Abstract
Background
Idiopathic toe walking (ITW) is an exclusionary diagnosis and varies in severity, from those children with full range of ankle motion, to those with associated ankle equinus. In the absence of a consensus in the treatment for this gait pattern, many clinicians are faced with challenges in understanding available evidence-based treatment options. The research aim was to understand agreement between health professionals’ knowledge of evidence for common treatment strategies for idiopathic toe walking (ITW) and if health professionals supported these strategies being used in clinical practice.
Methods:
An international online survey was opened to registered health professionals who treat children with ITW between July 2017 and March 2018. The survey had two components: 1) demographic variables and variables relating to knowledge of evidence about ITW treatments and 2) support for common treatment strategies. Additional data on strategy use, referrals, and preference were collected. Kappa statistics described intra-rater agreement between evidence knowledge and support. Multivariable regression analyses identified factors associated with the 10 most commonly preferred treatments.
Results:
There were 908 international responses. Kappa agreement for paired correct responses determined a fair agreement for evidence support knowledge for four strategies including Watch and Wait (Kappa=0.24), Stretching (Kappa=0.30), Sensory Integration Strategies (Kappa=0.40) and Motor Control Strategies (Kappa =0.24) and moderate responses for thirteen others. No strategies had greater than moderate agreement between correct knowledge of evidence and strategy support. Profession, location, number of children seen in practice, and not correctly identifying the evidence factored into many of the most commonly used strategies for ITW (p<0.05).
Conclusions:
The results from this study confirm a variety of interventions are utilised in the management of ITW around the world. Furthermore, there remains a disconnect between clinicians understanding of the evidence of common treatment strategies of ITW and a consensus for the treatment of this condition.