Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review. Eur Spine J. 2016;25:450-466. [PMID: 25917824 DOI: 10.1007/s00586-015-3961-7]

Repeatability and intra and interrater reproducibility of the DIPA-S eHealth© capture and analysis system for clinical assessment of scoliosis

PURPOSE

To assess the repeatability, intra and interrater reproducibility of the DIPA-S eHealth© system for capturing and measuring clinical variables of scoliosis, including frontal trunk imbalance (FTI), sagittal trunk imbalance (STI), and angle of trunk rotation (ATR).

METHODS

Patients were photographed using the DIPA-S eHealth Capture© mobile application by family members, physiotherapists, or surgeons. Three photos were taken in each position: standing in the frontal and sagittal planes and in the axial plane in forward bending position of the trunk. The photos were analyzed by three independent evaluators using the DIPA-S eHealth Analysis© software. For repeatability, each photo was analyzed twice consecutively by the three evaluators. For intrarater reproducibility, only one evaluator reanalyzed the first photo from each plane with a 5-day interval. For interrater reproducibility, the three evaluators analyzed the first photo from each plane. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were used (p < 0.05).

RESULTS

The sample comprised 262 images (n = 30). Repeatability was excellent for all three evaluators in all three planes (ICC 0.94 to 1.00). Intrarater reproducibility was excellent in all three planes (ICC 0.88 to 0.99). Interrater analysis was excellent for the frontal and axial planes (ICC 0.98 and 0.93), respectively. However, it was weak in the sagittal plane ICC 0.32. The SEM ranged from 0.02 to 17.6 and MDC from 0.03 to 34.6.

CONCLUSION

The DIPA-S eHealth© Capture and Analysis system demonstrates reproducibility for use in the clinical assessment of scoliosis through teleconsultations.

Biomechanical Posture Analysis in Healthy Adults with Machine Learning: Applicability and Reliability

Posture analysis is important in musculoskeletal disorder prevention but relies on subjective assessment. This study investigates the applicability and reliability of a machine learning (ML) pose estimation model for the human posture assessment, while also exploring the underlying structure of the data through principal component and cluster analyses. A cohort of 200 healthy individuals with a mean age of 24.4 ± 4.2 years was photographed from the frontal, dorsal, and lateral views. We used Student's t-test and Cohen's effect size (d) to identify gender-specific postural differences and used the Intraclass Correlation Coefficient (ICC) to assess the reliability of this method. Our findings demonstrate distinct sex differences in shoulder adduction angle (men: 16.1° ± 1.9°, women: 14.1° ± 1.5°, d = 1.14) and hip adduction angle (men: 9.9° ± 2.2°, women: 6.7° ± 1.5°, d = 1.67), with no significant differences in horizontal inclinations. ICC analysis, with the highest value of 0.95, confirms the reliability of the approach. Principal component and clustering analyses revealed potential new patterns in postural analysis such as significant differences in shoulder-hip distance, highlighting the potential of unsupervised ML for objective posture analysis, offering a promising non-invasive method for rapid, reliable screening in physical therapy, ergonomics, and sports.

Assessment of reliability and validity of a handheld surface spine scanner for measuring trunk rotation in adolescent idiopathic scoliosis

PURPOSE

To assess the reliability and validity of a handheld scanner (SpineScan3D) for trunk rotation measurement in adolescent idiopathic scoliosis (AIS) subjects, as compared with Scoliometer.

METHODS

This was a cross-sectional study with AIS subjects recruited. Biplanar spine radiographs were performed using an EOS imaging system with coronal Cobb angle (CCA) determined. The angle of trunk rotation (ATR) was measured using Scoliometer. SpineScan3D was employed to assess the axial rotation of subjects' back at forward bending, recorded as surface tilt angle (STA). Intra- and inter-examiner repeats were conducted to evaluate the reliability of SpineScan3D.

