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Li X, Huo Z, Hu Z, Lam TP, Cheng JCY, Chung VCH, Yip BHK. Which interventions may improve bracing compliance in adolescent idiopathic scoliosis? A systematic review and meta-analysis. PLoS One 2022; 17:e0271612. [PMID: 35857763 PMCID: PMC9299303 DOI: 10.1371/journal.pone.0271612] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
This review aimed to systematically review and meta-analyze the effects of interventions in improving bracing compliance among adolescent idiopathic scoliosis (AIS) patients. Eight databases were searched from their inception to April 2022. The eligibility criteria included controlled studies that used any type of intervention to enhance bracing compliance in braced AIS patients. Two researchers independently screened articles and extracted data based on the PICO (participant, intervention, comparator, and outcome) framework. Quality appraisal of included studies was performed using GRADE (overall assessment), and the risk of bias was assessed with Cochrane RoB Tool 2 for randomized controlled trials (RCT) and ROBINS-I for non-RCT studies. The primary outcome was bracing compliance and secondary outcomes included Cobb Angle and measurements for quality of life. Six eligible studies involving 523 participants were included. All studies were evaluated as low or very low quality with a high risk of bias. Four types of interventions were identified, including sensor monitoring (n = 2, RCTs), auto-adjusted brace (n = 1, RCT), more intensive or collaborated medical care (n = 2), and psychosocial intervention (n = 1). A meta-analysis of 215 patients from the three RCTs suggested that the compliance-enhancing intervention group had 2.92 more bracing hours per day than the usual care control (95%CI [1.12, 4.72], P = 0.001). In subgroup analysis, sensor monitoring significantly improved bracing wearing quantity compared to usual care (3.47 hours/day, 95%CI [1.48, 5.47], P = 0.001), while other aforementioned interventions did not show a significant superiority. Compliance-enhancing interventions may be favorable in preventing curve progression and promoting quality of life, but the improvements cannot be clarified according to limited evidence. In conclusion, although the results of this study suggested that sensor monitoring may be the most promising approach, limited high-quality evidence precludes reliable conclusions. Future well-designed RCTs are required to confirm the actual benefit of compliance-improving interventions in clinical practice.
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Affiliation(s)
- Xue Li
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaohua Huo
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zongshan Hu
- Department of Spine Surgery, Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR, China
| | - Vincent Chi-ho Chung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Hon Kei Yip
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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Pang H, Wong YS, Yip BHK, Hung ALH, Chu WCW, Lai KKL, Zheng YP, Chung TWH, Sharma G, Cheng JCY, Lam TP. Using Ultrasound to Screen for Scoliosis to Reduce Unnecessary Radiographic Radiation: A Prospective Diagnostic Accuracy Study on 442 Schoolchildren. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2598-2607. [PMID: 34210559 DOI: 10.1016/j.ultrasmedbio.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children and adolescents. School scoliosis screening programs in Hong Kong follow the protocol of referring children screened positive with a scoliometer and Moiré topography for confirmatory standard radiography. Despite being highly sensitive (88%) in detecting those who require specialist referral, the screening program was found to have a false-positive rate >50%, which could lead to unnecessary X-ray radiation. Radiation-free ultrasound has been reported to be valid and reliable for quantitative assessment of curve severity in scoliosis patients. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the threshold of referral that requires X-ray for children screened positive with the scoliometer and Moiré topography. Our study recruited 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6°. The sensitivity and specificity of ultrasound in predicting the correct referral status, confirmed by X-ray, were 92.3% and 51.6%, with positive and negative predictive values of 29.0% and 96.9%, respectively. Receiver operating characteristic curve analysis revealed area under the curve values of 0.735 for ultrasound alone and 0.832 for ultrasound in combination with measurement of angle of trunk rotation. The finding supports the accuracy of using ultrasound to determine referral status, which could result in a >50% reduction of unnecessary radiation for children undergoing scoliosis screening.
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Affiliation(s)
- Henry Pang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Yi-Shun Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Benjamin Hon-Kei Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Alec Lik-Hang Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | | | - Geeta Sharma
- Student Health Service, Department of Health, Hong Kong SAR
| | - Jack Chun-Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR.
