A New Clinical Tool for Scoliosis Risk Analysis: Scoliosis Tele-Screening Test.

STUDY DESIGN: Methodological, observational clinical study. PURPOSE: This study aimed to develop a virtual screening test to detect scoliosis risk initially by parents without the need for medical visit during the coronavirus disease 2019 pandemic. OVERVIEW OF LITERATURE: The scoliosis screening program has been implemented to early detect scoliosis. Unfortunately, access to health professionals was limited during the pandemic. However, during this time, interest in telemedicine has increased remarkably. Recently, mobile applications related to postural analysis were developed, but none permits evaluation by parents. METHODS: Researchers developed the Scoliosis Tele-Screening Test (STS-Test), which included drawing-based images of body asymmetries, to assess the scoliosis-associated risk factors. The STS-Test was shared on social networks, allowing the parents to evaluate their children. After test completion, the risk score was generated automatically, and children with medium and high risks were then advised for medical consultation for further evaluation. The test accuracy and consistency between the clinician and parents were also analyzed. RESULTS: Of the 865 tested children, 358 (41.4%) consulted clinicians to confirm their STS-Test results. Scoliosis was then confirmed in 91 children (25.4%). The parents were able to detect asymmetry in 50% of the lumbar/thoracolumbar curvatures and 82% of the thoracic curvatures. In addition, the forward bend test revealed favorable agreement between parents and clinicians (r =0.809, p<0.0005). Internal consistency of the esthetic deformities domain in the STS-Test was also excellent (α=0.901). This tool was 94.97% accurate, 83.51% sensitive, and 98.87% specific. CONCLUSIONS: The STS-Test is a new parent-friendly, virtual, cost-effective, result-oriented, and reliable tool for scoliosis screening. It allows parents to actively participate in the early detection of scoliosis by screening their children for the risk of scoliosis periodically without the need to visit the health institution.

Cross-cultural validation of the Italian Spine Youth Quality of Life questionnaire: the ISYQOL international.

BACKGROUND: Adolescent idiopathic scoliosis and its treatments can severely impact health-related quality of life. The Italian Spine Youth Quality of Life (ISYQOL) questionnaire, initially developed in Italian and tested on Italian people, was created to measure quality of life in young persons with spine changes. ISYQOL was created using the Rasch analysis, a modern psychometric technique for questionnaires' assessment and development, which showed that the ordinal scores of the ISYQOL Italian version provide sound quality of life measures. AIM: The current work aims to evaluate the cross-cultural equivalence of the ISYQOL questionnaire in seven different countries. DESIGN: Cross-sectional, international, multi-centre study. SETTING: Outpatient clinic. POPULATION: Five hundred fifty persons with adolescent idiopathic scoliosis from English Canada, French Canada, Greece, Italy, Spain, Poland, and Türkiye. METHODS: The ISYQOL Italian version was translated into six languages with the forward-backwards procedure. The conceptual equivalence of the items' content was verified, and any inconsistency was resolved by consensus. The Rasch analysis was used here to evaluate that ISYQOL translations retained the good measurement properties of the Italian version of the questionnaire. In addition, the Differential Item Functioning (DIF) was checked to assess the psychometric equivalence of the ISYQOL items in patients from different countries. RESULTS: Four items of the translated ISYQOL were dropped from the questionnaire since they did not contribute to measuring due to their poor fit to the model of Rasch. Seven items were affected by DIF for nationality, a finding pointing out that these items do not work the same (i.e. are not equivalent) in the different countries. Thanks to the Rasch analysis, the DIF for nationality was amended, and ISYQOL International was eventually obtained. CONCLUSIONS: ISYQOL International returns interval quality of life measures in people with adolescent idiopathic scoliosis with high cross-cultural equivalence in the tested countries. CLINICAL REHABILITATION IMPACT: Rigorous testing showed that ISYQOL International ordinal scores return quality of life measures cross-culturally equivalent in English and French Canada, Greece, Italy, Spain, Poland, and Türkiye. A new, psychometrically sound patient-reported outcome measure is thus available in rehabilitation medicine to measure health-related quality of life in idiopathic scoliosis.

Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics.

PURPOSE: This retrospective study aimed to present the clinical and radiological features of functional scoliosis due to LLD and LLD concurrent with AIS; it also aimed to define their relationships for differentiating functional scoliosis due to LLD and LLD concurrent with AIS. METHODS: This study was conducted as a single-center retrospective comparative study on 47 scoliosis patients with diagnosed LLD, aged 10-18 years. Cases with a diagnosis of structural LLD were divided into two groups according to the presence or absence of concurrent AIS. Data on demographics and the angle of trunk rotation on a sacral basis (ATRsacrum) were recorded. Limb length was clinically measured with a tape measure and clinical LLD (C-LLD) scoliometer test. Cobb angle, axial rotation, pelvic obliquity, and radiological LLD (R-LLD) were obtained from standing spine radiographs and measured by two blinded orthopedic spine surgeons. RESULTS: The prevalence of LLD was 6.7% in scoliosis patients in our study population. Cobb angle and apical rotation were higher in the LLD concurrent with AIS group than in the LLD group (p ≤ 0.05). The C-LLDscoliometer test results were strongly correlated with both C-LLDtape measure (r = 0.651; p = 0.000) and ATRsacrum (r = 0.688; p = 0.000). CONCLUSION: LLD may develop as a result of adaptive changes due to scoliosis, or a concurrent condition to scoliosis. Cobb angle and apical rotation are the features that differentiate AIS from functional scoliosis in patients with LLD. The C-LLD scoliometer test can be an effective, practical, and useful method for measuring C-LLD, but its validity and reliability should be determined. TRIAL REGISTRATION: This study was retrospectively registered at ClinicalTrials.gov (number: NCT04713397, date of registration: 01/14/2021). LEVEL OF EVIDENCE: III.