Bruininks Osteretsky Test of Motor Proficiency (BOTMP)
Zapata KA, Karol LA, Jeans KA, Jo C-H. Gross Motor Function at 10 Years of Age in Children With Clubfoot Following the French Physical Therapy Method and the Ponseti Technique. Journal of Pediatric Orthopaedics. 2018;38(9).
Purpose/Population/Outcome Measures: The purpose of this article was to compare and assess the gross motor skills of 183 individuals with idiopathic clubfoot that had not undergone operative treatment methods following treatment with either the PT method or Ponseti method. In an abridgment, the PT method consists of participating in physical therapy sessions 3-5 times per week for corrective measures, therapeutic exercises, taping and orthotic interventions. The Ponseti method consists of leg casting, possible percutaneous Achilles tenotomy’s (not considered an operative intervention in this article) and orthotic interventions. The Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) was utilized to assess gross motor skills and is specific to evaluating children between the ages of 4 and 21 years. This outcome measure consists of 8 sub-tests including 4 in Gross Motor function and 4 in Fine Motor function.
Methods/Intervention: Initially this long-term study assessed 373 patients with idiopathic clubfoot that were evaluated at 2 years of age. At 10 years of age, 183 patients returned for follow up re-evaluation testing with 172 being included. These individuals were given the BOT-2. Bilateral Coordination, Balance, Running Speed/Agility and Strength were specifically assessed out of the BOT-2 with higher scores equating to a more superior performance.
Results: Following re-testing, patients who underwent the PT method scored higher on Running Speed/Agility, Body Coordination and Strength in comparison to those treated with the Ponseti method. It was also shown that patients with bilateral clubfoot scored significantly lower on Body Coordination and Balance tests in comparison to those with unilateral clubfoot.
Strength: The strength of this article lies in its extension over a long-term period. It assesses patients at the age of 2 and reassesses them at the age of 10 years.
Limitation: One limitation recognized in this article suggests that the BOT-2 is self-selective for individuals with unilateral clubfoot. This infers that they have the choice of not performing the BOT-2 activities on the clubfoot side and puts bilaterally involved patients at a fundamental disadvantage.
Secondly, the study stated that the physical therapists administering the BOT-2 testing were not blinded and had access to all patient medical records. Treatment allocations for each patient were revealed which could create bias and affect the overall validity of the results.
Thirdly, the article does not include or discuss any activities including participation of physical activity that could affect overall ankle strength, stability, balance and coordination between testing at 2 years of age and 10 years of age.
Conclusion: In conclusion, individuals with bilateral clubfoot or surgical intervention at 10 years of age may show impairments in balance. It can also be suggested that the PT method may produce more functional outcomes in comparison to the Ponseti method.
4 responses to “Bruininks Osteretsky Test of Motor Proficiency (BOTMP)”
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Were there any differences in the groups at the pretest (2 years old)? What were the specific inclusion and exclusion criteria (other than having surgery performed as exclusionary)?
Unfortunately little details were given about the inclusion/exclusion criteria. To qualify inclusion started with children at 2 years of age and who were diagnosed with clubfoot either bilaterally or unilaterally. The only true exclusion criteria stated was children who had undergone surgical intervention. In regards to the groups at the pretest (2 years old), no significant details were described and are most likely referenced in a separate article.
I had the opportunity to work with a 20 year old who had club foot and underwent physical therapy after the surgical intervention. I would be interested to see if this study would extend even farther (past 10 years old). I am also curious if there was any exclusion criteria for the 182 that were eligible for retesting.
This article stated that children were excluded if they had a diagnosis other than idiopathic clubfoot and that they did not previously undergo surgery. Clearly this was unfortunate as this was the only reference to exclusion criteria in the presented article and contributes to a disadvantage. Although, it would be very interesting to see this study carried over into patients surpassing the age of 10.