Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Impact of a physical rehabilitation program on the respiratory function of adolescents with idiopathic scoliosis. Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients Braces for Idiopathic Scoliosis in Adolescents Objective Assessment of the Cardiorespiratory Function of Adolescents With Idiopathic Scoliosis Through the Six-Minute Walk Test Spinal Range of Motion, Muscle Endurance, and Back Pain and Function at Least 20 Years After Fusion or Brace Treatment for Adolescent Idiopathic Scoliosis: A Case-Control Study The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle. The Spinal Appearance Questionnaire: Results of Reliability, Validity, and Responsiveness Testing in Patients With Idiopathic Scoliosis Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis. Curvature progression in patients treated with scoliosis in-patient rehabilitation--a sex and age matched controlled study. Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature Reliability of photogrammetry in the evaluation of the postural aspects of individuals with structural scoliosis. Effect of Schroth exercises on curve characteristics and clinical outcomes in adolescent idiopathic scoliosis: protocol for a multicentre randomised controlled trial. Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study. Objective parallel-forms reliability assessment of 3 dimension real time body posture screening tests Chiropractic manipulation in Adolescent Idiopathic Scoliosis: a pilot study Evaluation of segmental postural characteristics during quiet standing in control and Idiopathic Scoliosis patients. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis
BACKGROUND The feasibility of conducting a definitive r and omised controlled trial ( RCT ) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises ( SSEs ) for adolescent idiopathic scoliosis ( AIS ) is uncertain . OBJECTIVES The aim of this study was to assess the feasibility of conducting a large , multicentre trial of SSE treatment for patients with AIS , in comparison with st and ard care , and to refine elements of the study design . The objectives were to ( 1 ) up date a systematic review of controlled trials evaluating the efficacy of SSE in AIS ; ( 2 ) survey UK orthopaedic surgeons and physiotherapists to determine current practice , patient population s and equipoise ; ( 3 ) r and omise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites ; ( 4 ) develop , document and assess acceptability and adherence of interventions ; ( 5 ) assess and describe training requirements of physiotherapists ; and ( 6 ) gain user input in all relevant stages of treatment and protocol design . DESIGN Multicomponent feasibility study including UK clinician survey , systematic literature review and a r and omised feasibility trial . SETTING The r and omised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS . PARTICIPANTS The r and omised feasibility study recruited people aged 10 - 16 years with mild AIS ( Cobb angle of < 50 ° ) . INTERVENTIONS The r and omised study allocated participants to st and ard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan . Our choice of intervention was informed by a systematic review of exercise interventions for AIS . MAIN OUTCOME MEASURES The main outcome was feasibility of recruitment to the r and omised study . Other elements were to inform choice of outcomes for a definitive trial and included curve severity , quality of life , requirement for surgery/brace , adverse events , psychological symptoms , costs and health utilities . RESULTS A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services . It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study . A systematic review up date found five new studies that were generally of low quality but showed some promise of effectiveness of SSE . The r and omised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month , with acceptable 6-month follow-up ( currently 73 % ) . Adherence to treatment was variable ( 56 % of participants completed treatment offered ) . The qualitative study found the exercise programme to be highly acceptable . We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation , as well as practical elements such as scheduling of intervention sessions . CONCLUSIONS A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible . Such a RCT is a priority for future work in the area . There is a sufficiently large patient base , combined with willingness to be r and omised within specialist UK centres . Interventions developed during the feasibility study were acceptable to patients , families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning . TRIAL REGISTRATION Current Controlled Trials IS RCT N90480705 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 55 . See the NIHR Journals Library website for further project information BACKGROUND CONTEXT Three-dimensional ( 3D ) deformations of the spine are predominantly characterized by two-dimensional ( 2D ) angulation measurements in coronal and sagittal planes , using anteroposterior and lateral X-ray images . For coronal curves , a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice , and these methods have been shown to exhibit good-to-excellent reliability and reproducibility , carried out either manually or by computer-based tools . Recently , an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column . PURPOSE Comparison of accuracy , correlation of measurement values , intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting . STUDY DESIGN / SETTING Retrospective nonr and omized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009 . PATIENT SAMPLE In total , 201 individuals ( 170 females , 31 males ; mean age , 19.88 years ) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis ( 175 cases ) , adult degenerative scoliosis ( 11 cases ) , and Scheuermann hyperkyphosis ( 5 cases ) .  