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Thomas JJ, Stans AA, Milbrandt TA, Kremers HM, Shaughnessy WJ, Larson AN. Trends in Incidence of Adolescent Idiopathic Scoliosis: A Modern US Population-based Study. J Pediatr Orthop 2021; 41:327-332. [PMID: 34096545 PMCID: PMC8542350 DOI: 10.1097/bpo.0000000000001808] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A successful disease screening strategy requires a high incidence of the condition, efficacy of early treatment, and efficient detection. There is limited population-based data describing trends in incidence of adolescent idiopathic scoliosis (AIS) in the United States and potential role of school screening programs on the incidence of AIS. Thus, we sought to evaluate the incidence of AIS over a 20-year period between 1994 and 2013 using a population-based cohort. METHODS The study population comprised 1782 adolescents (aged 10 to 18 y) with AIS first diagnosed between January 1, 1994 and December 31, 2013. The complete medical records and radiographs were reviewed to confirm diagnosis and coronal Cobb angles at first diagnosis. Age-specific and sex-specific incidence rates were calculated and adjusted to the 2010 United States population. Poisson regression analyses were performed to examine incidence trends by age, sex, and calendar period. RESULTS The overall age-adjusted and sex-adjusted annual incidence of AIS was 522.5 [95% confidence interval (CI): 498.2, 546.8] per 100,000 person-years. Incidence was about 2-fold higher in females than in males (732.3 vs. 338.8/100,000, P<0.05). The incidence of newly diagnosed AIS cases with radiographs showing a Cobb angle >10 degrees was 181.7 (95% CI: 167.5, 196.0) per 100,000 person-years. The overall incidence of AIS decreased significantly after discontinuation of school screening in 2004 (P<0.001). The incidence of bracing and surgery at initial diagnosis was 16.6 (95% CI: 12.3, 20.9) and 2.0 (95% CI: 0.5, 3.4) per 100,000 person-years, respectively. CONCLUSIONS Overall population-based incidence of AIS decreased after school screening was discontinued. However, incidence of patients with a Cobb angle >10 degrees, initiation of bracing and surgery did not change significantly over time. This provides further data to help determine the role of scoliosis screening. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joshua J Thomas
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Abstract
The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam's forward bending test alone, Adam's forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.
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Rathjen K, Dieckmann RJ, Thornberg DC, Karam A, Birch JG. Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints. J Child Orthop 2021; 15:70-75. [PMID: 33643461 PMCID: PMC7907767 DOI: 10.1302/1863-2548.15.200158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints. METHODS Surgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics. RESULTS The most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as 'clinically inconsequential'. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI.Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication 'curve magnitude at presentation' was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology. CONCLUSION Radiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years' younger than those with a normal or inconsequential MRI. 'Curve magnitude at presentation' in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. 'Pain' was the only indication significantly associated with clinically inconsequential findings on MRI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Karl Rathjen
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Correspondence should be sent to Karl E. Rathjen, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA. E-mail:
| | | | | | - AnnMarie Karam
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - John G. Birch
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
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Yang J, Zhang K, Fan H, Huang Z, Xiang Y, Yang J, He L, Zhang L, Yang Y, Li R, Zhu Y, Chen C, Liu F, Yang H, Deng Y, Tan W, Deng N, Yu X, Xuan X, Xie X, Liu X, Lin H. Development and validation of deep learning algorithms for scoliosis screening using back images. Commun Biol 2019; 2:390. [PMID: 31667364 PMCID: PMC6814825 DOI: 10.1038/s42003-019-0635-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/24/2019] [Indexed: 02/08/2023] Open
Abstract
Adolescent idiopathic scoliosis is the most common spinal disorder in adolescents with a prevalence of 0.5-5.2% worldwide. The traditional methods for scoliosis screening are easily accessible but require unnecessary referrals and radiography exposure due to their low positive predictive values. The application of deep learning algorithms has the potential to reduce unnecessary referrals and costs in scoliosis screening. Here, we developed and validated deep learning algorithms for automated scoliosis screening using unclothed back images. The accuracies of the algorithms were superior to those of human specialists in detecting scoliosis, detecting cases with a curve ≥20°, and severity grading for both binary classifications and the four-class classification. Our approach can be potentially applied in routine scoliosis screening and periodic follow-ups of pretreatment cases without radiation exposure.
