TRACE (Trunk Aesthetic Clinical Evaluation), a routine clinical tool to evaluate aesthetics in scoliosis patients: development from the Aesthetic Index (AI) and repeatability

Fabio Zaina, Stefano Negrini, Salvatore Atanasio, Fabio Zaina, Stefano Negrini, Salvatore Atanasio

Abstract

Background: Aesthetic appearance is of primary importance in the treatment of adolescent idiopathic scoliosis (AIS), but to date tools for routine clinical practice have not become available. The aim of the present study is to develop such a tool and to verify its repeatability.

Instrumentation: At first we developed the Aesthetic Index (AI), based on a three-point scale for asymmetry of the shoulders, scapulae and waist that we tested for 5 years. From this experience we developed another tool we called TRACE, the acronym of Trunk Aesthetic Clinical Evaluation; TRACE is a 12-point scale based on four sub-scales, shoulders (0-3), scapulae (0-2), hemi-thorax (0-2) and waist (0-4).

Population: Posterior-anterior (PA) photographs of one hundred-sixty AIS patients.

Procedures: Each photograph was scored in two independent tests by four observers using AI, and subsequently TRACE.

Data analysis: Kappa statistical analysis and 95% level of agreement were used; we also identified the minimum significant change (95% confidence level).

Results: We found the intra- and inter-raters repeatability of AI to be fair. Three points out of seven was the minimum significant change between two different evaluations. For TRACE, intra-rater repeatability was fair and inter-raters poor; but the minimum significant change was three (intra-rater), or four (inter-raters) out of twelve points.

Conclusion: Widening the scale from 7 (AI) to 12 points (TRACE) increased the clinical sensitivity to changes of the aesthetic scale, even if TRACE has only a fair repeatability. TRACE is a no-cost tool for routine clinical practice in AIS patients. Due to the absence of other comparable validated tools, once the inherent measurement error is known and understood, its routine clinical use by physicians is advised.

Figures

Figure 1
Figure 1
Shoulder asymmetry, as evaluated in TRACE, ranges from 0 to 3. For the shoulders it is easy to detect some intermediate values, so we defined asymmetry (from the top) slight (1), moderate (2) and important (3).
Figure 2
Figure 2
Hemi-thorax asymmetry as evaluated in TRACE: This item was created as a complement of the scapulae, since we noted that occasionally there is an evident prominence of the last ribs on the back even when there is no real asymmetry in the scapulae. From the left: slight (1) and important (2) asymmetry.
Figure 3
Figure 3
Scapulae asymmetry as evaluated in TRACE: (from the left) slight (1) and important (2).
Figure 4
Figure 4
Waist asymmetry as evaluated in TRACE: it was quite easy to define a total asymmetry (a score of 4) when one flank was straight or when there was a lateral decompensation of the trunk. It was easy as well to define a very slight (a score of 1) and an important but not complete (a score of 3) asymmetry; between these points we defined a mild asymmetry (a score of 2). In the figure, from the top: slight (1), mild (2), moderate (3) and important (4) asymmetry.

