Magda M Oledzka
Hospital for Special Surgery, USA
Title: Congenital muscular torticollis: Implementation of clinical practice guideline and reliability of the severity classification system
Biography
Biography: Magda M Oledzka
Abstract
Statement of the Problem: Congenital muscular torticollis (CMT) is a musculoskeletal deformity observed at birth or in infancy characterized by unilateral contracture of the sternocleidomastoid muscle. It is the third most common congenital musculoskeletal disorder after congenital hip dislocation and clubfoot. Clinical presentation consists of persistent head tilt toward the involved side with the chin rotated toward the contralateral shoulder. Since introduction of the back to sleep program by the American Academy of Pediatrics in 1992, the incidence of CMT in infants and young children has been on the rise and is currently thought to be as high as 16%. In 2013 clinical practice guideline, published by the American Physical Therapy Association (APTA), a CMT severity classification system (CMT-SCS) was proposed based on the child’s age at the time of referral, differences in cervical rotation passive ROM restrictions, and presence or absence of sternocleidomastoid mass. The purpose of this study was to establish intra - and inter rater reliability for determining severity grades of CMT in infants.
Methodology: A prospective reliability study was conducted, using a fully crossed design. One hundred forty-five physical therapists from North America and Europe recorded severity ratings on 24 randomly ordered patient cases with the following clinical information: age of infant, cervical range of motion measures, and presence or absence of sternocleidomastoid mass. To compute intrarater reliability, cases were randomly re-ordered and graded by 82 of the original raters. ICC estimates and 95% confidence intervals were calculated based on a single rater (k=1), absolute agreement, 2-way mixed-effects model.
Results: For the CMT-SCS, overall reliability was good with an interrater reliability ICC (2.1) of 0.83 (95% CI 0.74-0.91) and intrarater reliability ICC (3.1) of 0.81 (95% CI 0.66-0.91).
Conclusion & Significance: The CMT-SCS has good reliability for infants up to 12 months of age, permitting medical professionals to use the scale during initial assessment of infants with suspected CMT. The CMT-SCS should be considered a priority for standard documentation for infants with CMT in USA and globally.