Summary of findings 2. Treatment for resistant congenital talipes equinovarus (CTEV; clubfoot).
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Patient or population: participants with resistant CTEV Settings: single centre Intervention: various Comparison: various | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| PMSTR | Subtalar release | |||||
| PMSTR | PMSTR + talocalcaneal interosseus ligament lengthening | |||||
| FHL & FDL lengthening | Simple decompression surgery | |||||
| CTEV surgery + CPM | CTEV surgery + immobilisation | |||||
| Function | Not measured | |||||
| Foot alignment | 4 trials assessed foot alignment, but data were not suitable to re‐analyse. 3 compared surgical techniques; the 4th compared CPM with immobilisation in a case post‐surgery | |||||
| Gait assessment | Not measured | |||||
| Health‐related quality of life | Not measured | |||||
| Adverse events | 1 trial reported skin infections following: PMSTR (N = 4 feet, 8.5%) and complete circumferential subtalar release (N = 2 feet, 5.1%). The remaining trials did not report adverse events. Relapses were documented in all trials but data were not available to analyse. |
⊕⊝⊝⊝ Very lowa | ‐ | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CPM: continuous passive motion; PMSTR: posteromedial soft tissue release; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aWe downgraded the evidence twice: once for study limitations, and once for blinding of intervention provider (not possible); unclear about prior treatment. The risk of bias was unclear in several other domains, including allocation concealment.