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Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory. J Pediatr Orthop B 2019; 28:271-277. [PMID: 30807511 DOI: 10.1097/bpb.0000000000000611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although several procedures for treating scoliosis have been developed, the most effective treatment is still based on early detection. For early diagnosis of idiopathic scoliosis, many authors have proposed methods of school screening; however, there is still no standardized screening program. The aim of this study was to evaluate a school screening method and the prevalence and distribution of scoliosis in Italian school children, aged 9-14 years, and to determine if the screening method can reduce morbidity in an Italian territory. The screening program consisted of three steps: the first step was a clinical examination carried out by the school physician and two specialists. In the second step, doubtful cases (presence of a hump between the two sides of the torso, in the thoracic or thoracolumbar region, measured using a hump meter) were evaluated by an orthopedic specialist and subsequently controlled every 6 months either clinically or by radiographic examination. The third step was the classification of the scoliosis and procedures for treatment. All patients were scheduled for a follow-up program and were evaluated during the subsequent 3 years. Statistical analyses were performed with GraphPad Prism 6. A total of 8995 children were screened for scoliosis. Of these, 487 showed clinical signs of scoliosis, and 181 were referred for anteroposterior radiographs because of a positive result on the forward-bending test (hump>5 mm). No significant statistical difference was observed by the three clinical examiners. Of the 181 patients who were referred, 69 were radiographed, and the clinical diagnosis was confirmed in 94.2% of the cases. The prevalence of scoliosis (defined as a curve of ≥10°) was 0.76% (65 of 8995 children), and most of the curves (44; prevalence 67.69%) were small (<20°). The overall ratio of boys to girls was 1 : 3.3, but varied according to the magnitude of the curve (1 : 3 for curves of <20°, 1 : 3.25 for curves of 20-29°, and 1 : 4 for curves of ≥30°). Double curves were the most common type identified, followed by thoracolumbar curves; specifically, of the 65 children who had a curve, 21 (32.30%) had a double curve, 18 (27.6%) had a thoracolumbar curve, 17 (26.1%) had a lumbar curve, and nine (13.84%) had a thoracic curve. In the following 3 years, only four patients were found to have curves more than 20° and none more than 30°. Our results show that the school screening program was accurate and repeatable. Moreover, screening children for scoliosis using a simple test appears to be an effective means of early detection. Above all, the screening process effectively decreased morbidity in the territory at a negligible cost.
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Beauséjour M, Goulet L, Roy-Beaudry M, Grimard G, Labelle H. Association between lay perception of morbidity and appropriateness of specialized health care use in adolescent idiopathic scoliosis. J Orthop Res 2019; 37:727-736. [PMID: 30756421 DOI: 10.1002/jor.24249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/05/2019] [Indexed: 02/04/2023]
Abstract
In absence of school scoliosis screening programs (SSSP) in Canada, this study examined the relationships between the lay person's perception of morbidity and the appropriateness of referral in orthopedics. A cross-sectional study was conducted with all children consecutively referred in orthopedics for suspected scoliosis. The 831 participants were classified as Appropriate, Late, or Inappropriate referrals for the orthopedic setting. Perceived morbidity was operationalized by: the scoliosis detection originator, the perceptions of the seriousness of the condition and urgency to consult a physician, the perception of the general health, as well as Visible Back Deformity, Self-image, and Pain. Direct associations between the perceived morbidity and the appropriateness of referral were found in all scoliosis-specific measures; the most discriminant variable was Visible Back Deformity. Lay perceived morbidity is a good indicator of the objective morbidity, and thus reflects in the appropriateness of referral status. The important role of the lay persons in symptoms appraisal does not however insure appropriate referral. Searching for alternatives to SSSP would wisely include a health promotion and medical management program. Statement of Clinical Significance: Perceived morbidity by the lay persons is strongly associated with the objectively evaluated severity of scoliosis deformity. Therefore, in absence of SSSP, lay person awareness plays an important role in symptom recognition and search for care. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Marie Beauséjour
- Sainte-Justine University Health Centre, 3175 Ch. Côte-Sainte-Catherine, Montréal, Québec, Canada, H3T 1C5.,Department of Community Health Sciences, Université de Sherbrooke, 150 Place Charles-LeMoyne - Bureau 200, Longueuil, Québec, Canada, J4K 0A8.,Department of Surgery, Université de Montréal, PO Box 6128, Succ. Centre-Ville, Montréal, Québec, Canada
| | - Lise Goulet
- École de santé publique de l'Université de Montréal, PO Box 6128, Succ. Centre-Ville, Montréal, Québec, Canada