RESULTS

97 AIS patients were recruited. Intra- and inter-examiner reliability of STA measures were good to excellent in major thoracic and lumbar curves (p < 0.001). A strong correlation was found between STA and ATR measures in both curve types (p < 0.001) with a standard error of the ATR estimate of between 1 and 2 degrees from linear regression models (R squared: 0.8-0.9, p < 0.001). A similar correlation with CCA was found for STA and ATR measures (r: 0.5-0.6, p < 0.002), which also demonstrated a similar sensitivity (72%-74%) and specificity (62%-77%) for diagnosing moderate to severe curves.

CONCLUSION

SpineScan3D is a handheld surface scanner with a potential of wide applications in subjects with AIS. The current study indicated that SpineScan3D is reliable and valid for measuring trunk rotation in AIS subjects, comparable to Scoliometer. Further studies are planned to investigate its measurements in coronal and sagittal planes and the potential of this device as a screening and monitoring tool.

TRIAL REGISTRATION NUMBER (DATE OF REGISTRATION)

HKUCTR-2288 (06 Dec 2017).

LEVEL OF EVIDENCE

Level III.

A feasibility study of applying two-dimensional photogrammetry for screening and monitoring of patients with adolescent idiopathic scoliosis in clinical practice

Standing posteroanterior radiographs have been the golden standard to quantify the severity of scoliosis deformity. However, it exposes ionizing radiation to scoliosis patients, and cannot be used for routine screening and monitoring. This study aimed to develop a protocol of measuring postural indexes by using the noninvasive and radiation-free two-dimensional (2D) photogrammetry method and identify its clinical value in scoliosis screening and monitoring. The five postural indexes were measured from the posterior view of 110 participants. One-way ANOVA with post hoc Tukey HSD/Games-Howell analysis was used to compare the differences between the participants in the scoliosis group and the non-scoliosis group. Pearson coefficients of correlation were analyzed to identify the relationships between Cobb angles and each of the five quantitative postural indexes. Based on 2D photogrammetry, the postural indexes of C7 deviation (p = 0.02), shoulder alignment (p < 0.001), scapula alignment (p < 0.001), waist angle discrepancy (p < 0.001), and PSIS alignment (p < 0.001) could significantly differentiate scoliosis and non-scoliosis patients during screening. The waist angle discrepancy (r = 0.4, p = 0.01; r = 0.8, p = 0.03; r = 0.7, p = 0.01) and shoulder alignment (r = 0.6, p = 0.03) had moderate to strong positive correlations with the Cobb angles, which supported their clinical values in monitoring scoliotic curvature changes of adolescent idiopathic scoliosis (AIS) patients.

Parents can reliably and accurately detect trunk asymmetry using an inclinometer smartphone app

PURPOSE

An inclinometer smartphone application has been developed to enable the measurement of the angle of trunk inclination (ATI) to detect trunk surface asymmetry. The objective was to determine the reliability and validity of the smartphone app in the hands of non-professionals.

METHODS

Three non-professional observers and one expert surgeon measured maximum ATI twice in a study involving 69 patients seen in the spine clinics to rule out scoliosis or for regular follow-up (10-18 y.o., Cobb [0°-58°]). Observers were parents not familiar with scoliosis screening nor use of an inclinometer. They received training from a 4-minute video. Intra and inter-observer reliability was determined using the generalizability theory and validity was assessed from intraclass correlation coefficients (ICC), agreement with the expert on ATI measurements using Bland-Altman analysis, and correct identification of the threshold for consultation (set to ≥6° ATI).

RESULTS

Intra-observer and inter-observer reliability coefficients were excellent ϕ = 0.92. The standard error of measurement was 1.5° (intra-observer, 2 measurements) meaning that a parent may detect a change of 4° between examinations 95% of the time. Comparison of measurements between non-professionals and the expert resulted in ICC varying from 0.82 [0.71-0.88] to 0.84 [0.74-0.90] and agreement on the decision to consult occurred in 83 to 90% of cases.