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Affiliation(s)
- Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Hengwei Fan
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zifang Huang
- Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Jingfan Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lin He
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Lei Zhang
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Fan Liu
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Haoqing Yang
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Yaolong Deng
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiqing Tan
- Health Promotion Centre for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, Guangdong China
| | - Nali Deng
- Health Promotion Centre for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, Guangdong China
| | - Xuexiang Yu
- Department of Sports and Arts, Guangzhou Sport University, Guangzhou, Guangdong China
| | - Xiaoling Xuan
- Xinmiao Scoliosis Prevention of Guangdong Province, Guangzhou, Guangdong China
| | - Xiaofeng Xie
- Xinmiao Scoliosis Prevention of Guangdong Province, Guangzhou, Guangdong China
| | - Xiyang Liu
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong China
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Kadhim M, Lucak T, Schexnayder S, King A, Terhoeve C, Song B, Heffernan MJ. Current status of scoliosis school screening: targeted screening of underserved populations may be the solution. Public Health 2019; 178:72-77. [PMID: 31627054 DOI: 10.1016/j.puhe.2019.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 06/23/2019] [Accepted: 08/25/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The growing body of evidence documenting the effectiveness of brace treatment for scoliosis has renewed interest in potential benefits of early detection through school screening. We aimed to assess the prevalence and identify barriers of screening. We hypothesized that school screening is more frequent in schools that have a nurse on staff compared to schools without nurse on staff. STUDY DESIGN A questionnaire survey. METHODS All schools located in four counties in Louisiana, United States of America comprising the New Orleans metropolitan area between September 2015 and January 2016 were contacted by phone to assess rates of scoliosis screening, report the availability of a school nurse, and specify barriers if screening was not performed. RESULTS Two hundred and ninety-one schools responded to the survey including 152 public, 30 charter, and 109 private schools (101 had religious affiliation). A staff nurse was available in 180 schools (61.8%). Only 21 schools (7.2%) performed scoliosis screening. The majority were charter schools (11 schools), while six were private and four were public (P < 0.0001). Of these 21 schools, 16 (76.2%) had a nurse on staff while five schools did not (P = 0.16). Lack of a referral pathway in the event of a positive screen was the most common barrier to performing scoliosis screening. CONCLUSION Scoliosis screening is infrequent in the examined school districts. Efforts to support school screening can facilitate clear referral pathways for schools in the event of a positive screen. These findings suggest a potential need for different pathway of scoliosis screening. Pediatricians and family physicians can assist with scoliosis screening during the annual visit. While universal screening is overburdensome and likely unnecessary, targeted screening of underserved populations may prove to be beneficial. Further investigation should include assessment of the economic viability of targeted screening programs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Kadhim
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA
| | - T Lucak
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA
| | - S Schexnayder
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA
| | - A King
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA
| | - C Terhoeve
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA
| | - B Song
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA
| | - M J Heffernan
- Department of Orthopaedic Surgery, Children Hospital of New Orleans, New Orleans, LA, USA.
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Cioana M, Peterson D, Missiuna P, El-Hawary R, Carey T, Potter MA, Banfield L, Thabane L, Samaan MC. The creation of a national coalition to target adolescent idiopathic scoliosis: a meeting report. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2019; 10:15-19. [PMID: 30863194 PMCID: PMC6390871 DOI: 10.2147/ahmt.s199489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this report, we document the discussions and recommendations of a national conference designed to create a coalition to tackle adolescent idiopathic scoliosis (AIS) held on June 6 and 7, 2017 in Hamilton, ON, Canada. The goal of the establishment of this coalition is to join the efforts of patients, parents, physicians, researchers and other stakeholders to identify stakeholders' perspectives and to categorize gaps in knowledge and target further AIS research and clinical care priorities. The participants' main priorities included focus on shared decision making regarding clinical and research priorities between the stakeholders on the clinical, research and policy sides with patients and families. In addition, improvements in the dissemination of information via digital platforms and identification of cost-effective screening strategies that may help early identification and intervention were also recognized as a priority. Commitment was reached to form a national coalition to understand the determinants of this condition and enhance patient outcomes through improved clinical care and research efforts.
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Affiliation(s)
- Milena Cioana
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada, .,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada,
| | - Devin Peterson
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Missiuna
- Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ron El-Hawary
- Orthopedic Surgery Department, IWK Children's Health Center, Dalhousie University, Halifax, NS, Canada
| | - Timothy Carey
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Murray A Potter
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada, .,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicines, St Joseph's Health Care, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada, .,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada, .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
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Ha AS, Beauchamp EC. Editorial on " Screening for adolescent idiopathic scoliosis: US preventive services task force recommendation statement". JOURNAL OF SPINE SURGERY 2018; 4:812-816. [PMID: 30714016 DOI: 10.21037/jss.2018.10.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alex S Ha
- New-York Presbyterian/Columbia University Medical Center, New York, NY, USA
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10
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Kwok G, Yip J, Yick KL, Cheung MC, Tse CY, Ng SP, Luximon A. Postural Screening for Adolescent Idiopathic Scoliosis with Infrared Thermography. Sci Rep 2017; 7:14431. [PMID: 29089528 PMCID: PMC5663704 DOI: 10.1038/s41598-017-14556-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/12/2017] [Indexed: 01/06/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a multifactorial, three-dimensional deformity of the spine and trunk. School scoliosis screening (SSS) is recommended by researchers as a means of early detection of AIS to prevent its progression in school-aged children. The traditional screening technique for AIS is the forward bending test because it is simple, non-invasive and inexpensive. Other tests, such as the use of Moiré topography, have reduced the high false referral rates. The use of infrared (IR) thermography for screening purposes based on the findings of previous studies on the asymmetrical paraspinal muscle activity of scoliotic patients compared with non-scoliotic subjects was explored in this study. IR thermography is performed with an IR camera to determine the temperature differences in paraspinal muscle activity. A statistical analysis showed that scoliotic subjects demonstrate a statistically significant difference between the left and right sides of the regions of interest. This difference could be due to the higher IR emission of the convex side of the observed area, thereby creating a higher temperature distribution. The findings of this study suggest the feasibility of incorporating IR thermography as part of SSS. However, future studies could also consider a larger sample of both non-scoliotic and scoliotic subjects to further validate the findings.
