title: Bracing in Ponseti Clubfoot Treatment: Improving Parental Adherence Through an Innovative Health Education Intervention.
abstract: Clubfoot is the most common musculoskeletal birth defect, characterized by abnormal tendon and muscle development, leading to abnormal bone alignment of the feet. The Ponseti method is considered the gold standard in clubfoot treatment, and consists of a series of plaster castings, followed by 4 years of brace use. The most common cause of clubfoot relapse is nonadherence with the bracing protocol by the child's caretakers. The purpose of this study was to design, implement, and evaluate an educational bracing program for parents of children with clubfoot in an effort to improve bracing adherence. The educational bracing program for parents of children with clubfoot was designed with incorporation of findings from previous research, adult teaching methodology, and parental feedback. An educational brochure and a practice doll were created for use in educational sessions with parents during routine treatment visits. Two educational sessions were conducted with a health educator, employing identical questionnaires to assess changes in parental knowledge and skills upon completion of the program. Thirty parents completed the educational bracing program, and the majority reported increased knowledge and self-efficacy regarding the bracing protocol of the Ponseti method. In addition, the health practitioners who conducted the educational sessions witnessed an improved ability of all parents to apply the brace as directed, and to recognize and correct improper fit. Completion of the educational program by the parents resulted in immediate improvements in knowledge and skills related to clubfoot bracing. Given that noncompliance to the bracing protocol is the most common cause of clubfoot relapse, these immediate effects of the educational program are promising not only because they encourage proper brace use, but because these immediate improvements have the potential to reduce future rates of clubfoot relapse.
authors.affiliation: Laura Seegmiller, MPH, Research Associate, University of Iowa College of Public Health, Iowa City, IA. Rebecca Burmeister, MPH, Graduate Student, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Maria Paulsen-Miller, MSN, RN, Orthopedic and Rehabilitation Nurse, University of Iowa Hospitals and Clinics, Iowa City, IA. Jose Morcuende, MD, PhD, Associate Professor, Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Laura
authors.initials: L
authors.lastname: Seegmiller
authors.forename: Rebecca
authors.initials: R
authors.lastname: Burmeister
authors.forename: Maria
authors.initials: M
authors.lastname: Paulsen-Miller
authors.forename: Jose
authors.initials: J
authors.lastname: Morcuende
mesh_terms: D000328:Adult; D001915:Braces / Q000592:standards*; D002370:Casts, Surgical; D002648:Child; D003025:Clubfoot / Q000628:therapy*; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000193:education*; D010290:Parents / Q000193:education* / Q000523:psychology; D010349:Patient Compliance; D010865:Pilot Projects; D055502:Secondary Prevention; D011795:Surveys and Questionnaires