Overall range of coronal curves was between 2.4 ° and 117.5 ° . Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation : 0 ° to 10 ° ( Group 1 , n=36 ) , 10 ° to 25 ° ( Group 2 , n=25 ) , 25 ° to 50 ° ( Group 3 , n=69 ) , 50 ° to 75 ° ( Group 4 , n=49 ) , and more than 75 ° ( Group 5 , n=22 ) . METHODS Coronal and sagittal curvature measurements were determined by three experienced examiners , using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions . Manual measurements were performed three times , and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner . Means comparison t test , Pearson bivariate correlation analysis , reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software ( IBM Corp. , Armonk , NY , USA ) . No funds were received in support of this work . No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article . RESULTS In comparison with manual 2D methods , only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data . Intraobserver reliability was excellent for both methods , and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations . CONCLUSIONS This is the first clinical report on EOS 2D/3D system ( EOS Imaging , Paris , France ) and its sterEOS 3D software , documenting an excellent capability for accurate , reliable , and reproducible spinal curvature measurements BACKGROUND Idiopathic adolescent scoliosis ( AIS ) causes not only spinal deformities but rib cage abnormalities that lead to abnormal volumes and pulmonary capacity on pulmonary function testing ( PFT ) . The objective of this study was to analyze the impact of a physical rehabilitation program on respiratory function in surgical patients with AIS . METHODS From October 2003 to October 2004 , a total of 34 patients ( age range , 10 to 18 years ) presenting with AIS and a thoracic curvature between 45 degrees and 88 degrees were studied prospect ively at a tertiary academic hospital . The patients underwent clinical and radiographic evaluations of the  vertebral deformity , chest radiographs , PFT , evaluation of peak expiratory flow , and 6-min walk tests ( 6MWTs ) before and after joining a physical rehabilitation program for 4 months . RESULTS An improvement in FVC , inspiratory capacity , FEV(1 ) , expiratory reserve volume , and performance assessed by 6MWT were observed after rehabilitation . CONCLUSIONS Global conditioning improved after the rehabilitation program . This was expressed by both PFT and 6MWT results The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis ( AIS ) was investigated . Sixteen ( 16 ) AIS patients with progressing or high-risk curves ( Cobb 's angle between 25 ° and 35 ° at start and reducible by lateral bending ) were fitted with a device with tone alarm for poor posture . In the first 18 months of application , 3 patients defaulted and 4 showed curve progression > 10 ° ( 2 changed to rigid spinal orthoses and 2 underwent surgery ) . The curves for the other 9 patients were kept under control ( within ±5 ° of Cobb 's angle ) and 5 of them have reached skeletal maturity and terminated the application . The remaining 4 patients were still using the devices until skeletal maturity or curve progression . The curve control rate was 69 % . A long-lasting active spinal control could be achieved through the patient 's own spinal muscles . Nevertheless , before the postural training device could become a treatment modality , a long-term study for more AIS patients was necessary . This project is ongoing in the Duchess of Kent Children 's Hospital , S and y Bay , Hong Kong Study Design . A Cochrane systematic review . Objective . To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments , on quality of life , disability , pulmonary disorders , progression of the curve , psychological , and cosmetic issues . Summary of Background Data . Idiopathic scoliosis is a three-dimensional deformity of the spine . The most common form is diagnosed in adolescence . Although adolescent idiopathic scoliosis ( AIS ) can progress during growth and cause a surface deformity , it is usually not symptomatic . Methods . We search ed CENTRAL , MEDLINE , EMBASE , five other data bases , and two trials registers up to February 2015 . We also checked reference lists and h and search ed grey literature . R and omized controlled trials ( RCTs ) and prospect i ve controlled cohort studies comparing braces with no treatment , other treatment , surgery , and different types of braces for adolescent with AIS . We used st and ard method ological procedures expected by the Cochrane Collaboration . Results . We included seven studies . Five were planned as RCTs , two as prospect i ve controlled clinical trials . One RCT failed completely , another was continued as an observational study . There was very low quality evidence from one small RCT that quality of life ( QoL ) during treatment did not differ significantly between rigid bracing and observation . Conclusion . Two studies showed that bracing did not change QoL during treatment , and QoL , back pain psychological and cosmetic issues in the long term ( 16 years . ) All articles showed that bracing prevented curve progression . The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject r and omization of their children . Level of Evidence : Study Design . Clinical prospect i ve , r and om study . Objective . Analyze the results of the six-minute walk test ( 6MWT ) in patients with adolescent idiopathic scoliosis . Summary of Background Data . Although it is widely believed that Adolescent Idiopathic Scoliosis ( AIS ) causes cardiorespiratory dysfunctions , there is no report in literature of objective measurements of this restriction in the ventilatory performance during physical exertion . Methods . One hundred twenty-six adolescents matched by gender and age were prospect ively studied at a tertiary teaching institution : 40 patients without