CONCLUSION

The use of a smartphone app resulted in excellent reliability, sufficiently low standard error of measurement (SEM) and good validity in the hands of non-professionals. The device and the instructional video are adequate means to allow detection and regular examination of trunk asymmetries by non-professionals.

Clinical application of the Buffalo Concussion Treadmill Test and the Buffalo Concussion Bike Test: A systematic review

Objective

To identify and synthesise research evidence regarding psychometric properties and clinical utility of the Buffalo Concussion Treadmill Test (BCTT) and Buffalo Concussion Bike Test (BCBT) for use with patients with acute concussion, post-concussion syndrome (PCS) or physiological post-concussion disorder (PPCD).

Data sources

ProQuest (ProQuest Central), PEDro, Medline (Ovid), Emcare (Ovid), EBSCOhost (Health collection) and Google Scholar, searched September 8th-12th, 2020.

Study selection

Two authors independently selected studies that met eligibility criteria. Studies were selected if they were original research of any design, that investigated the properties of the testing protocols in either concussed or uninjured participants. Articles not published in English, that were not original research or that used significantly different testing protocols were excluded. The search yielded 250 articles, 11 of which were eligible and included in this review.

Data extraction

Included studies were critically appraised independently by two authors, using the Mixed Methods Appraisal Tool (MMAT). Data relating to study characteristics and key findings were extracted from the studies, documented in tables, and used to inform a critical narrative synthesis of findings.

Data synthesis

To provide recommendations relating to each aim of the review, a strength of evidence scoring system was used. Available evidence supported use of the BCTT, with strong evidence supporting the safety and construct validity of the test and moderate evidence supporting its prognostic value. There has been very limited research investigating use of the BCBT.

Conclusion

The findings support a recommendation for use of the BCTT in clinical settings for management of acute concussion, PCS and PPCD. There is limited evidence available for the BCBT. Additional studies are needed of both tests to further establish their clinical value.

Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS)

Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston brace night shift (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group (p = 0.014, p= 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; p = 0.004; ηp2 = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, p = 0.002; ηp2 = 0.11, and large (F = 8.3, p = < 0.001, ηp2 = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, p = 0.019, ηp2 = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.

Physical Functioning in Adolescents with Idiopathic Scoliosis: A Systematic Review of Outcome Measures and Their Measurement Properties

STUDY DESIGN

A systematic review.

OBJECTIVE

To summarize evidence on measurement properties of Outcome Measures (OM) used to assess physical functioning in adolescents with idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems (e.g., back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with patient-reported outcome measures (PROM), performance-based outcome measures (PBOM), and body structure and function OM. Adequate measurement properties of OM are important for precision in research and practice.

METHODS

A two-staged search strategy was performed on electronic databases up to December 2019. Search one revealed a list of OM was used for physical functioning assessment in AIS. Search two identified studies that evaluated the measurement properties of OM in AIS; using the list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] checklist), and performed data extraction. The level of evidence was established using a modified GRADE approach.

RESULTS

Search one yielded: 28 PROM, 20 PBOM, and 10 body structure and function OM. Search two revealed: 16 measurement properties studies for PROM, one for PBOM, and three for body structure and function measures. Construct validity, reliability, and responsiveness of most PROM has been established in AIS, but not content validity or internal consistency (moderate evidence). Construct validity was sufficient for the Timed Up and Go test and body structure and function measures (very low to low evidence).

CONCLUSION

Currently, physical functioning is evaluated with a variety of measures in AIS. The majority of measurement properties studies evaluated PROM with a paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of the OM identified in this review can be recommended with confidence in individuals with AIS.Level of Evidence: 2.

The smartphone as a tool to screen for scoliosis, applicable by everyone

PURPOSE (MAIN PURPOSES AND RESEARCH QUESTION)

The purpose of this study is to assess the accuracy and precision of the smartphone with application and casing (Scolioscreen) compared to the Scoliometer.