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Affiliation(s)
- Garcia Kwok
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Kit-Lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Yung Tse
- Centre for Orthopaedic Surgery, Central, Hong Kong, China
| | - Sun-Pui Ng
- Division of Science & Technology, Hong Kong Community College, Hong Kong, China
| | - Ameersing Luximon
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
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11
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Lee WH, Kang H, Kim SY. Discrepancy between self-awareness and actual diagnosis and treatment of the conditions among adolescent with scoliosis in middle-school age. J Phys Ther Sci 2017; 29:567-571. [PMID: 28533586 PMCID: PMC5430249 DOI: 10.1589/jpts.29.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this research was to determine the awareness of the actual conditions of the diagnosis and treatment of scoliosis by focusing on middle-school students in order to provide a basis for active education and treatment of scoliosis. [Subjects and Methods] The survey was conducted among 4,782 students. The students performed Adam's forward bend test, and some of the students who showed predictive features of scoliosis were further examined for the spine structure with rasterstereography. [Results] The proportion of students with awareness about scoliosis appeared to be 71.47%. Among the students, 50.84% knew the definition of scoliosis and 4.37% were diagnosed as having scoliosis, of whom 46.37% underwent treatment. It was a significant difference between to get a diagnosis and the predictive scoliosis or the scoliosis. [Conclusion] The results showed that the students in the second grade of middle school had high awareness levels, but about 50% of them did not know the definition of scoliosis. More than 50% of them did not receive treatment after diagnosed as having scoliosis. Therefore, active education and school screening for scoliosis should be provided to adolescent students.
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Affiliation(s)
- Wan-Hee Lee
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - Hyojeong Kang
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - Seong Yeol Kim
- Graduate School of Physical Therapy, Kyungnam University, Republic of Korea
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12
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Hresko MT, Talwalkar V, Schwend R. Early Detection of Idiopathic Scoliosis in Adolescents. J Bone Joint Surg Am 2016; 98:e67. [PMID: 27535448 DOI: 10.2106/jbjs.16.00224] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M Timothy Hresko
- Departments of Orthopaedic Surgery, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Vishwas Talwalkar
- Departments of Orthopaedic Surgery, University of Kentucky and Shriners Hospitals for Children, Lexington, Kentucky
| | - Richard Schwend
- University of Missouri-Kansas City School of Medicine and University of Kansas Medical Center, Children's Mercy Hospital, Kansas City, Missouri
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Adobor RD, Joranger P, Steen H, Navrud S, Brox JI. Re: To screen or not to screen for adolescent idiopathic scoliosis? A review of the literature. Public Health 2016; 133:124-5. [PMID: 26872737 DOI: 10.1016/j.puhe.2015.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Affiliation(s)
- R D Adobor
- Section for Spine Surgery, Department of Orthopedic Surgery, Oslo University Hospital-Rikshospitalet, Pb 4950, Nydalen, N-0424 Oslo, Norway.
| | - P Joranger
- Oslo and Akershus University College of Applied Sciences, P. O. Box 4, St.Olavs plass, N-0130 Oslo, Norway; School of Economics and Business, Norwegian University of Life Sciences, P. O. Box 5003, N-1432 Ås, Norway
| | - H Steen
- Biomechanic Lab, Department of Orthopedic Surgery, Oslo University Hospital-Rikshospitalet, Pb 4950, Nydalen, N-0424 Oslo, Norway; Oslo and Akershus University College of Applied Sciences, P. O. Box 4, St. Olavs plass, N-0130 Oslo, Norway
| | - S Navrud
- School of Economics and Business, Norwegian University of Life Sciences, P. O. Box 5003, N-1432 Ås, Norway
| | - J I Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Pb 4950, Nydalen, N-0424 Oslo, Norway
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School Scoliosis Screenings: Family Experiences and Potential Anxiety After Orthopaedic Referral. Spine (Phila Pa 1976) 2015; 40:E1135-43. [PMID: 26165212 DOI: 10.1097/brs.0000000000001040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sequential study design that used data from Texas Scottish Rite Hospital for Children (TSRHC). OBJECTIVE Examine anxiety symptoms and family experiences subsequent to school scoliosis screening (SSS) referrals. SUMMARY OF BACKGROUND DATA Use of SSS remains controversial. Prior research suggested that SSS programs may result in anxiety for both children and parents. Unfortunately, no study has examined the SSS referral processes and anxiety in families. METHODS Study consisted of 2 groups-patients/parents from TSRHC evaluated for Adolescent Idiopathic Scoliosis (AIS) (n = 27) and control participants/parents (n = 27) between ages 9 and 17. All participants completed the primary outcome measure (State-Trait Anxiety Inventory) before and after the scoliosis evaluation or controlled wait time. Parents also rated experience and satisfaction with SSS. RESULTS Compared with the control group, children/parents in patient group experienced significantly elevated levels of state-anxiety at preappointment. Children/parents in the patient group not diagnosed with AIS experienced a significant decline in state-anxiety. Children/parents in the patient group diagnosed with AIS continued to report elevated levels of anxiety. The control group remained consistent, reporting of low levels of anxiety pre to post. More than half (55.5%) of families indicated they received no information from the school about scoliosis. A third of the families who received information indicated it did not adequately address their concerns. Nonetheless, most families reported overall satisfaction with SSS. CONCLUSION This study suggested that children and parents referred through the SSS program experienced significantly elevated levels of state-anxiety. This supports the subjective concerns of anxiety experiences in families voiced by researchers previously. However, families deemed the costs of the SSS referral process as worth the benefits. Though challengers of SSS programs were accurate in observing anxiety in families, it may not constitute significant burden to eliminate SSS programs altogether. Improvements to the current system may be warranted. LEVEL OF EVIDENCE 3.