spine deformities ( group I – controls ) , and 86 patients with AIS with a spine curve ranging from 45 ° to 138 ° ( group II ) . All patients underwent radiographic evaluations and the 6MWT . Results . Normal controls presented significantly lower mean heart rate and Borg scores , as well as higher oxygen saturation and walked longer distances on the 6MWT . Conclusion . The 6MWT effectively demonstrated the cardiorespiratory restrictions presented by patients with AIS Study Design . A consecutive series of patients with adolescent idiopathic scoliosis ( AIS ) , treated between 1968 and 1977 before 21 years of age with either distraction and fusion using Harrington rods ( ST , n = 156 ; 145 females and 11 males ) or with brace ( BT , n = 127 ; 122 females and 5 males ) , were followed at least 20 years after completion of the treatment . Objectives . To determine the long-term outcome in terms of spinal mobility and muscle strength and its possible correlations to present back pain and function in patients surgically or brace treated for AIS . Summary of Background Data . Few reports on long-term outcome on these variables have previously been presented for this group of patients . Methods . A total of 135 ( 87 % ) of ST and 102 ( 80 % ) of BT patients underwent a complete examination by two unbiased observers incl . evaluation of lumbar muscle endurance and spinal mobility , curve size ( Cobb method ) , vali date d question naires in terms of general and disease-specific quality of life aspects , as well as present back function and pain . An age- and sex-matched control group of 100 persons was r and omly selected and subjected to the same examinations . Results . For both ST and BT groups , lumbar spinal motion as well as muscle endurance were significantly decreased compared with controls . For ST patients , better lumbar extensor and flexor muscle endurance or lumbar spinal mobility correlated with a better physical function . The length of fusion into the lumbar spine correlated inversely with lumbar range of motion , but the finger-floor distance was not affected . BT patients with reduced lumbar spinal mobility experienced lumbar back pain more often than controls . Conclusions . For both brace treated and surgically treated AIS patients , spinal mobility and muscle endurance were reduced more than 20 years after completed treatment . The physical function was not severely restricted Background Recently an RCT confirmed brace efficacy in adolescent idiopathic scoliosis ( AIS ) patients . Previously , a Cochrane review suggested also producing studies according to the Scoliosis Research Society ( SRS ) criteria on the effectiveness of bracing for AIS . Even if the SRS criteria propose a prospect i ve design , until now only one out of 6 published studies was prospect i ve . Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment ( SOSORT ) criteria for AIS conservative treatment . Methods Study design / setting : prospect i ve cohort study nested in a clinical data base of all out patients of a clinic specialized in scoliosis conservative treatment . Patient sample : seventy-three patients ( 60 females ) , age 12 years 10 months ±17 months , 34.4±4.4 Cobb degrees , who satisfied SRS criteria were included out of 3,883 patients at first evaluation . Outcome measures : Cobb angle at the end of treatment according to SRS criteria : ( unchanged ; worsened 6 ° or more , over 45 ° and surgically treated , and rate of improvement of 6 ° or more).Braces were prescribed for 18–23 hours/day according to curves magnitude and actual international guidelines . Weaning was gradual after Risser 3 . All patients performed exercises and were managed according to SOSORT criteria . Results in all patients were analyzed according to intent-to-treat at the end of the treatment . Funding and Conflict of Interest : no. Results Overall 34 patients ( 52.3 % ) improved . Seven patients ( 9.6 % ) worsened , of which 1 patient progressed beyond 45 ° and was fused . Referred compliance was assessed during a mean period of 3 years 4 months ±20 months ; the median adherence was 99.1 % ( range 22.2 - 109.2 % ) . Employing intent-to-treat analysis , there were failures in 11 patients ( 15.1 % ) . At start , these patients had statistically significant low BMI and kyphosis , high thoracic rotation and higher Cobb angles . Drop-outs showed reduced compliance and years of treatment ; their average scoliosis at discontinuation was low : 22.7 ° ( range 16 - 35 ° ) at Risser 1.3 ± 1 . Conclusions Bracing in patients with AIS who satisfy SRS criteria is effective . Combining bracing with exercise according to SOSORT criteria shows better results than the current literature BACKGROUND CONTEXT Evidence demonstrating the biomechanical effects of the Hueter-Volkmann principle on vertebral body growth in spinal deformities is lacking . Bracing a scoliotic curve should , in theory , unload the growth plates on the concave side of the vertebral bodies near the curve 's apex . Growth stimulation , leading to structural remodeling of the vertebral bodies , on the curve 's concave side may explain the improvement or lack of curve progression , as measured by Cobb angles , reported with successful brace management of adolescent idiopathic scoliosis ( AIS ) . PURPOSE To determine whether brace treatment stimulated asymmetric chondrogenesis in the apical three vertebral bodies . STUDY DESIGN A prospect i ve cohort of patients with AIS receiving brace treatment were followed from the initiation of brace treatment until skeletal maturity . Patients were then retrospectively divided into those with and without radiographic progression . This post hoc analysis was included to determine risk factors for curve progression . PATIENT SAMPLE Forty-one skeletally immature patients with AIS meeting criteria for brace treatment were followed until skeletal maturity . All