Factors associated with adherence to bracing in Ponseti management of clubfoot: a systematic scoping review
Paterson, Kelly J., Clough, Alan R., Farry, Katheryn, Virgin, James W., Taylor, Sean, and Barker, Ruth N. (2024) Factors associated with adherence to bracing in Ponseti management of clubfoot: a systematic scoping review. Physical Therapy Reviews, 29 (4). pp. 134-152.
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Abstract
Background: Clubfoot management according to the Ponseti method, including 4–5 years of bilateral foot abduction bracing to prevent relapse, is widely accepted as gold standard. Adherence to bracing is often low, despite non-adherence being associated with poor outcomes. Objectives: This systematic scoping review aimed to identify and synthesize factors associated with brace adherence and non-adherence in the Ponseti method, to identify strategies shown to improve adherence, and to provide a clinically meaningful synthesis of available evidence. Methods: This scoping review utilized systematic search and formal guidance on conduct and reporting. Medline, SCOPUS, Informit, EmCare, CINAHL, and PEDro databases were searched for peer-reviewed primary research reporting factors associated with brace adherence or non-adherence during Ponseti management. Factors were identified, then grouped using inductive then deductive methods and reported in a narrative synthesis. Results: A total of 413 studies were identified and 42 were included in the review: 31 quantitative and 11 qualitative, generally of low quality. Meta-analysis was not feasible. Factors associated with non-adherence were identified more often than with adherence, and findings for both were inconsistent. Fifty-three factors were investigated, with conflicting findings common. No studies evaluating strategies to improve brace adherence were identified. Conclusions: Available evidence does not indicate that any one factor or set of factors is consistently associated with adherence or non-adherence to bracing in Ponseti clubfoot management, and so clinically meaningful factors are proposed. Adequately powered longitudinal studies of adherence to bracing are required. Mixed methods approaches would help to inform and evaluate strategies to improve adherence, particularly those routinely recommended in clinical practice.
| Item ID: | 87408 |
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| Item Type: | Article (Research - C1) |
| ISSN: | 1743-288X |
| Keywords: | brace, Clubfoot, patient compliance, Ponseti method |
| Copyright Information: | © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/ licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. |
| Date Deposited: | 02 Dec 2025 21:39 |
| FoR Codes: | 42 HEALTH SCIENCES > 4203 Health services and systems > 420309 Health management @ 100% |
| SEO Codes: | 28 EXPANDING KNOWLEDGE > 2801 Expanding knowledge > 280112 Expanding knowledge in the health sciences @ 100% |
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