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Çolak TK, Apti A, Dereli EE, Özdinçler AR, Çolak İ. Scoliosis screening results of primary school students (11-15 years old group) in the west side of Istanbul. J Phys Ther Sci 2015; 27:2797-801. [PMID: 26504296 PMCID: PMC4616097 DOI: 10.1589/jpts.27.2797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/03/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study aimed to find out the scoliosis prevalence 11–15 years old
children and to create awareness about scoliosis. [Subjects and Methods] All of the
children were assessed using the Adams Forward Bendings Test and a scoliometer. Sagittal
plane changes such as kyphosis, lordosis, hypokyphosis, hypolordosis and anterior head
tilt were screened. Children with trunk rotation angles (ATR) of 4 degrees or more were
suspected of having scoliosis, and were evaluated for a second time for gibbosity height,
arm-trunk distance, and ATR. [Results] A total of 2,207 children were screened and the
evaluation revealed there were 11 girls (0.49%) with a Cobb angle of 10 degrees and more.
The maximum Cobb angle was 43° (right thoracic-left lumbar) and the maximum ATR was 12°.
Two children had kyphosis and lordosis, and one had hypokyphosis and was diagnosed as
having idiopathic scoliosis. [Conclusion] Families should regularly check their children,
even if they are not diagnosed as having scoliosis in school screenings. It is our opinion
that our study increased the awareness of the families about scoliosis by screening,
brochures and posters. In the future, if school screenings were performed as a routine
procedure and scoliotic students were followed over the long term, the actual
effectiveness of screening would be able to be detected.
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Affiliation(s)
- Tuğba Kuru Çolak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Turkey
| | - Adnan Apti
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - E Elçin Dereli
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Istanbul Bilgi University, Turkey
| | - Arzu Razak Özdinçler
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - İlker Çolak
- Department of Orthopedics and Traumatology, Dr Lütfi Kırdar Kartal Education and Research Hospital, Turkey
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Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015; 1:15030. [PMID: 27188385 DOI: 10.1038/nrdp.2015.30] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
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Affiliation(s)
- Jack C Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Aina J Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew B Dobbs
- Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Theodoros B Grivas
- Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Keith D Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Alain Moreau
- Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada.,Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Ian A Stokes
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Stuart L Weinstein
- Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust - Queen's Medical Centre Campus, Nottingham, UK
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Fong DYT, Cheung KMC, Wong YW, Wan YY, Lee CF, Lam TP, Cheng JCY, Ng BKW, Luk KDK. A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening. Spine J 2015; 15:825-33. [PMID: 25615844 DOI: 10.1016/j.spinee.2015.01.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/17/2014] [Accepted: 01/08/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The value of scoliosis screening has been recently shown in a multicenter randomized controlled trial. However, the long-term sustainability of the clinical effectiveness of scoliosis screening as a routine health service remains unknown. PURPOSE The aim of this study was to assess the sustainability of the clinical effectiveness of school scoliosis screening. STUDY DESIGN/SETTING A large population-based cohort study with a 10-year follow-up was conducted. PATIENT SAMPLE A total of 394,401 students who were in the fifth grade during the five academic years from 1995/1996 to 1999/2000 formed five consecutive annual cohorts. The students were eligible for the Hong Kong scoliosis screening program, with their screening history and medical records until their nineteenth birthdays being assessed. OUTCOME MEASURES The outcome measures considered in the study were development of adolescent idiopathic scoliosis by the 19 years of age and the Cobb angle. METHODS The clinical effectiveness of scoliosis screening was assessed by referral rate for radiographic diagnosis, sensitivity, specificity, and predictive values. RESULTS A total of 306,144 students (78%) participated in scoliosis screening, which used a two-tier system. The prevalence of curves of 20° or greater was 1.8% (95% confidence interval [CI], 1.7-1.8%), whereas the referral rate for radiography, the sensitivity, and the positive predictive value (PPV) for curves of 20° or greater were 4.1% (95% CI, 4.0-4.2%), 91% (95% CI, 90-92%), and 40% (95% CI, 39-41%), respectively. Across the five consecutive annual cohorts, the prevalence and sensitivity for curves of 20° or greater increased by 0.23% (95% CI, 0.21-0.25%; p<.001) and 0.76% (95% CI, 0.43-1.04%; p<.001) per year, respectively; however, the PPV was reduced by 1.71% (95% CI, 1.09-2.33%; p<.001) per year. CONCLUSIONS This report describes the first large population-based study with a long-term follow-up indicating that a scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation. As the prevalence of adolescent idiopathic scoliosis increases, scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy.
