Introduction
This paper presents a critique of an article titled Ten-Year Follow-Up Evaluation of a School Screening Program for Scoliosis that Karachalios, Sofianos, Roidis, Sapkas, Korres, and Nikolopoulus authored in 1999. You can find the full reference of this article in the reference list section.
Clinicians have faced the challenge of choosing the best screening technique for scoliosis for a long time. In fact, researchers have performed various tests on the methodology and effectiveness of many screening tests to assert the best methods out of the available many. Such studies focused mainly on Adams-forward bending test (FBT) (Brooks, Azen, Gerberg, Brooks, & Chan, 1975, p.969). Nevertheless, a single screening method cannot accurately diagnose the onset of scoliosis; it requires a series of tests to ascertain if it is really a scoliosis.
Researchers have developed various methods for distinguishing scoliosis from back shape and trunk deformities. These techniques include humpograms, scoliometer, goniometer, photo stereometry, the integrated-imaging system [ISIS], and stereography in the orders of their invention. In addition, Karachalios, Sofianos, Roidis, Sapkas, Korres, and Nikolopoulus (1999) posit that clinicians have used techniques that “scientists have improved for the same purpose, including ultrasound real-time linear array scanner” (p.2319). Nevertheless, these new methods have not replaced traditional method including the Adams forward-bending test, scoliometer, Moire topography, and the dimension of rib hump form.
This study seeks to evaluate the diagnostics validity and safety of FBT and back-shape analysis by comparing their sensitivity, specificity, and the positive and negative features; and to support the long-term importance of school screening tests for scoliosis in marginalized residents of an island.
Quality appraisal
The article does not clearly describe the interventions that the researchers used in the study. The article only mentioned that the researchers used Boston Brace interventions in three cases and one surgery in one case. Moreover, the author merely stated the numbers of the adverse events associated with the interventions without giving their description. However, I guess that was not necessary since the objective of the study was to compare the accuracy of Adams Forward Bending Test against other screening techniques, especially scoliometer.
Regarding the external validity of the study, I can say that the results of the study can be generalized to any population. These participants represented the entire population because we know where the participants were derived from. The sample source was clear. The pupils were from all social background, because 251 pupils came from Navy families, 259 from public staff families, 810 from entrepreneurs’ families, 41 from scientists’ families.
As far as internal validity is concerned, researchers have not defined clearly the factors that make the study seem bias. It is not clear if there were any blind measurements of the major outcomes of the intervention. The article did not show any compliance with the intervention.
Results
Researchers found “153 (5.66%) case of spinal deformity in pupils while they detected 32 cases of scoliosis indicating a prevalence of 1.18%” (Karachalios et al., 1999, p.2322). At 93.44% specificity and 84.37% sensitivity, there were 5 false-negative results in AFBT for scoliosis. According to Karachalios et al. (1999), the “sensitivities of Moire topography, the hump meter, and the scoliometer were 100%, 93%, and 62%, respectively” (p. 2318). At 100%, specificity stood at 85.38%, at 93% it stood at 78.11 while at 62% specificity read 79.76%. In terms of the negative predictive value, the FBT techniques scored lowly in relation to other techniques. There was a possibility of reducing radiologic examination by 89.4% if during the scoliosis screening program, “the results estimated that if cutoff limits for referral were used, such as the asymmetry of two Moire fringes, a humogram deformity of (D1H) 5 10 mm, and 8° scoliometer angle” (Karachalios et al., 1999, p.2318).
There were three pupils who constituted 0.11%, were exposed to the Boston Braces and they aged between 12 and 14 years. Pupils with a 40° thoracic curvature were treated surgically one year later due to progression. Nevertheless, “there was a progression of 35.8% of spinal deformities out of the 121 initial cases and 48.3% of scoliotic abnormalities out of the 29 initial cases” (Karachalios et al., 1999, p.2318). All these observations were qualified by Cobb angle deviation of at least 5° in several examinations. Except in one student, the researchers used physiotherapy and observation as the sole cure for the cases handled.
Clinical or practical importance
The Adams forward-bending test, clearly, is not the diagnostic criterion for diagnosis of scoliosis at its onset, particularly when used solely for its screening because it yields an inappropriate number of false-negative findings. This study has proven the inadequacies of the Adams forward-bending test as screening technique for scoliosis. Thus, the confidence placed on the screening technique by nurses will diminish after the study. The proceeding paragraph examines this phenomenon against other method for scoliosis screening.
Considering spinal curvatures based on radiography, the FBT test yielded 51 false-negative results. This implies that FBT test did not detect 51 scoliotic pupils. Moire topography tested positive for 50 of these cases, while humpogarm confirmed 42 pupils. Further, a single case of positive radiography tested negative with Moire topography. The scientist characterized the case with thoracolumbar curvature of 5° with positive scoliometer and humpogram dimensions. In addition, 12 and 36 (hump A and B respectively) false-negative, humpogram dimension were detected.
Scoliometer yielded 27 false-negative results. The FBT tests produced false-negative results for all radiographic scoliosis curvatures results. Moiré topography confirmed the outcomes of all cases, while hump A, hump B, and scoliometry yielded two, four and three false-negative results respectively. Finally, scoliotic curvatures of Cobb angle equal or above 15°, FBT yielded one false-negative result, while Moiré topography, Hump A and Scoliometer yielded none.
Conclusion
The Adams forward-bending test scoliosis screening method is not the best for diagnosing this abnormality at the preliminary stages particularly when it is used singly because it yields an unprecedented number of false-negatives results. Majority of the research articles favored Adams Forwards Bending Test over the scoliometer in terms of accuracy. Nevertheless, the popular use of the Adams forward-bending test over the other apparently more reliable screening test is questionable.
Reference list
Brooks, H. L., Azen, S. P., Gerberg, E, Brooks, R, & Chan, L. (1975). Scoliosis: A Prospective epidemiological study. J Bone Joint Surg, 57(5), 968–72.
Karachalios, T., Sofianos, J., Roidis, N., Sapkas, G., Korres, D., & Nikolopoulus, K. (1999). Ten-Year Follow-Up Evaluation of a School Screening Program for Scoliosis: Is the Forward-Bending Test an Accurate Diagnostic Criterion for the Screening of Scoliosis? SPINE, 24(22), 2318–2324.