METHODS

The Axial Trunk Rotation (ATR) was measured in adolescent scoliosis patients visiting the outpatient clinic while performing the Adam Forward Bending Test. The Scolioscreen measurements were performed by the orthopedic surgeon and a parent. They were compared to the measurement with the Scoliometer by the orthopedic surgeon, the gold standard. The accuracy was determined with the Pearson's correlation coefficient, and precision was determined by assessing the intra- and inter-variability with the intra-class correlation coefficient (ICC).

RESULTS

Fifty patients with adolescent idiopathic scoliosis (44 girls) were included with a mean age of 14.1 years and a mean Cobb angle of 38.5°. The accuracy of both the parents and orthopedic surgeon was excellent with a Pearson correlation coefficient of 0.92 and 0.97, respectively. All the ICC's, both intra- and inter-observer, were over 0.92 demonstrating excellent precision.

CONCLUSION

This study confirms the accuracy and precision of the Scolioscreen when measuring the ATR on patients with AIS. Therefore, the Scoliometer can be replaced by the more easily available Scolioscreen which can be used by both physician and parents.

Validity and Reliability of Interactive Virtual Reality in Assessing the Musculoskeletal System: a Systematic Review

PURPOSE OF REVIEW

Assessment of the musculoskeletal system requires consideration of its integrated function with the nervous system. This may be assisted by using valid and reliable methods that simulate real-life situations. Interactive virtual reality (VR) technology may introduce various auditory and visual inputs that mimic real-life scenarios. However, evidence supporting the quality and strength of evidence regarding the adequacy of its psychometric properties in assessing the musculoskeletal function has not been evaluated yet. Therefore, this study reviewed the validity and reliability of VR games and real-time feedback in assessing the musculoskeletal system.

RECENT FINDINGS

Nine studies were included in quality assessment. Based on outcome measures, studies were categorized into range of motion (ROM), balance, reaction time, and cervical motion velocity and accuracy. The majority of the studies were of moderate quality and provided evidence of VR adequate concurrent and, in some cases, known-groups validity. Also, VR showed high intra-rater reliability for most of the measured outcomes. Based on the included studies, there is a limited promising evidence that interactive VR using games or real-time feedback is highly valid and reliable in assessing ROM in asymptomatic participants and patients with chronic neck pain and radial fracture. For the remaining outcomes, evidence is limited to draw a robust conclusion. Future studies are recommended to test VR psychometric properties in different patients' population using a rigor research methodology.

Assessment of the reliability of hand-held surface scanner in the evaluation of adolescent idiopathic scoliosis

PURPOSE

Spinal deformities due to adolescent idiopathic scoliosis (AIS) result in impairment in the back surface topography. Sophisticated interventions are needed that address different aspects of deformity. The purpose of our study is to test the reliability of hand-held 3D scanners on the assessment of AIS.

METHODS

Forty-two AIS patients were included in our study. The back surfaces of the patients were scanned with the hand-held 3D scanner, while the patients were in the standing position with the arms hanging at the sides (P1), with the arms extended (P2), and forward bending position (P3). The acquired original image was superimposed with the mirror image. Root mean square (RMS) of the point-to-point distance was calculated, and the differences between the surfaces were determined. Correlation between RMS, Cobb, POTSI, scoliometer, radiographic rotations, TRACE results was calculated.

RESULTS

A significant correlation coefficency (r) was found between the RMS and Cobb values in the thoracic (P1 = 0.80, P2 = 0.76, P3 = 0.71) and lumbal region (P1 = 0.56, P2 = 0.65, P3 = 0.63); between RMS and Raimondi in the thoracic (r, P1 = 0.80, P2 = 0.81, P3 = 0.78) and lumbar regions (P1 = 0.54, P2 = 0.64, P3 = 0.59); between RMS and scoliometer measurements in the thoracic (r, P1 = 0.58, P2 = 0.50, P3 = 0.41) and lumbar regions (P1 = 0.35, P2 = 0.41, P3 = 0.59); in thoracolumbar region between RMS and POTSI (P1 = 0.50, P2 = 0.25, P3= 0.36), between RMS and TRACE (P1 = 0.68, P2 = 0.5, P3 = 0.52), CONCLUSION: The hand-held scanners may contribute to gaining new insight into diagnosis and follow-up of AIS by its mobility that enables the acquisition of data in desired body position and place such as bedside or our patient clinics.