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Affiliation(s)
- Daniel Y T Fong
- School of Nursing, The University of Hong Kong, 21 Sassoon Rd, Hong Kong
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F Professorial Block, Pokfulam, Hong Kong
| | - Yat-Wa Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F Professorial Block, Pokfulam, Hong Kong
| | - Yuen-Yin Wan
- School of Nursing, The University of Hong Kong, 21 Sassoon Rd, Hong Kong
| | - Chun-Fan Lee
- Department of Biostatistics of the Singapore Clinical Research Institute, 31 Biopolis Way, Nanos #02-01, Singapore 138669; Centre for Quantitative Medicine of the Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Jack C Y Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Bobby K W Ng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F Professorial Block, Pokfulam, Hong Kong.
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A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis. SCOLIOSIS 2014; 9:21. [PMID: 25601889 PMCID: PMC4298059 DOI: 10.1186/s13013-014-0021-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022]
Abstract
SUMMARY OF BACKGROUND DATA Adolescent idiopathic scoliosis can progress and affect the health related quality of life of the patients. Research shows that screening is effective in early detection, which allows for bracing and reduced surgical rates, and may save costs, but is still controversial from a health economic perspective. STUDY DESIGN Model based cost minimisation analysis using hospital's costs, administrative data, and market prices to estimate costs in screening, bracing and surgical treatment. Uncertainty was characterised by deterministic and probabilistic sensitivity analyses. Time horizon was 6 years from first screening at 11 years of age. OBJECTIVE To compare estimated costs in screening and non-screening scenarios (reduced treatment rates of 90%, 80%, 70% of screening, and non-screening Norway 2012). METHODS Data was based on screening and treatment costs in primary health care and in hospital care settings. Participants were 4000, 12-year old children screened in Norway, 115190 children screened in Hong Kong and 112 children treated for scoliosis in Norway in 2012. We assumed equivalent outcome of health related quality of life, and compared only relative costs in screening and non-screening settings. Incremental cost was defined as positive when a non-screening scenario was more expensive relative to screening. RESULTS Screening per child was € 8.4 (95% CrI 6.6 to10.6), € 10350 (8690 to 12180) per patient braced, and € 45880 (39040 to 55400) per child operated. Incremental cost per child in non-screening scenario of 90% treatment rate was € 13.3 (1 to 27), increasing from € 1.3 (-8 to 11) to € 27.6 (14 to 44) as surgical rates relative to bracing increased from 40% to 80%. For the 80% treatment rate non-screening scenario, incremental cost was € 5.5 (-6 to 18) when screening all, and € 11.3 (2 to 22) when screening girls only. For the non-screening Norwegian scenario, incremental cost per child was € -0.1(-14 to 16). Bracing and surgery were the main cost drivers and contributed most to uncertainty. CONCLUSIONS With the assumptions applied in the present study, screening is cost saving when performed in girls only, and when it leads to reduced treatment rates. Cost of surgery was dominating in non-screening whilst cost of bracing was dominating in screening. The economic gain of screening increases when it leads to higher rates of bracing and reduced surgical rates.
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Abstract
School nurses have provided routine health screenings of school-age children for decades. During the 1970s, recommendations for school scoliosis screening, which were based upon poor access to health care, led state boards of education to mandate that school nurses screen for scoliosis. The history of mandated scoliosis screening in U.S. schools is reviewed, and current school nurse practices for scoliosis screening are presented. Elevated referral rates for repeat scoliosis examination following school scoliosis screenings have led to questions of efficacy. Further controversy exists regarding school nurses screening for scoliosis due to a lack of evidence indicating a decreased need for scoliosis surgery. This article contains evidence-based recommendations for discontinuing school scoliosis screening to help school nurses refocus their efforts on complex health needs and preventive health issues more likely to impact the majority of their students.
