Radiographic measurement error of the scoliotic curve angle depending on positioning of the patient and the side of scoliotic curve.

BACKGROUND: The Cobb angle measurement is well established for the measurement of coronal deformity aspect of scoliotic curves. The effect of positional differences in relation to the apex side of the scoliosis is not yet fully quantified. While theoretically plausible that positioning error with rotation toward the apex of the scoliosis would decrease the Cobb angle, the relations are not investigated yet and were object of this study. MATERIALS AND METHODS: Multiple measurements of the Cobb angle were performed, while turning a spine-pelvic cadaveric specimen with a right-sided thoracic scoliosis of 47° (in neutral position) from 45° to -45° in steps of 5° using biplanar radiography. Statistical methods were applied to find the critical position, in which measurement errors potentially become clinically relevant (Cobb angle deviation >5°). RESULTS: Turning the specimen to the right (toward the apex of the scoliosis) produced during the first -15° of rotation, a Cobb angle ranging from 47° to 45°. At -20°, the Cobb angle was 42°, at -25° rotation 37° and at -30° rotation 36°. Above -30° rotation, the measured Cobb angle decreased to 36° (77 % of the original Cobb angle). No relevant differences were found by rotating the specimen to the left (away from the apex) (47° at neutral rotation and 44° at maximal error rotation of +45°). CONCLUSION: The influence of rotational misplacement of the patient at the time of image acquisition on Cobb angle measurements is negligible for a rotational misplacement of ±20° of rotation for a idiopathic right-sided thoracic scoliosis of 47°. Over 20° of rotational misplacement of the patient toward the apex of the scoliosis falsely decreases the Cobb angle.

Concordance of qualitative bone scintigraphy results with presence of clinical complex regional pain syndrome 1: meta-analysis of test accuracy studies.

BACKGROUND: To date, no attempt has been made to investigate the agreement between qualitative bone scintigraphy (BS) and the presence of complex regional pain syndrome 1 (CRPS 1) and the agreement between a negative BS in the absence of CRPS 1. AIMS: To summarize the existing evidence quantifying the concordance of qualitative BS in the presence or absence of clinical CRPS 1. DATA SOURCES: We searched Medline, Embase, Dare and the Cochrane Library and screened bibliographies of all included studies. STUDY ELIGIBILITY CRITERIA: We selected diagnostic studies investigating the association between qualitative BS results and the clinical diagnosis of CRPS 1. The minimum requirement for inclusion was enough information to fill the two-by-two tables. RESULTS: Twelve studies met our inclusion criteria and were included in the meta-analysis. The pooled mean sensitivity of 12 two-by-two tables was 0.87 (95% CI, 0.68-0.97) and specificity was 0.69 (95% CI, 0.47-0.85). The pooled mean sensitivity for the subgroup with clearly defined diagnostic criteria (seven two-by-two tables) was 0.80 (95% CI, 0.44-0.95) and specificity was 0.73 (95% CI, 0.40-0.91). CONCLUSIONS: Based on this study, clinicians must be advised that a positive BS is not necessarily concordant with presence of absence or CRPS 1. Given the moderate level of concordance between a positive BS in the absence of clinical CRPS 1, discordant results potentially impede the diagnosis of CRPS 1.

Child adjustment as related to financial security and employment status of fathers with spinal cord injuries.

Many rehabilitation professionals have expressed concern about the effects that socioeconomic changes associated with disability in a parent have on children's adjustment. It has been speculated that financial insecurity and unemployment among fathers with disabilities adversely affect child development, because of the presumed consequence of reversal in parental roles. This study tested these notions by comparing children whose fathers with spinal cord injuries (SCI) were: (1) receiving ample, secure income vs low income that was not guaranteed, and (2) employed vs unemployed. All subjects were given seven tests measuring personality, values, and interests, which were completed in a standardized order and time period. On 16 demographic indices and more than 150 measures of children's personality, behavior, and attitudes, only 17 were related to the financial resources of fathers with SCI and 11 to their employment status. Contrary to opinions in previous reports, no adverse relationships were found between child adjustment and the financial security or employment status of fathers with SCI. Limitations and implications of the study are discussed.

Child adjustment as related to severity of paternal disability.

Many rehabilitation professionals have speculated that the more severe a parent's physical disability, the more disruptive are the effects on family life and child development. The present study tested this prediction by comparing children of fathers with paraplegia and quadriplegia on measures of personality adjustment, sex role identification, body image, health patterns, athletic interests, interpersonal relationships, parent-child relations, values, and attitudes. Few relationships between severity of paternal disability and child adjustment were found on more than 150 variables of child personality, behavior, and attitudes. When 6 variables showed differences between children of fathers with quadriplegia and paraplegia, there was no evidence of disturbed development in either group.

Personality, behavior, values, and family relations of children of fathers with spinal cord injury.

Many opinions have been expressed about the adverse effects on children of being raised by a parent who is physically disabled, but little research has been done. The present study examined the relationship between spinal cord injury (SCI) in fathers and the subsequent adjustment patterns of their children. Two groups of adult children were studied: 45 children reared from early age by fathers with SCI and a matched control group of 36 children with able-bodied fathers. The 2 groups were compared on psychologic tests assessing areas speculated in the literature to be influenced by parental disability. Although children of fathers with SCI differed from children with able-bodied fathers in some behaviors, values, and attitudes, the data failed to confirm any of the hypothesized relations between parental disability and child development. Children whose fathers had SCI were well-adjusted, emotionally stable persons who had attained normal sex role identities. Health patterns, body image, recreational interests, interpersonal relationships, and family relations were not found to be adversely associated with the disability status of the father. Limitations of the study and implications for rehabilitation, adoption, and court custody issues are discussed.

Issues in replicating the trauma--Stren conversion.

The Trauma--Stren (T-S) conversion procedure was examined at a large state university and the construct related to personality and cognitive process variables. Significantly more respondents reported T-S conversion than in the original studies. Conversion was not significantly correlated with personal variables. The presence of experiences in which an event was reported as simultaneously traumatic and strenful is reported, and the criteria for clearly identifying the conversion phenomenon are questioned.