LEVEL OF EVIDENCE IV

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Reliability of a New Smartphone Accessory for Scoliosis Measurements

BACKGROUND: Idiopathic scoliosis is the most common pathology of the children’s spine, identified as spine lateral curvature with Cobb angle greater than 10°. The rapid development of technology allows, even mobile devices, to perform a quick and cheap diagnosis ensuring an accuracy similar to the Bunnell scoliometer.

OBJECTIVE: The study aimed to validate the accuracy of a newly developed accessory for measuring the angle of trunk rotation (ATR) using mobile devices.

METHODS: ATR measurements were carried out on a group of 30 adults using 3 diagnostic tools: the Bunnell scoliometer, Scolioscreen, and mScolio designed by the authors. Scolioscreen and mScolio were used together with a smartphone and the Clinometer app. Three measurements were performed using each of the methods.

RESULTS: The greatest data discrepancy was obtained between the Bunnell scoliometer and Scolioscreen (-3.7°÷4.4°) and was twice larger than between the Bunnell scoliometer and mScolio (-1.8°÷2.1°). The excellent agreement was obtained for the mScolio device, where the concordance correlation coefficient was 0.9381 (95% CI of 0.9076÷0.9588) and the interclass correlation coefficient was 0.9501 (95% CI of 0.9242÷0.9671).

CONCLUSIONS: Tests showed excellent reliability and validity of ATR using the mScolio solution. Obtained results show excellent consistency between mScolio and the Brunnell scoliometer measurements.

Mobile Applications for Assessing Human Posture: A Systematic Literature Review

Smartphones are increasingly incorporated with features such as sensors and high resolution cameras that empower their capabilities, enabling their use for varied activities including human posture assessments. Previous reviews have discussed methods used in postural assessment but none of them focused exclusively on mobile applications. This paper systematically reviews mobile applications proposed for analyzing human posture based on alignment of the body in the sagittal and coronal plane. The main digital libraries were searched, 26 articles published between 2010 and 2020 were selected, and 13 mobile applications were identified, classified and discussed. Results showed that the use of mobile applications to assist with posture assessment have been demonstrated to be reliable, and this can contribute to clinical practice of health professionals, especially the assessment and reassessment phases of treatments, despite some variations when compared to traditional methods. Moreover, in the case of image-based applications, we highlight the advantage that measurements can be taken with the assessor at a certain distance with respect to the patient’s position, which is an important function for assessments performed in pandemic times such as the outbreak of COVID-19.

Asymmetric Unilateral Vestibular Perception in Adolescents With Idiopathic Scoliosis

The cause of Adolescent Idiopathic Scoliosis (AIS) remains unclear, but one proposed cause of AIS is asymmetric vestibular function and the related descending drive to the spine musculature. The objective of this study was to determine if asymmetric vestibular function is present in individuals with AIS. Ten individuals with AIS (8F, 2M) and 10 healthy age- and sex-matched controls were exposed to 10s-long virtual rotations induced by monaural or binaural electrical vestibular stimulation (EVS), and 10s-long real rotations delivered by a rotating chair. Using a forced-choice paradigm, participants indicated their perceived rotation direction (right or left) to stimuli of varying intensity. A Bayesian adaptive algorithm adjusted the stimulus intensity and direction to identify a stimulus level, which we called the direction recognition threshold, at which participants correctly identified the rotation direction 69% of the time. For unilateral vestibular stimuli (monaural EVS), the direction recognition thresholds were more asymmetric in all participants with AIS compared to control participants [(0.22-1.00 mA) vs. (0.01-0.21 mA); p < 0.001]. For bilateral vestibular stimuli, however, the direction recognition thresholds did not differ between groups for either the real or virtual rotations (multiple p > 0.05). Previous reports of semicircular canal orientation asymmetry in individuals with AIS could not explain the magnitude of the vestibular function asymmetry we observed, suggesting a functional cause to the observed vestibular asymmetry. Thus, the present results suggest that a unilateral vestibular dysfunction is linked to AIS, potentially revealing a new path for the screening and monitoring of scoliosis in adolescents.