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Lee JY, Moon SH, Kim HJ, Park MS, Suh BK, Nam JH, Jung JK, Lee HM. The prevalence of idiopathic scoliosis in eleven year-old Korean adolescents: a 3 year epidemiological study. Yonsei Med J 2014; 55:773-8. [PMID: 24719147 PMCID: PMC3990085 DOI: 10.3349/ymj.2014.55.3.773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/15/2013] [Accepted: 08/20/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE School screening allows for early detection and early treatment of scoliosis, with the purpose of reducing the number of patients requiring surgical treatment. Children between 10 and 14 years old are considered as good candidates for school screening tests of scoliosis. The purpose of the present study was to assess the epidemiological findings of idiopathic scoliosis in 11-year-old Korean adolescents. MATERIALS AND METHODS A total of 37856 11-year-old adolescents were screened for scoliosis. There were 17110 girls and 20746 boys. Adolescents who were abnormal by Moire topography were subsequently assessed by standardized clinical and radiological examinations. A scoliotic curve was defined as 10° or more. RESULTS The prevalence of scoliosis was 0.19% and most of the curves were small (10° to 19°). The ratio of boys to girls was 1:5.5 overall. Sixty adolescents (84.5%) exhibited single curvature. Thoracolumbar curves were the most common type of curve identified, followed by thoracic and lumbar curves. CONCLUSION The prevalence of idiopathic scoliosis among 11-year-old Korean adolescents was 0.19%.
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Affiliation(s)
- Jin-Young Lee
- Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Medical College of Hallym University, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Han Jo Kim
- Spine and Scoliosis Service, Hospital for Special Surgery, New York, NY, USA
| | - Moon Soo Park
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Anyang, Korea
| | - Bo-Kyung Suh
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Anyang, Korea
| | - Ji Hoon Nam
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Anyang, Korea
| | - Jae Kyun Jung
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Anyang, Korea
| | - Hwan-Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Glinkowski W, Michoński J, Żukowska A, Glinkowska B, Sitnik R, Górecki A. The Time Effectiveness of Three-Dimensional Telediagnostic Postural Screening of Back Curvatures and Scoliosis. Telemed J E Health 2014; 20:11-7. [DOI: 10.1089/tmj.2013.0107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wojciech Glinkowski
- Department of Orthopedics and Traumatology of the Locomotor System, Center of Excellence “TeleOrto,” Medical University of Warsaw, Warsaw, Poland
- Polish Telemedicine Society, Warsaw, Poland
| | - Jakub Michoński
- Institute of Micromechanics and Photonics, Warsaw University of Technology, Warsaw, Poland
| | - Agnieszka Żukowska
- Polish Telemedicine Society, Warsaw, Poland
- “TeleHealth,” Student's Scientific Club, Medical University of Warsaw, Warsaw, Poland
| | - Bożena Glinkowska
- Department of Sports and Physical Education, Medical University of Warsaw, Warsaw, Poland
| | - Robert Sitnik
- Institute of Micromechanics and Photonics, Warsaw University of Technology, Warsaw, Poland
| | - Andrzej Górecki
- Department of Orthopedics and Traumatology of the Locomotor System, Center of Excellence “TeleOrto,” Medical University of Warsaw, Warsaw, Poland
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Lee CF, Fong DYT, Cheung KMC, Cheng JCY, Ng BKW, Lam TP, Yip PSF, Luk KDK. A new risk classification rule for curve progression in adolescent idiopathic scoliosis. Spine J 2012; 12:989-95. [PMID: 22727318 DOI: 10.1016/j.spinee.2012.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/16/2011] [Accepted: 05/17/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prognostic factors for curve progression of adolescent idiopathic scoliosis (AIS) have been reported previously. There is only one existing rule that classifies AIS patients into two groups by a curvature of 25°. PURPOSE This study aimed to develop a more refined risk classification rule for AIS. STUDY DESIGN This was a retrospective cohort study. PATIENT SAMPLE We examined 2,308 untreated AIS patients, aged 10 years and older, who had a Risser sign of 2 and lesser and a curvature less than 30° at presentation. OUTCOME MEASURES Outcome was taken as the time to progression to 30°. METHODS Patients' clinical parameters were analyzed by Classification and Regression Tree analysis. RESULTS The new classification rule identified four risk groups of curve progression. Patients with a curvature of 26° and more and less than 18° constituted the highest and lowest risk groups, respectively. The two intermediate groups were identified by the age (11.3 years), menarcheal status, and body height (154 cm). CONCLUSIONS The risk classification rule only uses information at the first presentation and can aid physicians in deriving an efficient management.