patients were treated with thoracolumbosacral orthotics ( TLSOs ) . OUTCOME MEASURES The positional derotation of the TLSO on the spine was measured by comparing the initial radiograph with the first radiograph in a brace . The long-term structural changes of the vertebral bodies were determined by comparing the initial and final radiographs . Differences in initial radiographic parameters between the groups of patients with AIS with and without curve progression indicated predictive factors for successful brace treatment . METHODS Initial radiographic measurements were compared with those observed in a brace and those observed at final follow-up . The same analysis was retrospectively repeated comparing patients with AIS with and without radiographic progression . RESULTS Cobb measurements ( p=.0001 ) and concave-to-convex height ratios of the apical three vertebral bodies improved when the brace was initially applied ( p=.0035 ) . Structural remodeling or a rotational correction of the apical three vertebral bodies was appreciated only in patients with flexible curves ( p=.01 ) . CONCLUSION Brace application results in immediate positional derotations of the spine in patients with AIS . These positional derotations were maintained only in patients with flexible curves , at final follow-up . Brace treatment was not recommended in patients whose curves did not correct at least 20 % in a TLSO Study Design . Prospect i ve , sequential enrollment . Objective . We report the development and testing of the Spinal Appearance Question naire ( SAQ ) for reliability , validity , and responsiveness in patients with idiopathic scoliosis . Summary of Background Data . The SAQ was design ed to measure patients ’ and their parents ’ perception of their spinal deformity ’s appearance using st and ardized drawings and questions . This study was design ed to test the instrument ’s psychometric properties . Methods . The SAQ was administered as a test-retest to idiopathic scoliosis patients and parents for reliability and initial validity assessment ( Group I ) . It was then administered to patients before surgery and 1 year after surgery ( Group II ) for responsiveness and further validity testing . Finally , both the SAQ and SRS instruments were administered to adolescent idiopathic patients before surgery and 1 year after surgery ( Group III ) for comparison of the 2 instruments . Results . Group I : The individual scale items had good to excellent reliability ( Spearman ’s rho , 0.57–0.99 ) and high internal scale consistency ( Cronbach ’s alpha > 0.7 ) . The mean scale scores differentiated between curves greater than 30 ° and lesser curves ( P < 0.01 ) . Surgery improved scores compared with those with “ surgery recommended . ” Group II : The domains correlated with clinical and radiographic aspects of the deformity before surgery . All of the domains showed significant difference after surgery ( P < 0.0001 ) and large effect size for all domains except for the patient chest domain . Group III : Both the SAQ and the SRS instruments had significant improvement in all of their domains except for the SRS Activity scale . The relative efficiency of the SAQ domains to the SRS appearance domain ( the most responsive SRS domain ) was greater for 5 SAQ domains . Conclusion . The SAQ is reliable , responsive to curve improvement , and shows strong evidence of validity . It provides more detail than the SRS in the appearance domain , and provides explanation of spinal deformity ’s concerns and improvements Purpose To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life ( HRQL ) in patients with mild adolescent idiopathic scoliosis ( AIS ) ( Cobb angle < 25 ° ) . Methods This was a parallel-group , r and omised , superiority-controlled study in which 110 patients were r and omly assigned to a rehabilitation programme consisting of active self-correction , task-oriented spinal exercises and education ( experimental group , 55 subjects ) or traditional spinal exercises ( control group , 55 subjects ) . Before treatment , at the end of treatment ( analysis at skeletal maturity ) , and 12 months later ( follow-up ) , all of the patients underwent radiological deformity ( Cobb angle ) , surface deformity ( angle of trunk rotation ) and HRQL evaluations ( SRS-22 question naire ) . A linear mixed model for repeated measures was used for each outcome measure . Results There were main effects of time ( p < 0.001 ) , group ( p < 0.001 ) and time by group interaction ( p < 0.001 ) on radiological deformity : training in the experimental group led to a significant improvement ( decrease in Cobb angle of > 5 ° ) , whereas the control group remained stable . Analysis of all of the secondary outcome measures revealed significant effects of time , group and time by group interaction in favour of the experimental group . Conclusions The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS . The effects lasted for at least 1 year after the intervention ended OBJECTIVE To determine overall , test-retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis . DESIGN A reliability study using two raters and two test sessions . SETTING Tertiary care paediatric centre . PARTICIPANTS Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis ( Cobb angle 15 to 60 ° ) were recruited from the scoliosis clinic . MAIN OUTCOME MEASURES Based on the XY co-ordinates of natural reference points ( e.g. , eyes ) as well as markers placed on several anatomical l and marks ,  32 angular and linear posture indices taken from digital photographs in the st and ing position were calculated from a specially developed software program . Generalisability theory served to estimate the reliability and st and ard error of measurement ( SEM ) for the overall , test-retest and inter-rater design s. Bl and and Altman 's method was also used to document agreement between sessions and raters . RESULTS In the r and om design , dependability coefficients demonstrated a moderate level of reliability for six posture indices ( ϕ=0.51 to 0.72 ) and a good level of reliability for 26 posture indices out of 32 ( ϕ≥0.79 ) . Error attributable to marker placement was negligible for most indices . Limits of agreement and SEM values were larger for shoulder protraction , trunk list , Q angle , cervical lordosis and scoliosis angles . The most reproducible indices were waist angles and knee valgus and varus . CONCLUSIONS Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis . Despite the good reliability of marker placement , other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time The aim of this study is to test the hypothesis that physiotherapy-based intervention can reduce incidence of progression in children with IS because progression of spinal curvature in patients with idiopathic scoliosis ( IS ) is of paramount concern in treatment strategies . Follow-up of the outcome of two prospect i ve studies using the outcome parameter , incidence of progression ( > or = 5 degrees ) , in treated and untreated patient groups matched by age , sex , and degree of curvature at diagnosis . A six-week scoliosis in-patient rehabilitation ( SIR ) program offering patient-specific physiotherapy including intensive therapist-assisted exercise in diagnosis-matched groups . A followup home therapy regime is design ed for each patient . Incidence of progression in groups of untreated patients ranged from 1.5-fold ( 71.2 % vs 46.7 % ) to 2.9-fold ( 55.8 % vs 19.2 % ) higher than in groups of patients treated with SIR , even when SIR-treated groups included patients with more severe curvatures . Statistically , the differences were highly significant . Postural imbalance is a component of spinal curvature and can be a causative mechanism . However , efforts to test the hypothesis that physical therapies addressing postural imbalance can be used effectively in the treatment of IS have been limited . The results of this study indicate that a supervised program of exercise-based therapies can reduce incidence of progression in children with IS This is a prospect i ve study to establish prediction models that map the refined Scoliosis Research Society 22-item ( SRS-22r ) onto EuroQoL-5 dimension 5-level ( EQ-5D-5L ) utility scores in adolescent idiopathic scoliosis ( AIS ) patients . Comparison of treatment outcomes in AIS can be determined by cost-utility analysis . However , the mainstay spine-specific health-related quality of life outcome measure , the SRS-22r question naire does not provide utility assessment . In this study , AIS patients were prospect ively recruited to complete both the EQ-5D-5L and SRS-22r question naires by trained interviewers . Ordinary least squares regression was undertaken to develop mapping models , which the validity and robustness were assessed by using the 10-fold cross-validation procedure .  EQ-5D-5L utility scores were regressed on demographics , Cobb angle , curve types , treatment modalities , and five domains of the SRS-22r question naire . Three models were developed using stepwise selection method . EQ-5D-5L scores were regressed on 1 ) main effects of SRS-22r subscale scores , 2 ) as per 1 plus squared and interaction terms , and 3 ) as per 2 plus demographic and clinical characteristics . Model goodness-of-fit was assessed using R-square , adjusted R-square , and information criteria ; whereas the predictive performance was evaluated using root mean square error ( RMSE ) , mean absolute error ( MAE ) , and the proportion of absolute error within the threshold of 0.05 and 0.10 . A total of 227 AIS patients with mean age of 15.6 years were recruited . The EQ-5D-5L scores were predicted by four domains of SRS-22r ( main effects of ‘ Function ’ , ‘ Pain ’ , ‘ Appearance ’ and ‘ Mental Health ’ , and squared term of ‘ Function ’ and ‘ Pain ’ ) , and Cobb angle in Model 3 with the best goodness-of-fit ( R-square/adjusted R-square : 62.1%/60.9 % ) . Three models demonstrated an acceptance predictive performance in error analysis applying 10-fold cross-validation to three models where RMSE and MAE were between 0.063–0.065 and between 0.039–0.044 , respectively . Model 3 was therefore recommended out of three mapping models established in this paper . To our knowledge , this is the first study to map a spine-specific health-related quality of life measure onto EQ-5D-5L for AIS patients . With the consideration and incorporation of demographic and clinical characteristics , over 60 % variance explained by mapping model 3 enabled the satisfactory prediction of EQ-5D-5L utility scores from existing SRS-22r data for health economic appraisal of different treatment options There is an increasing awareness of the risks and dangers of exposure to radiation associated with repeated radiographic assessment of spinal curvature and spinal movements . As such , attempts are continuously being made to develop skin-surface devices for use in examining the progression and response to treatment of various spinal disorders . However , the reliability and validity of measurements recorded with such devices must be established before they can be recommended for use in the research or clinical environment . The aim of this study was to examine the reliability of measurements using a newly developed skin-surface device , the Spinal Mouse .  