| | - Marjolaine Roy-Beaudry
- Sainte-Justine University Health Centre, 3175 Ch. Côte-Sainte-Catherine, Montréal, Québec, Canada, H3T 1C5
| | - Guy Grimard
- Sainte-Justine University Health Centre, 3175 Ch. Côte-Sainte-Catherine, Montréal, Québec, Canada, H3T 1C5.,Department of Surgery, Université de Montréal, PO Box 6128, Succ. Centre-Ville, Montréal, Québec, Canada
| | - Hubert Labelle
- Sainte-Justine University Health Centre, 3175 Ch. Côte-Sainte-Catherine, Montréal, Québec, Canada, H3T 1C5.,Department of Surgery, Université de Montréal, PO Box 6128, Succ. Centre-Ville, Montréal, Québec, Canada
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Beauséjour M, Goulet L, Ehrmann Feldman D, Da Silva RB, Pineault R, Rossignol M, Roy-Beaudry M, Labelle H. Pathways of healthcare utilisation in patients with suspected adolescent idiopathic scoliosis: a cross-sectional study. BMC Health Serv Res 2015; 15:500. [PMID: 26547908 PMCID: PMC4637137 DOI: 10.1186/s12913-015-1152-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 10/25/2015] [Indexed: 11/29/2022] Open
Abstract
Background School screening programs for adolescent idiopathic scoliosis (AIS) have been discontinued in Canada and elsewhere because they were not considered cost-effective. In communities lacking such programs, we expect a significant variety of healthcare pathways and timeframes for patient referrals to orthopaedics. The objectives of this study were: 1) to characterise the healthcare pathways of young children with suspected AIS in a population without school screening; and 2) to investigate the relationships between these healthcare pathways and the appropriateness of referrals to specialised orthopaedic clinics. Methods This study concerned all children, ages 10 to 18, referred for an initial visit for suspected AIS to any of the five out-patient paediatric orthopaedic clinics of south-western Quebec (Canada). For the 831 participants, referrals to orthopaedics were characterised as appropriate, late, or inappropriate, based on known risk factors for AIS progression and on treatment indications. Parents documented the circumstances of healthcare use prior to the orthopaedic consultation. Relevant predisposing, enabling, and need variables derived from Andersen’s Behavioral Model of Health Services Use were also documented. Healthcare pathways were characterised by developing a taxonomy using multiple correspondence analysis prior to hierarchical classification. Associations between the healthcare pathways and appropriateness of referral were assessed using multinomial regression analyses. Results We constructed a taxonomy of five distinct healthcare pathways: 1) Lay/regular source of care interrelation, 2) Other professionals, 3) Lay/consultation discontinuity, 4) Other medical doctor, and 5) Regular source of care continuity. Laypersons played an important role in AIS suspicion (53 % of cases), but did not prevent late referrals. Continuity of care, as opposed to numerous uncoordinated consultations, was an effective strategy to prevent late referrals (OR = 0.32 [0.17–0.59]), but was related to increased probability of inappropriate referrals. Conclusions We identified two cardinal characteristics that distinguished the healthcare pathways and related significantly to appropriateness of referral status, namely the role of laypersons and the involvement of the regular source of care. This suggests directions for intervention such as advocating for access to a regular source of care, increasing awareness of the disease to medical practitioners’ and improving their knowledge of AIS detection and referral criteria.
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Affiliation(s)
- Marie Beauséjour
- Research Centre, Sainte-Justine University Hospital Centre, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada. .,University of Montreal Public Health Research Institute (IRSPUM), P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada. .,Department of Surgery, Faculty of Medicine, University of Montreal, P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada.
| | - Lise Goulet
- University of Montreal Public Health Research Institute (IRSPUM), P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada.
| | - Debbie Ehrmann Feldman
- University of Montreal Public Health Research Institute (IRSPUM), P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada.
| | - Roxane Borgès Da Silva
- University of Montreal Public Health Research Institute (IRSPUM), P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada. .,Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke St. E., Montreal, Quebec, H2L 1M3, Canada.
| | - Raynald Pineault
- University of Montreal Public Health Research Institute (IRSPUM), P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada. .,Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke St. E., Montreal, Quebec, H2L 1M3, Canada.
| | - Michel Rossignol
- Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montreal, Quebec, H3A 0G4, Canada.
| | - Marjolaine Roy-Beaudry
- Research Centre, Sainte-Justine University Hospital Centre, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - Hubert Labelle
- Research Centre, Sainte-Justine University Hospital Centre, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada. .,Department of Surgery, Faculty of Medicine, University of Montreal, P.O. Box 6128, Centre-Ville Station, Montreal, Quebec, Canada.
