Research Award Details

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Impact of Family Educational Videos for Increasing Clubfoot Bracing Compliance

Grant Recipient: Sarah Nossov

Shriners Hospital, Philadelphia
Presentations & Publications:
Further Funding:
Additional Information:
Final Report
Impact of Family Educational Videos for Increasing Clubfoot Bracing Compliance”
Sarah Nossov, MD. Philadelphia Shriners Hospital for Children, Philadelphia, PA

It is a common occurrence at our institution to see many patients who have recurrent clubfoot. Many of these children had problems with use of braces that led to recurrence. The goal of this project was to generate an educational video for caregivers to better understand the diagnosis, treatment plan, importance and technique of bracing to improve compliance with instructions. We intended then to survey families who watched the video to gauge the level of understanding of consequences of inadequate bracing and comfort level with bracing along with some demographic information.
We wanted to create a video that was aimed towards idiopathic clubfoot as this would be more globally applicable to most practitioners and families, however in our practice we have far more patients who are non-idiopathic and present as previously treated. This created some complexity in designing a video that would apply to both. This also makes it harder to assess the intervention as we originally intended. Initially, we hoped to do a pilot survey where we assessed immediate response to watching the video at the time of brace pick-up of a new patient. Then, we would re-survey in the future to see if the video was referred to again and if it correlates with use of bracing. It did become apparent that the best final result would be comparison of parent confidence in education with actual recurrence rates which, given our diverse population, may be difficult to interpret and would perhaps take years to collect. We are currently still in the pilot phase with a completed video which we have started to distribute.
The initial phase of this project was the creation of the video. Scripts were designed with input of research assistants and residents. Mock scenes were designed with our videographer. Our physician assistants, orthotists, physicians, and patients were filmed and involved with the editing process. The final pilot video took much longer than anticipated to complete and was just finished in early January 2019. This delay was in part due to my initial ABOS oral board examination which coincided with production.
The video is about 8 minutes long. It was uploaded to a YouTube channel for viewing access on iPads. Over the past week, patients who have been arriving at my clinic have been surveyed after their clinic visit. The preliminary results are too small in quantity to make definitive conclusions, but the expected self-reported improvement in understand the importance in bracing has been seen along with increased confidence in using braces; improvement in understanding is not as great in families that have experience with bracing in the past and is to be expected. Of the ten families that filled out surveys average patient age is 2.8 years, the most common responsible caregiver is the mother (100%), most common level of education was bachelors degree (57%), average number of siblings 2.6, 80% were bilaterally affected, 57% were idiopathic, 44% were first time brace users, and. 100% of viewers felt the video made it easier to use braces, 80% would watch it again.
Ongoing collection will continue for the next three months to provide a more robust data set for pilot results to be incorporated in an e-poster for POSNA this spring.
This video has been published on our Shriners Hospital YouTube channel and Facebook feed. The POSNA technology oversight committee has expressed interest in publishing the video in OrthoKids and/or POSNAcademy and I intend to give access to the video to these sites. After sufficient data collection I intend to create an article for submission. Additionally, we intend to generate a Spanish version with captions.
Expenses were managed by our research department and include 90% of the $1000 grant directed at direct filming and editing of the video and 10% towards survey generation and online management of the video.