Construct validity of the Trunk Aesthetic Clinical Evaluation (TRACE) in young people with idiopathic scoliosis

BACKGROUND

Aesthetics is recognized as a main outcome in idiopathic scoliosis (IS) treatment, but to date, there is no criterion standard for physicians' evaluation. Trunk Aesthetic Clinical Evaluation (TRACE) is a simple 12-point ordinal scale to quantify symmetry as a proxy of aesthetics. TRACE is already diffused worldwide and has been used in clinical research.

OBJECTIVE

We aimed to validate TRACE and improve it with Rasch analysis.

MATERIAL AND METHODS

This study involved an observational Rasch analysis validation of an evaluation tool in outpatient rehabilitation centres. From a clinical database, we randomly selected patients who had IS, were age 10 to 18, had brace prescription at first evaluation, and had at least 2 consultations. Rasch analysis (partial credit model) was used. Differential item functioning (DIF) was assessed for age, sex, disease severity, bracing and treatment. The median was chosen to dichotomize disease severity and bracing. We removed 64 outlier participants (4%).

RESULTS

We included 1553 participants (1334 females; mean [SD] age 13 [1.7] years old). TRACE items showed ordered thresholds and proper fit to the Rasch model. The score-to-measure conversion table showed proper length (range -4.55 to 4.79 logit) with a mean (SE) measure of -0.52 (0.04) logit. The principal component analysis supported the TRACE unidimensionality. The TRACE was free from DIF for age, sex and bracing.

CONCLUSIONS

The TRACE ordinal scale has been converted into a Rasch-consistent, interval-level measure of trunk aesthetics in IS patients and can be used to compare different populations. Its main flaw is low reliability, likely because of the small number of items. TRACE can be used as an outcome measure and in everyday clinical evaluation of IS, even if new developments of the scale are advised.

Impact of wearable physical activity monitoring devices with exercise prescription or advice in the maintenance phase of cardiac rehabilitation: systematic review and meta-analysis

BACKGROUND

Physical activity (PA) is a component of cardiac rehabilitation (CR). However, life-long engagement in PA is required to maintain benefits gained. Wearable PA monitoring devices (WPAM) are thought to increase PA. There appear to be no reviews which investigate the effect of WPAM in cardiac populations. We firstly aimed to systematically review randomised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR. We specifically examined the effect on cardiorespiratory fitness (CRF), amount and intensity of daily PA, and sedentary time. Secondly, we aimed to collate outcome measures reported, reasons for drop out, adverse events, and psychological impact from utilising a WPAM.

METHODS

A systematic search (up to January 2019) of relevant databases was completed, followed by a narrative synthesis, meta-analysis and qualitative analysis.

