Minde V1,2,3, Sundelin G3, Waling K3
1Kilimanjaro Christian Medical University College, Physiotherapy, Moshi, Tanzania, 2Kilimanjaro Christian Medical Centre, Physiotherapy, Moshi, Tanzania, 3Umeå University, Community Medicine and Rehabilitation, Physiotherapy, Umeå, Sweden
Background: The Pirani scoring system is extensively used in clinical practice to evaluate severity of clubfoot deformity and to predict treatment outcome. In low-income countries, physiotherapists have become front line practitioners in management of clubfoot. Most studies on Pirani instrument have assessed the reliability among physicians. However, there is scarce information on the inter-rater reliability among physiotherapists.
Purpose: To assess the inter- rater reliability between physiotherapists using the Pirani Scoring instrument in assessing clubfeet deformity in Tanzanian children.
Methods: Three experienced physiotherapists assessed independently 62 clubfeet in 32 children (24 males and 8 females), who had a median age of 48 weeks (range 2 to 130 weeks). Feet at different grade of severity and treatment stages were included. The weighted kappa statistics, percentage observation agreement and intra-class correlation coefficients was interpreted. Pirani scoring instrument was used to collect the data from the study participants. The Pirani Scoring instrument is an ordinal scale based on six clinical signs of foot contractures. Each component has maximum of 1 point making a total of 6 points. The score for each clinical sign is ranging from 0 to 1, whereby 0 no deformity; 0.5 minor deformity and 1 severe deformity.
Results: The mean difference of the Pirani score between raters were less than 0.6 points. Inter- rater reliability was assessed as moderate to high for all clinical signs. Nine attributes had a kappa value > 0.49. Two attributes varied from 0.29 to 0.39. The mean percentage agreement was 69% (range from 52 to 79%). The mean intra-class correlation coefficient for total scores was 0.81. Seven children out of 32 had severe clubfoot. The most severe deformity was located at the hind foot.
Conclusion(s): The Pirani scoring instrument has acceptable inter- rater reliability among physiotherapists. The study therefore suggests that, physiotherapists who have undergone standard training protocols on Pirani clubfoot scoring instrument, will score the Pirani score in a similar manner.
Implications: Inter-rater reliability between physiotherapists is acceptable. This will ease the clubfoot management especially in low-income countries, where several physiotherapists usually are involved in the treatment of children with clubfoot.
Keywords: Pirani Scoring Instrument, Inter-rater, Reliability
Funding acknowledgements: Umeå University, Sweden
Purpose: To assess the inter- rater reliability between physiotherapists using the Pirani Scoring instrument in assessing clubfeet deformity in Tanzanian children.
Methods: Three experienced physiotherapists assessed independently 62 clubfeet in 32 children (24 males and 8 females), who had a median age of 48 weeks (range 2 to 130 weeks). Feet at different grade of severity and treatment stages were included. The weighted kappa statistics, percentage observation agreement and intra-class correlation coefficients was interpreted. Pirani scoring instrument was used to collect the data from the study participants. The Pirani Scoring instrument is an ordinal scale based on six clinical signs of foot contractures. Each component has maximum of 1 point making a total of 6 points. The score for each clinical sign is ranging from 0 to 1, whereby 0 no deformity; 0.5 minor deformity and 1 severe deformity.
Results: The mean difference of the Pirani score between raters were less than 0.6 points. Inter- rater reliability was assessed as moderate to high for all clinical signs. Nine attributes had a kappa value > 0.49. Two attributes varied from 0.29 to 0.39. The mean percentage agreement was 69% (range from 52 to 79%). The mean intra-class correlation coefficient for total scores was 0.81. Seven children out of 32 had severe clubfoot. The most severe deformity was located at the hind foot.
Conclusion(s): The Pirani scoring instrument has acceptable inter- rater reliability among physiotherapists. The study therefore suggests that, physiotherapists who have undergone standard training protocols on Pirani clubfoot scoring instrument, will score the Pirani score in a similar manner.
Implications: Inter-rater reliability between physiotherapists is acceptable. This will ease the clubfoot management especially in low-income countries, where several physiotherapists usually are involved in the treatment of children with clubfoot.
Keywords: Pirani Scoring Instrument, Inter-rater, Reliability
Funding acknowledgements: Umeå University, Sweden
Topic: Outcome measurement; Musculoskeletal; Paediatrics
Ethics approval required: Yes
Institution: Kilimanjaro Christian Medical University College
Ethics committee: College Research Ethical Committee
Ethics number: 2285
All authors, affiliations and abstracts have been published as submitted.