Twenty healthy volunteers ( mean age 41±12 years , nine males , 11 females ) took part . On 2 separate days , spinal curvature was measured with the Spinal Mouse during st and ing , full flexion , and full extension ( each three times by each of two examiners ) . Paired t-tests , intraclass correlation coefficients ( ICC ) , and st and ard errors of measurement ( SEM ) with 95 % confidence intervals were used to characterise between-day and interexaminer reliability for : st and ing sacral angle , lumbar lordosis , thoracic kyphosis , and ranges of motion ( flexion , extension ) of the thoracic spine , lumbar spine , hips , and trunk . The between-day reliability for segmental ranges of flexion was also determined for each motion segment from T1 - 2 to L5-S1 . The majority of parameters measured for the ‘ global regions ’ ( thoracic , lumbar , or hips ) showed good between-day reliability . Depending on the parameter of interest , between-day ICCs ranged from 0.67 to 0.92 for examiner 1 ( average 0.82 ) and 0.57 to 0.95 for examiner 2 ( average 0.83 ) ; for 70 % of the parameters measured , the ICCs were greater than 0.8 and generally highest for the lumbar spine and whole trunk measures . For lumbar spine range of flexion , the SEM was approximately 3 ° . The ICCs were also good for the interexaminer comparisons , ranging from 0.62 to 0.93 on day 1 ( average 0.81 ) and 0.70 to 0.94 on day 2 ( average 0.86 ) , although small systematic differences were sometimes observed in their mean values . The latter were still evident even if both examiners used the same skin markings . For segmental ranges of flexion , the ICCs varied between vertebral levels but overall were lower than for the global measures ( average for all levels in all analyses , ICC 0.6 ) . For each examiner , the average between-day SEM over all vertebral levels was approximately 2 ° . For ‘ global ’ regions of the spine , the Spinal Mouse delivered consistently reliable values for st and ing curvatures and ranges of motion which compared well with those reported in the literature . This suggests that the device can be reliably implemented for in vivo studies of the sagittal profile and range of motion of the spine . As might be expected for the smaller angles being measured , the segmental ranges of flexion showed lower reliability . Their usefulness with regard to the interpretation of individual results and the detection of ‘ real change ’ on an individual basis thus remains question able . Nonetheless , the group mean values showed few between-day differences , suggesting that the device may still be of use in providing clinical ly interesting data on segmental motion when examining groups of individuals with a given spinal pathology or undergoing some type of intervention PURPOSE The purpose of this study was to investigate the reliability of photogrammetry in the measurement of the postural deviations in individuals with idiopathic scoliosis . METHODS Twenty participants with scoliosis ( 17 women and three men ) , with a mean age of 23.1 ± 9 yrs , were photographed from the posterior and lateral views . The postural aspects were measured with CorelDRAW software . RESULTS High inter-rater and test-retest reliability indices were found . It was observed that with more severity of scoliosis , greater were the variations between the thoracic kyphosis and lumbar lordosis measures obtained by the same examiner from the left lateral view photographs . A greater body mass index ( BMI ) was associated with greater variability of the trunk rotation measures obtained by two independent examiners from the right , lateral view ( r = 0.656 ; p = 0.002 ) . The severity of scoliosis was also associated with greater inter-rater variability measures of trunk rotation obtained from the left , lateral view ( r = 0.483 ; p = 0.036 ) . CONCLUSIONS Photogrammetry demonstrated to be a reliable method for the measurement of postural deviations from the posterior and lateral views of individuals with idiopathic scoliosis and could be complementarily employed for the assessment procedures , which could reduce the number of X-rays used for the follow-up assessment s of these individuals INTRODUCTION The promising results of Schroth scoliosis-specific exercises for adolescent idiopathic scoliosis found in low- quality studies will be strengthened by confirmation in a r and omised controlled trial . RESEARCH QUESTIONS 1 . Are Schroth exercises combined with st and ard care for 6 months more effective than st and ard care alone in improving radiographic and clinical outcomes for adolescents with idiopathic scoliosis ? 2 . Will the outcomes of the control group ( who will be offered Schroth therapy delayed by 6 months ) improve after 6 months of Schroth therapy ? 3 . Are the effects maintained 6 months after discontinuing the supervised intervention ? DESIGN This is an assessor-blinded and statistician-blinded r and omised controlled trial with transfer of the controls to the exercise group after 6 months . PARTICIPANTS AND SETTING Two hundred and fifty-eight consecutive adolescents with idiopathic scoliosis , aged 10 to 16 years , treated with or without a brace , with curves between 10 and 45 deg Cobb and Risser sign ≤ 3 will be recruited from three scoliosis clinics . INTERVENTION Combined with st and ard care , the Schroth group will receive five individual training sessions , followed by weekly group classes and daily home exercises for 6 months . CONTROL Controls will only receive st and ard care consisting of observation or bracing , and will be offered Schroth therapy 6 months later . MEASUREMENTS Curve severity ( Cobb angle ) and vertebral rotation will be assessed from radiographs at baseline , 6 and 12 months . Secondary clinical outcomes ( back muscle endurance , surface topography measures of posture , and self-reported perceived spinal appearance and quality of life ) will be assessed at baseline , and every 3 months until 1-year follow-up . ANALYSIS Data will be analysed using intention-to-treat linear mixed models . DISCUSSION The results will demonstrate whether Schroth exercises combined with st and ard of care  can improve outcomes in adolescents with idiopathic scoliosis . This study has potential to influence clinical practice worldwide , where exercises are not routinely prescribed for adolescents with idiopathic scoliosis Patients with