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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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Scoliosis detection, patient characteristics, referral patterns and treatment in the absence of a screening program in Norway. SCOLIOSIS 2012; 7:18. [PMID: 23098059 PMCID: PMC3527139 DOI: 10.1186/1748-7161-7-18] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/22/2012] [Indexed: 11/10/2022]
Abstract
UNLABELLED BACKGROUND Early diagnosis of idiopathic scoliosis allows for observation and timely initiation of brace treatment in order to halt progression. School scoliosis screening programs were abolished in Norway in 1994 for lack of evidence that the programs improved outcome and for the costs involved. The consequences of this decision are discussed. OBJECTIVES To describe the detection, patient characteristics, referral patterns and treatment of idiopathic scoliosis at a scoliosis clinic during the period 2003-2011, when there was no screening and to compare treatment modalities to the period 1976-1988 when screening was performed. METHODS Patient demographics, age at detection, family history, clinical and radiological charts of consecutive patients referred for scoliosis evaluation during the period 2003-2011, were prospectively registered. Patients were recruited from a catchment area of about 500000 teenagers. Maturity was estimated according to Risser sign and menarcheal status. Severity of pain was recorded by a verbal 5-point scale from no pain to pain at all times. Physical and neurological examinations were conducted. The detector and patient characteristics were recorded. Referral patterns of orthopedic surgeons at local hospitals and other health care providers were recorded. Patient data was obtained by spine surgeons. Treatment modalities in the current period were compared to the period 1976-1988. RESULTS We registered 752 patients with late onset juvenile and adolescent idiopathic scoliosis from 2003-2011. There were 644 (86%) girls and 108 (14%) boys. Mean age at detection was 14.6 (7-19) years. Sixty percent had Risser sign ≥ 3, whilst 74% were post menarche with a mean age at menarche of 13.2 years. Thirty-one percent had a family history of scoliosis. The mean major curve at first consultation at our clinic was 38° (10°-95°). About 40% had a major curve >40°. Seventy-one percent were detected by patients, close relatives, and friends. Orthopaedic surgeons referred 61% of the patients. The mean duration from detection to the first consultation was 20(0-27) months. The proportion of the average number of patients braced each year was 68% during the period with screening compared to 38% in the period without screening, while the proportion for those operated was 32% and 62%, respectively ( p=0.002, OR 3.5, (95%CI 1.6 to 7.5). CONCLUSION In the absence of scoliosis screening, lay persons most often detect scoliosis. Many patients presented with a mean Cobb angle approaching the upper limit for brace treatment indications. The frequency of brace treatment has been reduced and surgery is increased during the recent period without screening compared with the period in the past when screening was still conducted.
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Adobor RD, Rimeslatten S, Steen H, Brox JI. School screening and point prevalence of adolescent idiopathic scoliosis in 4000 Norwegian children aged 12 years. SCOLIOSIS 2011; 6:23. [PMID: 22024241 PMCID: PMC3213177 DOI: 10.1186/1748-7161-6-23] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/24/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND School screening for adolescent idiopathic scoliosis (AIS) is discussed. The aim of the present study was to describe the point prevalence of AIS and to evaluate the effectiveness of school screening in 12-year- old children. METHODS Community nurses and physical therapists in the Southern Health region of Norway including about 12000 school children aged 12 years were invited to participate. All participating community nurses and physical therapists fulfilled an educational course to improve their knowledge about AIS and learn the screening procedure including the Adam Forward Bending Test and measurement of gibbus using a scoliometer. RESULTS Sub-regions including 4000 school children participated. The prevalence of idiopathic scoliosis defined as a positive Adam Forward Bending Test, gibbus > 7° and primary major curve on radiographs > 10°, was 0.55%. Five children (0.13%) had a major curve > 20°. Bracing was not indicated in any child; all children were post menarche; four had Risser sign of 4, and one with Risser 1 did not have curve progression > 5° at later follow-up. In one of these 5 children however, the major curve progressed to 45° within 7 months after screening and the girl was operated. CONCLUSION The point prevalence of AIS in 12- year old children is in agreement or slightly lower than previous studies. The screening model employed demonstrates acceptable sensitivity and specificity and low referral rates. Screening at the age of 12 years only was not effective for detecting patients with indication for brace treatment.
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Affiliation(s)
- Raphael D Adobor
- Department of Orthopaedic Surgery, Section for Spine Surgery, Oslo University Hospital- Rikshospitalet, Sognsvannsveien 20, Oslo, 0372, Norway.