RESULTS

Nine studies involving 1,352 participants were included. CRF was improved to a greater extent in participants using WPAM with exercise prescription or advice compared with controls (MD 1.65 mL/kg/min;95% confidence interval [CI; 0.64-2.66]; p = 0.001; I2 = 0%). There was no significant between group difference in six-minute walk test distance. In 70% of studies, step count was greater in participants using a WPAM with exercise prescription or advice, however the overall effect was not significant (SMD 0.45;95% [CI; - 0.17-1.07] p = 0.15; I2 = 81%). A sensitivity analysis resulted in significantly greater step counts in participants using a WPAM with exercise prescription or advice and reduced the heterogeneity from 81 to 0% (SMD 0.78;95% [CI;0.54-1.02]; p < 0.001; I2 = 0%). Three out of four studies reporting on intensity, found significantly increased time spent in moderate and moderate-vigorous intensity PA. No difference between groups was found for sedentary time. Three of six studies reported improved psychological benefits.No cardiac adverse events related to physical activity were reported and 62% of non-cardiac adverse events were primarily musculoskeletal injuries. Reasons for dropping out included medical conditions, lack of motivation, loss of interest, and technical difficulties.

CONCLUSIONS

Our meta-analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use. Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count. WPAM with exercise prescription or advice did not change sedentary time. Psychological health and exercise intensity may potentially be enhanced by WPAM with exercise prescription or advice, however further research would strengthen this conclusion.

TRIAL REGISTRATION

PROSPERO Registration Number: CRD42019106591.

Standard reference values of the upper body posture in healthy young female adults in Germany: an observational study

OBJECTIVE

Classifications of posture deviations are only possible compared with standard values. However, standard values have been published for healthy male adults but not for female adults.

DESIGN

Observational study.

SETTING

Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main.

PARTICIPANTS

106healthy female volunteers (21-30 years old; 25.1±2.7 years) were included. Their body weight ranged from 46 to 106 kg (60.3±7.9 kg), the heights from 1.53 to 1.82 m (1.69±0.06 m) and the body mass index from 16.9 kg/m² to 37.6 kg/m² (21.1±2.6 kg/m²).

OUTCOME MEASURES

A three-dimensional back scan was performed to measure the upper back posture in habitual standing. The tolerance ranges and CI were calculated. Group differences were tested by the Wilcoxon Mann-Whitney U test.

RESULTS

In normal posture, the spinal column was marginally twisted to the left, and the vertebrae were marginally rotated to the right. The kyphosis angle is larger than the lumbar angle. Consequently, a more kyphotic posture is observed in the sagittal plane. The habitual posture is slightly scoliotic with a rotational component (scapular depression right, right scapula marginally more dorsally, high state of pelvic right, iliac right further rotated anteriorly).

CONCLUSIONS

Healthy young women have an almost ideally balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. Compared with young males, women show only marginal differences in the upper body posture. These values allow a comparison to other studies, both for control and patient data, and may serve as guideline in both clinical practice and scientific studies.

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

BACKGROUND

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS).

METHODS

Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016.

RESULTS

The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8.

CONCLUSION

The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.

Assessing the Reliability of Ultrasound Imaging to Examine Peripheral Nerve Excursion: A Systematic Literature Review

Ultrasound imaging (USI) is gaining popularity as a tool for assessing nerve excursion and is becoming an important tool for the assessment and management of entrapment neuropathies. This systematic review aimed to identify current methods and report on the reliability of using USI to examine nerve excursion and identify the level of evidence supporting the reliability of this technique. A systematic search of five electronic databases identified studies assessing the reliability of using USI to examine nerve excursion. Two independent reviewers critically appraised and assessed the methodological quality of the identified articles. Eighteen studies met the eligibility criteria. The majority of studies were of "moderate" or "high" methodological quality. The overall analysis indicated a "strong" level of evidence of moderate to high reliability of using USI to assess nerve excursion. Further reliability studies with consistency of reporting are required to further strengthen the level of evidence.

Application of two-parameter scoliometer values for predicting scoliotic Cobb angle

BACKGROUND

Adolescent idiopathic scoliosis, in which obvious curves are visible in radiographic images, is also seen in combination with lumps in the back. These lumps contribute to inclination, which can be measured by a scoliometer. To the authors' knowledge, there are no previous formulas combining thoracic and lumbar scoliometer values simultaneously to predict thoracic and lumbar Cobb angles, respectively. This study aimed to create more accurate two-parameter mathematical formulas for predicting thoracic and lumbar Cobb angles.