adolescent idiopathic scoliosis ( AIS ) have lower potential for physical activity because of lung dysfunction and lower muscle strength , which can be reversed by the cardiorespiratory and musculoskeletal conditioning provided by st and ardized physical activities . We conducted a study to determine if a preoperative protocol of aerobic exercise would improve quality of life ( QoL ) both before and after training and if there would be any differences between patients who received the therapy and those who did not . Patients with the indication of surgical correction of AIS were r and omized to receive or not receive a 4-month preoperative course of aerobic physical training . At baseline and after 4 months , they were evaluated with the Short Form-36 question naire ( SF-36 ) . QoL scores improved for the study group but did not change for the control group . In all QoL domains , the study group 's mean score increased significantly between baseline and 4 months . We concluded that the proposed preoperative physical therapy protocol improved the QoL of patients with AIS Background Screening tests play a significant role in rapid and reliable assessment of normal individual development in the entire population of children and adolescents . Body posture screening tests carried out at schools reveal that 50 - 60 % of children and adolescents demonstrate body posture abnormalities , with 10 % of this group at risk for progressive spinal deformities . This necessitates the search for effective and economically feasible forms of screening diagnosis . The aim of this study was to assess the reliability of clinical evaluation of body posture compared to objective assessment with the Zebris CMS-10 system ( Zebris Medical GmbH ) . Methods The study enrolled 13 - 15-year-old pupils attending a junior secondary school ( mean age 14.2 years ) . The study group consisted of 138 participants , including 71 girls and 67 boys , who underwent a clinical evaluation of the body posture and an examination with the Zebris CMS 10 system .  Results Statistically significant discrepancies between the clinical and objective evaluation were noted with regard to lumbar lordosis in boys ( n = 67 ) and thoracic kyphosis in girls ( n = 71 ) . No statistically significant differences in both groups were noted for pelvic rotation and trunk position in the frontal plane . Conclusions 1 . The finding of significant discrepancies between the results of assessment in the sagittal plane obtained in the clinical examination and Zebris CMS-10-based assessment suggests that clinical evaluation should be used to provide a general estimation of accentuation or reduction of spinal curvatures in the sagittal plane.2 . The clinical evaluation of posture is reliable with regard to assessment in the frontal plane.3 . The Zebris CMS-10 system makes the clinical examination significantly more objective with regard to assessment of the physiological curvatures and may be used to make screening tests more objective with regard to detecting postural defects Background Adolescent idiopathic scoliosis ( AIS ) remains the most common deforming orthopedic condition in children . Increasingly , both adults and children are seeking complementary and alternative therapy , including chiropractic treatment , for a wide variety of health concerns . The scientific evidence supporting the use chiropractic intervention is inadequate . The purpose of this study was to conduct a pilot study and explore issues of safety , patient recruitment and compliance , treatment st and ardization , sham treatment refinement , inter-professional cooperation , quality assurance , and outcome measure selection . Methods Six patients participated in this 6-month study , 5 of whom were female . One female was braced . The mean age of these patients was 14 years , and the mean Cobb angle was 22.2 degrees . The study design was a r and omized controlled clinical trial with two independent and blinded observers . Three patients were treated by st and ard medical care ( observation or brace treatment ) , two were treated with st and ard medical care plus chiropractic manipulation , and one was treated with st and ard medical care plus sham manipulation . The primary outcome measure was Cobb , and the psychosocial measure was Scoliosis Quality of Life Index . Results Orthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial . Patient recruitment and compliance was good . Chiropractic treatments were safely employed , and research protocol s were successful . Conclusion Overall , our pilot study showed the viability for a larger r and omized trial . This pilot confirms the strength of existing protocol s with amendments for use in a full r and omized controlled trial . Trial registration This trial has been assigned an international st and ard r and omized controlled trial number by Current Controlled Trials , Ltd. http://www.controlled-trials.com/is rct n/. The number is IS RCT N41221647 BACKGROUND The complex skeletal deformations that accompany Idioapthic Scoliosis pose a challenge to the clinician to non-invasively discriminate Idiopathic Scoliosis patients from children with no pathology . Therefore , the focus of this study is to non-invasively evaluate the position and amplitude of displacement of the pelvis , shoulders and thorax during quiet st and ing of Idiopathic Scoliosis patients and control subjects . METHODS The quiet st and ing posture of 18 healthy adolescent females and 22 Idiopathic Scoliosis subjects was evaluated using an Optotrak 3020 position sensor over a period of 120 s , with 4 repeat trials . Outcome measures included the mean position , root mean square amplitude and range over the duration of 120 s trials for both linear and angular measures of the pelvis , thorax and shoulders . Appropriate sample times were chosen and evaluated for stability over the 120 s period , and