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Affiliation(s)
- C F Lee
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Tang NLS, Yeung HY, Hung VWY, Di Liao C, Lam TP, Yeung HM, Lee KM, Ng BKW, Cheng JCY. Genetic epidemiology and heritability of AIS: A study of 415 Chinese female patients. J Orthop Res 2012; 30:1464-9. [PMID: 22362628 DOI: 10.1002/jor.22090] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/02/2012] [Indexed: 02/04/2023]
Abstract
Recent familial segregation studies supported a multifactorial genetic model for the etiology of adolescent idiopathic scoliosis (AIS). However, the extent of quantitative genetic effects, such as heritability, have not been fully evaluated. This genetic epidemiology study examined the sibling recurrent risk and heritability of AIS in first-degree relatives of 415 Chinese female patients, which is up to now the largest cohort. They were first diagnosed by community screening program and compared to 203 age-matched normal controls. Out of the total 531 sibs of AIS cases, 94 sibs had scoliosis (sibling recurrence risk = 17.7%). The prevalence of AIS among male and female sibs of an index case were 11.5% (95% CI = 7.5-15.5) and 23.0% (95% CI = 18.1-27.9), respectively. Female sibs of an index case had an increased risk of 8.9-fold (95% CI = 3.2-34.4) for developing AIS. These recurrent risks were significantly higher than the risk in the control group (p < 0.0001). Overall, heritability was estimated to be 87.5 ± 11.1%. The results confirmed the prevailing impression of strong genetic influence on the risk of AIS. Here we provided a large-scale study for the genetic aggregation estimates in an Asian population for the first time. The finding also positioned AIS among other common disease or complex traits with a high heritability.
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Affiliation(s)
- Nelson L S Tang
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
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School screening for scoliosis: can surface topography replace examination with scoliometer? SCOLIOSIS 2012; 7:9. [PMID: 22472020 PMCID: PMC3349618 DOI: 10.1186/1748-7161-7-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/03/2012] [Indexed: 01/07/2023]
Abstract
Background Clinical examination with the use of scoliometer is a basic method for scoliosis detection in school screening programs. Surface topography (ST) enables three-dimensional back assessment, however it has not been adopted for the purpose of scoliosis screening yet. The purpose of this study was to assess the usefulness of ST for scoliosis screening. Methods 996 girls aged 9 to 13 years were examined, with both scoliometer and surface topography. The Surface Trunk Rotation (STR) was introduced and defined as a parameter allowing comparison with scoliometer Angle of Trunk Rotation taken as reference. Results Intra-observer error for STR parameter was 1.9°, inter-observer error was 0.8°. Sensitivity and specificity of ST were not satisfactory, the screening cut-off value of the surface topography parameter could not be established. Conclusions The study did not reveal advantage of ST as a scoliosis screening method in comparison to clinical examination with the use of the scoliometer.
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Suh SW, Modi HN, Yang JH, Hong JY. Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1087-94. [PMID: 21274729 DOI: 10.1007/s00586-011-1695-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 11/22/2010] [Accepted: 01/09/2011] [Indexed: 02/06/2023]
Abstract
Cross-sectional epidemiologic scoliosis screening was carried out to determine the current prevalence of scoliosis in the Korean population and to compare with the results of previous studies. Between 2000 and 2008, 1,134,890 schoolchildren underwent scoliosis screening. The children were divided into two age groups, 10-12-year-olds (elementary school) and 13-14-year-olds (middle school), to calculate age- and sex-specific prevalence rates. Children with a scoliometer reading ≥5° were referred for radiograms. Two surgeons independently measured curve types, magnitudes, and Risser scores (inter-observer r = 0.964, intra-observer r = 0.978). Yearly and overall prevalence rates of scoliosis were calculated. There were 584,554 boys and 550,336 girls in the sample, with a male to female ratio of 1.1:1. There were 77,910 (6.2%) children (26,824 boys and 51,086 girls) with scoliometer readings >5°, and 37,339 of them had positive results with Cobb angles ≥10° (positive predictive value, 46.4%). The overall scoliosis prevalence rate was 3.26%; girls had a higher prevalence (4.65%) than boys (1.97%). Prevalence rates increased progressively from 1.66 to 6.17% between 2000 and 2008, with the exception of 2002. According to age and gender, 10-12-year-old girls had the highest scoliosis prevalence rates (5.57%), followed by 13-14-year-old girls (3.90%), 10-12-year-old boys (2.37%), and 13-14-year-old boys (1.42%). In girls and boys, prevalence rates dropped by 64.53 and 60.65% among 10-12-year-olds and 13-14-year-olds, respectively (P = 0.00). The proportion of 10°-19° curves was 95.25 and 84.45% in boys and girls, respectively; and the proportion of 20°-29° curves was 3.91 and 11.28%, which was a significant difference (P = 0.00). Thoracic curves were the most common (47.59%) followed by thoracolumbar/lumbar (40.10%), double (9.09%), and double thoracic (3.22%) curves. A comparison of the curve patterns revealed significant differences between genders (P = 0.00). We present this report as a guide for studying the prevalence of idiopathic scoliosis in a large population, and the increasing trend in the prevalence of idiopathic scoliosis emphasizes the need for awareness.
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Affiliation(s)
- Seung-Woo Suh
- Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul, South Korea.
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