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Fong DYT, Lee CF, Cheung KMC, Cheng JCY, Ng BKW, Lam TP, Mak KH, Yip PSF, Luk KDK. A meta-analysis of the clinical effectiveness of school scoliosis screening. Spine (Phila Pa 1976) 2010; 35:1061-71. [PMID: 20393399 DOI: 10.1097/brs.0b013e3181bcc835] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A meta-analysis that systematically reviewed the evaluation studies of a scoliosis screening program reported in the literature. OBJECTIVE To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported. METHODS Data sources included 3 databases, namely, PubMed, Google scholar, CINAHL database, and the references from identified reviews and studies. Studies were included if: (1) they adopted a retrospective cohort design; (2) were screened using either the forward bending test (FBT), angle of trunk rotation, or Moiré topography; (3) reported results of screening tests and radiographic assessments; (4) screened adolescents only; (5) reported the incidence of curves with a minimum Cobb angle of 10 degrees or greater; and (6) reported the number of referrals for radiography. Reviews, comments, case studies, and editorials were excluded. RESULTS Thirty-six studies, including 34 from the 775 initially identified studies and 2 from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive values for detecting curves > or =10 degrees , curves > or =20 degrees , and treatment were 28.0%, 5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that programs using the FBT alone reported a higher referral rate (odds ratio [OR] = 2.91) and lower positive predictive values for curves > or =10 degrees (OR = 0.49) and curves > or =20 degrees (OR = 0.34) than programs using other tests. Only one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the specificity was not reported. No severe publication bias was noted. CONCLUSION The use of the FBT alone in school scoliosis screening is insufficient. We need large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening.
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Affiliation(s)
- Daniel Yee Tak Fong
- Department of Nursing Studies, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Affiliation(s)
- Eugene E. Bleck
- Stanford University Medical Center, Department of Surgery Orthopedic Division, 520 Sand Hill Road, Palo Alto, California, 94304, USA
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Grivas TB, Wade MH, Negrini S, O'Brien JP, Maruyama T, Hawes MC, Rigo M, Weiss HR, Kotwicki T, Vasiliadis ES, Sulam LN, Neuhous T. SOSORT consensus paper: school screening for scoliosis. Where are we today? SCOLIOSIS 2007; 2:17. [PMID: 18039374 PMCID: PMC2228277 DOI: 10.1186/1748-7161-2-17] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 11/26/2007] [Indexed: 12/24/2022]
Abstract
This report is the SOSORT Consensus Paper on School Screening for Scoliosis discussed at the 4th International Conference on Conservative Management of Spinal Deformities, presented by SOSORT, on May 2007. The objectives were numerous, 1) the inclusion of the existing information on the issue, 2) the analysis and discussion of the responses by the meeting attendees to the twenty six questions of the questionnaire, 3) the impact of screening on frequency of surgical treatment and of its discontinuation, 4) the reasons why these programs must be continued, 5) the evolving aim of School Screening for Scoliosis and 6) recommendations for improvement of the procedure.
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Affiliation(s)
- Theodoros B Grivas
- Orthopaedic Department, "Thriasio" General Hospital, G. Gennimata Av. 19600, Magoula, Attica, Greece
| | | | | | - Joseph P O'Brien
- President & CEO, National Scoliosis Foundation (NSF), Boston, USA
| | - Toru Maruyama
- Department of Orthopaedic Surgery, Saitama MedicalCenter, Saitama Medical University, 1981 Kamodatsujido, Kawagoe, Saitama 350-8550, Japan
| | | | | | - Hans Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany
| | | | - Elias S Vasiliadis
- Orthopaedic Department, "Thriasio" General Hospital, G. Gennimata Av. 19600, Magoula, Attica, Greece
| | - Lior Neuhaus Sulam
- Bpt physiotherapist specialist in treatment of spinal deformities, Moshe Dayan st. 18 Modiin, 71700, Israel
| | - Tamar Neuhous
- pt physiotherapist specialist in treatment of spinal deformities, Moshe Dayan st. 18 Modiin, 71700, Israel
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Abstract
Scoliosis screening has been practiced for nearly 50 years and has provided valuable knowledge about the prevalence and natural history of scoliosis. Early diagnosis allows for nonoperative treatment, like wearing an orthosis that has been shown to be effective by numerous outcome studies. Challenges in scoliosis screening include the low prevalence rate of clinically significant scoliosis, the inverse relationship of sensitivity and specificity in the screening process because of the poor correlation of clinical deformity and radiographic abnormality, and the inflated cost of these programs because of overreferral. Recommendations for improvement include redefinition of what actually constitutes a "significant" scoliosis for screening, diagnostic, and outcome purposes; selective screening of only immature females; the use of objective referral criteria; and re-screening patients rather than referring those who have borderline cases.
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Affiliation(s)
- William P Bunnell
- Department of Orthopaedic Surgery, Loma Linda University, School of Medicine, Loma Linda, CA, USA.
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Affiliation(s)
- R A Dickson
- University of Leeds, St Jame's University Hospital
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