METHODS

Between Dec. 2012 and Jan. 2013, patients diagnosed with idiopathic scoliosis in an outpatient clinic were enrolled. The maximal trunk rotations at the thoracic and lumbar regions were recorded with a scoliometer. Right asymmetry hump was deemed positive (+), and left asymmetry hump was deemed negative (-). The Cobb angles were measured with a Picture Archiving and Communication System. Statistical analysis included Pearson's correlation coefficient, multivariate regression and Bland-Atman analysis.

RESULTS

One-hundred and one patients were enrolled in our study. The average thoracic curve (TC) was 23.3 ± 1.8°, while the average lumbar curve (LC) was - 23.3 ± 1.4°. The thoracic inclination (TI) and lumbar inclination (LI) were 4.5 ± 0.7 and - 5.9 ± 0.6, respectively. The one-parameter formula for the thoracic curve was TC = 2.0 TI + 14.3 (r = 0.813); for the lumbar curve, it was LC = 0.9 LI - 16.9 (r = 0.409). By multivariate regression, the two-parameter formulas for the thoracic and lumbar curves were TC = 2.6 TI - 1.4 LI (r = 0.931) and LC = - 1.5 TI + 2.0 LI (r = 0.874), respectively. The two-parameter formulas were more accurate than the one-parameter formulas.

CONCLUSIONS

Based on the results of these two-parameter formulas for thoracic and lumbar curves, the Cobb angles can be predicted more accurately by the readings of the scoliometer. Physicians and other healthcare practitioners can thus evaluate patients with scoliosis more precisely than before with a scoliometer.

Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis

AIM

To investigate the reliability and concurrent validity of the Baseline^® Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes.

METHODS

This is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at Karolinska University Hospital, Stockholm, Sweden between March-May 2012. A total of 31 adolescents with idiopathic scoliosis (13.6 ± 0.6 years old) of mild-moderate curvatures (25°± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation (ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient (ICC) was used to determine the inter-examiner reliability (ICC2,1) and the intra-rater reliability (ICC3,3) of the Baseline^® Body Level/Scoliosis meter. Spearman’s correlation analyses were used to estimate concurrent validity between the Baseline^® Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer.

RESULTS

There was excellent reliability between examiners for thoracic kyphosis (ICC2,1 = 0.94), ATR (ICC2,1 = 0.92) and lumbar lordosis (ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis (ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner (ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer (rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR (rho = 0.627).

CONCLUSION

The Baseline^® Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity.

Estradiol via estrogen receptor beta inhibits chondrogenesis of mouse vertebral growth plate in vitro

PURPOSE

Abnormal growth of vertebral growth plate (VGP) was considered as one of the etiologic factors in adolescent idiopathic scoliosis (AIS). Previous studies described that estrogen played an important role in the pathogenesis of AIS. The present study was aimed to investigate the effect of estrogen/estrogen receptor axis on mouse VGP chondrocytes in vitro.

METHODS

Chondrocytes were isolated from mouse VGP and treated with or without 17β-estradiol (E2). Cell proliferation was measured by the cell growth rate assay. Gene expression of collagen type II and aggrecan were evaluated by real-time PCR. Expression of the proliferating cell nuclear antigen (PCNA), Sox9, and Smad4 were detected by Western blotting.

RESULTS

Estradiol inhibited the proliferation of VGP chondrocytes and the gene expression of collagen type II and aggrecan and downregulated the protein expression of PCNA, Sox9, and Smad4. In addition, the inhibitory effect of estradiol was reversed by ERβ small interfering RNA (siRNA) or PHTPP, an ERβ antagonist.

CONCLUSIONS

Estradiol via estrogen/estrogen receptor β axis inhibits the proliferation and differentiation of VGP chondrocytes, which might give some new insight into the regulatory mechanism of bone development.