The "value" of functional independence measure scores.

Functional independence measure (FIM) scores are frequently used as if the various sections are of equal importance and as if the interval between each score is equal. We tested this hypothesis by using marketing research techniques to assess the value to rehabilitation nurses and therapists of four of the six sections. Communication was valued more highly than continence, mobility and self care in that order. The interval between the scores is not equal, with difference between a FIM 2 and 3 being greater than between a FIM 5 and 6. However, when the other difficulties such as interexaminer reliability are considered, these score differences are not great. We concluded that for practical purposes FIM scores may be used as if they were of equal interval spacing, and the scores of the various sections may be added together.

The epidemiology of "schooliosis".

Questionnaires submitted to children subsequent to school screening for scoliosis reveal that 13% of respondents recall being referred to a physician. This rate is considerably higher than the 3% referral rate reported by school health officials. The discrepancy points to misperceptions by students and their parents as a likely cause of "schooliosis, " a condition which brings a flood of normal children into the offices of orthopaedists and pediatricians. Correcting possible communications problems, rather than blaming the screening program, should ease the over-referral phenomenon and allow screening to continue at its present efficient levels.

Pitfalls in the assessment of skeletal immaturity: an anthropologic case study.

Nonoperative treatment protocols in adolescent scoliosis require that growth is still occurring. The open iliac apophyses and vertebral ring apophyses are usually considered evidence that growth remains. Studies of adolescent skeletons are not consistent with this view, and one such example is presented. Of clinical importance is that determinant of immaturity should be based on the secondary sexual characteristics, not roentgenographic shadows.

Decision analysis of treatment choices in the osteochondroses.

Physicians tend to decry the lack of data on which they can make decisions. This is commendable, and all should encourage the pursuit of better data and more precise analysis. But decisions must be made, and each physician must deal with what data are available and evaluate them against all the general uncertainties. Equally important are the values that we place on the outcome of treatment. Much of the disagreement among physicians about treatment protocols involves a difference in values. While this is not necessarily bad, it points to the need to consider explicitly the value we place on a result or the morbidity possibly accompanying that result. In the osteochondroses, consideration of values will protect patients from overzealous treatment. Finally, the formality of a decision process should not necessarily modify a plan of treatment based on fundamentally sound principles, intuition, and anecdotal experience. Regardless of which factors represent the basis for an individual surgeon's selection of a particular approach, evaluation of both desirable and undesirable aspects of each alternative prevents impulsive acceptance of the most recently described, often unproven operation. Salter's aphorism: "The decision is more important than the incision," is particularly applicable in treatment of the osteochondroses.