between trial reliability was evaluated . FINDINGS There was a significant difference between groups for the mean position of the shoulder blade rotation in reference to the base of support and to the pelvis . The Idiopathic Scoliosis patients had a significantly larger root mean square amplitude of anterior-posterior displacement of the T1 and S1 spinous processes in reference to the base of support . There was no difference between the sample duration s to estimate the mean position of the body segments , however the root mean square increased significantly . INTERPRETATION This study demonstrates that postural abnormalities are evident during quiet st and ing in Idiopathic Scoliosis patients Objective : To compare the efficacy of three-dimensional ( 3D ) Schroth exercises in patients with adolescent idiopathic scoliosis . Design : A r and omised-controlled study . Setting : An outpatient exercise-unit and in a home setting . Subjects : Fifty-one patients with adolescent idiopathic scoliosis . Interventions : Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups . Schroth ’s 3D exercises were applied to the first group in the clinic and were given as a home program for the second group ; the third group was the control . Main Measures : Scoliosis angle ( Cobb method ) , angle of rotation ( scoliometer ) , waist asymmetry ( waist – elbow distance ) , maximum hump height of the patients and quality of life ( QoL ) ( SRS-23 ) were assessed pre-treatment and , at the 6th , 12th and 24th weeks . Results : The Cobb ( -2.53 ° ; P=0.003 ) and rotation angles ( -4.23 ° ; P=0.000 ) significantly decreased , which indicated an improvement in the clinic exercise group compared to the other groups . The gibbosity ( -68.66 mm ; P=0.000 ) and waist asymmetry improved only in the clinic exercise group , whereas the results of the other groups worsened . QoL did not change significantly in either group . Conclusion : According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups ; additionally , we observed that scoliosis progressed in the control group , which received no treatment The objective of this study is to compare the clinical and radiographic results of ultraporous β-tricalcium phosphate ( β-TCP ) versus autogenous iliac crest bone graft ( ICBG ) , through prospect i ve r and omized pilot study ( EBM-Level 1 ) , as graft extenders in scoliosis surgery . In the posterior correction of scoliosis , local bone resected as part of the procedure is used as the base bone graft material . Supplemental grafting from the iliac crest is considered the gold-st and ard in posterior spinal fusion . However , autograft is not available in unlimited quantities , and bone harvesting is a source of significant morbidity . Ultraporous β-TCP might be a substitute for ICBG in these patients and thus eliminate donor site morbidity . A total of 40 patients with adolescent idiopathic scoliosis ( AIS ) were r and omized into two treatment groups and underwent corrective posterior instrumentation . In 20 patients , ICBG harvesting was performed whereas the other half received β-TCP ( VITOSS ® ) to augment the local bone graft . If thoracoplasty was performed , the resected rib bone was added in both groups . Patients were observed clinical ly and radiographically for a minimum of 20 months postoperatively , with a mean follow-up of 4 years . Overall pain and pain specific to the back and donor site were assessed using a visual analog scale ( VAS ) . As a result , both groups were comparable with respect to the age at the time of surgery , gender ratio , preoperative deformity , and hence length of instrumentation . There was no significant difference in blood loss and operative time . In nine patients of the β-TCP group and eight patients of the ICBG group , thoracoplasty was performed result ing in a rib graft of on average 7.9 g in both groups . Average curve correction was 61.7 % in the β-TCP group and 61.2 % in the ICBG group at hospital discharge ( P = 0.313 ) and 57.2 and 54.3 % , respectively , at follow-up ( P = 0.109 ) . Loss of curve correction amounted on average 2.6 ° in the β-TCP group and 4.2 ° in the comparison group ( P = 0.033 ) . In the ICBG group , four patients still reported donor site pain of on average 2/10 on the VAS at last follow-up . One patient in the β-TCP group was diagnosed with a pseudarthrosis at the caudal end of the instrumentation . Revision surgery demonstrated solid bone formation directly above the pseudarthrosis with no histological evidence of β-TCP in the biopsy taken . In conclusion , the use of β-TCP instead of ICBG as extenders of local bone graft yielded equivalent results in the posterior correction of AIS . The promising early results of this pilot study support that β-TCP appears to be an effective bone substitute in scoliosis surgery avoiding harvesting of pelvic bone and the associated morbidity
iPhone measurements correlated well with scoliometer measurements .
2D photography results had a moderate to high correlation with 3D topography results .
Conclusions Overall , strong levels of evidence exist for iPhone and scoliometer measurements , with a high to very high reliability and moderate to very high validity .
Limited evidence exists for aesthetic tools TRACE and AI and 2D photography .
These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy setting s to assess postural asymmetry ; however , these only exist for measurement in the transverse plane , despite 3D characteristics of AIS .
Abstract Purpose As accurate and reproducible measurements of spinal curvature are crucial in the examination of patients with adolescent idiopathic scoliosis ( AIS ) , this systematic review aims to report on the reliability and validity of a range of inexpensive and easily administered anthropometric methods of postural asymmetry measurement in an AIS population , to inform practice in a clinical setting .