora, Melbourne 3083, Australia ; Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand ; Clinical Services, Walk For Life, Dhaka, Bangladesh.
authors.forename: Angela Margaret
authors.initials: AM
authors.lastname: Evans
authors.affiliation: Clinical Services, Walk For Life, Dhaka, Bangladesh.
authors.forename: Roksana
authors.initials: R
authors.lastname: Perveen
authors.affiliation: LAMB Project, Rajabashor, Parbatipur, Dinajpur 5250, Bangladesh.
authors.forename: Vikki A
authors.initials: VA
authors.lastname: Ford-Powell
authors.affiliation: Department of Paediatric Orthopaedic Surgery, Royal Aberdeen Childrens Hospital, Aberdeen, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Barker