Adolescent idiopathic scoliosis: a comprehensive approach to aetiology, diagnostic assessment and treatment

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.

Outcome measures evaluating physical functioning and their measurement properties in adolescent idiopathic scoliosis: a protocol for a systematic review

INTRODUCTION

Physical functioning (PF) is the ability to carry out the physical activity of daily living. It is an important outcome that provides a meaningful evaluation of individuals' life. PF can be assessed using patient-reported outcome measures, performance-based outcome measures or body structure and function measure. Measures need to be valid, reliable and responsive to change to evaluate the effects of an intervention. Adolescent idiopathic scoliosis (AIS) is the most common deformity among the paediatric population and impacts on individuals' lives. This systematic review will appraise evidence on the measurement properties of PF tools in individuals with AIS.

METHODS/ANALYSIS

A protocol for systematic review and meta-analysis informed by Cochrane guidelines is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, PsycINFO, EMBASE, CINAHL, SPORTdiscus, Web of Science and PubMed will be searched in two stages, from inception until December 2019. Search 1 will inventory all studies that assessed PF in participants with AIS, without any limitations. The search terms will be scoliosis, adolescent and PF-related terms. Search 2 will include studies which investigated instrument measurement properties in the same population for measures identified in search one. Two reviewers will independently perform study selection, data extraction, risk of bias and overall quality assessment. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias and a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used. A meta-analysis will be conducted if possible, or the evidence will be synthesised and summarised per measurement property per outcome measure per measurement type.

ETHICS AND DISSEMINATION

This review will provide recommendations for practice and future research, considering psychometric properties of outcome measures of PF in AIS. The results of this study will be disseminated through a peer-reviewed publication and conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42019142335.

Association between adolescent idiopathic scoliosis and sacroiliac joint dysfunction in young athletes: A case control study

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, a 3-dimensional deviation in the axis of the spine. Etiology of AIS is unclear and the general belief is that AIS is multifactorial disorder possibly caused by different factors. It would be worthwhile to reveal new factors associated with AIS. The present study aimed to investigate association between sacroiliac joint (SIJ) dysfunction and AIS in young athletes.This case-control study included 196 children athletes (basketball, football, volleyball, handball, ballet, and others), 82 males and 114 females aged 8 to 17, 98 of them with the diagnosis of AIS. The case group consisted of young athletes examined at a regular checkup by a sport physician and diagnosed with AIS. The control group consisted of athletes matched to the case group according to sex, age, sports, number of training years and number of training hours per week, but without AIS.The scoliosis was diagnosed with Adams' forward bend test and the scoliometer measurement. The SIJ dysfunction was determined using the palpation meter (PALM) measuring the sagittal pelvic position in standing position and in standing position with the hip flexion angle of 90°. The data were analyzed using Student t test, Mann-Whitney U test, contingency coefficients, and logistic regression.The average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was found to be statistically different in the case and the control groups (t = 13.88, P = .00). There was a strong positive association between variables representing presence of AIS and SIJ dysfunction (determined by contingency coefficient C = 0.62, coefficient Phi = 0.79 and tetrachoric correlation coefficient 0.95).The logistic regression indicated that the average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was significantly associated with the probability of scoliosis in young athletes (P = .00, Wald test).There was a strong positive association between SIJ dysfunction and AIS in young athletes.