The Novel Assessment Tool for Scoring of Functional Outcomes after Surgical Release in Congenital Muscular Torticollis
Keywords:
Thailand; novel assessment tool; scoring; functional outcome; surgical release; congenital muscular torticollisAbstract
Objective: Congenital muscular torticollis, characterized by unilateral shortening of the sternocleidomastoid
muscle that results in the head tilting towards the affected side, is the third most common musculoskeletal anomaly.
Subjective assessment using the Lee scoring system has been the most common method for evaluating the surgical
outcomes. The aim of this study was to investigate the efficacy of a novel assessment tool for scoring of functional
outcomes after surgical release in congenital muscular torticollis.
Methods: This study enrolled the patients aged 5-15 years who were diagnosed with congenital muscular torticollis
and treated by surgical release at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand during 1998-2011. An image processing program was used to measure all
evaluated parameters. Craniofacial asymmetry, neck rotation deficits, neck flexion/extension deficits, and degree
of head-tilting were graded as poor, fair, good, or excellent by 2 observers. The results of the Lee scoring system
and the new scoring system were then compared.
Results: Nineteen patients (7 males, 12 females) with a mean age of 7.2±2.57 years were included. Photographs of
the patients were evaluated and categorized by outcome score using both outcome scoring systems. All intraclass
correlation coefficients were higher than 0.6 for both scoring systems, which suggests good inter-operator reliability
(p<0.05). Percentage agreement was higher in the new system than in the Lee system (63.16% vs. 52.63%, respectively).
Conclusion: The new outcome scoring system which focuses on functional outcomes after surgical release was
found to be less subjective and more reliable than the Lee scoring system.
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