References

    1. Negrini S, Grivas TB, Kotwicki T, Maruyama T, Rigo M, Weiss HR. Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis. 2006;1:4. doi: 10.1186/1748-7161-1-4.
    1. Donaldson S, Hedden D, Stephens D, Alman B, Howard A, Narayanan U, Wright JG. Surgeon reliability in rating physical deformity in adolescent idiopathic scoliosis. Spine. 2007;32:363–367. doi: 10.1097/01.brs.0000253605.71168.2e.
    1. Asher M, Min Lai S, Burton D, Manna B. The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine. 2003;28:63–69. doi: 10.1097/00007632-200301010-00015.
    1. Sanders JO, Polly DW, Jr, Cats-Baril W, Jones J, Lenke LG, O'Brien MF, Stephens Richards B, Sucato DJ. Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale. Spine. 2003;28:2158–2163. doi: 10.1097/01.BRS.0000084629.97042.0B.
    1. Sanders JO, Harrast JJ, Kuklo TR, Polly DW, Bridwell KH, Diab M, Dormans JP, Drummond DS, Emans JB, Johnston CE, 2nd, et al. The Spinal Appearance Questionnaire: results of reliability, validity, and responsiveness testing in patients with idiopathic scoliosis. Spine. 2007;32:2719–2722.
    1. Weisz I, Jefferson RJ, Turner-Smith AR, Houghton GR, Harris JD. ISIS scanning: a useful assessment technique in the management of scoliosis. Spine. 1988;13:405–408. doi: 10.1097/00007632-198804000-00006.
    1. Weisz I, Jefferson RJ, Carr AJ, Turner-Smith AR, McInerney A, Houghton GR. Back shape in brace treatment of idiopathic scoliosis. Clin Orthop Relat Res. 1989:157–163.
    1. Theologis TN, Jefferson RJ, Simpson AH, Turner-Smith AR, Fairbank JC. Quantifying the cosmetic defect of adolescent idiopathic scoliosis. Spine. 1993;18:909–912. doi: 10.1097/00007632-199306000-00016.
    1. Liu XC, Thometz JG, Lyon RM, Klein J. Functional classification of patients with idiopathic scoliosis assessed by the Quantec system: a discriminant functional analysis to determine patient curve magnitude. Spine. 2001;26:1274–1278. doi: 10.1097/00007632-200106010-00020. discussion 1279.
    1. Hackenberg L, Hierholzer E, Potzl W, Gotze C, Liljenqvist U. Rasterstereographic back shape analysis in idiopathic scoliosis after anterior correction and fusion. Clin Biomech (Bristol, Avon) 2003;18:1–8. doi: 10.1016/S0268-0033(02)00165-1.
    1. Negrini A, Negrini S, Santambrogio GC. Data variability in the analysis of spinal deformity, a study performed by means of the AUSCAN system. In: D'Amico M, Merolli A, Santambrogio GC, editor. Three Dimensional Analysis of Spinal Deformities. Amsterdam: IOS Press; 1995. pp. 101–106.
    1. Negrini S, Negrini A, Rainero G, Sibilla P, Santambrogio GC. Correlation Between Trunk Gibbosity and the Spinal Torsion Measured by the AUSCAN System. In: D'Amico M, Merolli A, Santambrogio GC, editor. Three Dimensional Analysis of Spinal Deformities. Vol. 1. Amsterdam: IOS Press – Ohmsha; 1995. pp. 279–283.
    1. Buchanan R, Birch JG, Morton AA, Browne RH. Do you see what I see? Looking at scoliosis surgical outcomes through orthopedists' eyes. Spine. 2003;28:2700–2704. doi: 10.1097/01.BRS.0000103383.81904.5A. discussion 2705.
    1. Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960;20:37–46. doi: 10.1177/001316446002000104.
    1. Fleiss J. Measuring nominal scale agreement among many raters. Psychological Bulletin. 1971;76:378–381. doi: 10.1037/h0031619.
    1. Maclure M, Willett W. Misinterpretation and misuse of the kappa statistic. American Journal of Epidemiology. 1987;126:161–169.
    1. Uebersax JS. Modeling approaches for the analysis of observer agreement. Invest Radiol. 1992;27:738–743. doi: 10.1097/00004424-199209000-00017.
    1. Zaina F, Negrini S, Atanasio S. 5th International Conference on Conservative Management of Spinal Deformities: 2008. Athens: SOSORT; 2008. Brace treatment can change aesthetics in Adolescent Idiopathic Scoliosis (AIS) patients.
    1. Negrini S, Atanasio S, Zaina F, Romano M, Parzini S, Negrini A. End-growth results of bracing and exercises for adolescent idiopathic scoliosis. Prospective worst-case analysis. Stud Health Technol Inform. 2008;135:395–408.
    1. Zaina F, Negrini S, Monticone M, Paroli C. 4th International Conference on Conservative Management of Spinal Deformities: 13–16 May 2007. Boston: SOSORT (Society on Scoliosis Orthopaedic and Rehabilitation Treatment); 2007. TRACE (Trunk Aesthetic Clinical Evaluation), a new everyday clinical tool to assess adolescent idiopathic scoliosis patients aesthetics.
    1. Negrini S, Atanasio S, Fzaina F, Romano M. Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies. Europa Medicophysica-SIMFER 2007 Award Winner. Eur J Phys Rehabil Med. 2008;44:169–176.
    1. Negrini S, Atanasio S, Negrini F, Zaina F, Marchini G. The Sforzesco brace can replace cast in the correction of adolescent idiopathic scoliosis: A controlled prospective cohort study. Scoliosis. 2008;3:15. doi: 10.1186/1748-7161-3-15.
    1. Negrini S, Zaina F, Romano M, Negrini A, Parzini S. Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: A prospective controlled cohort study with worst-case analysis. J Rehabil Med. 2008;40:451–455. doi: 10.2340/16501977-0195.
    1. Asher M, Lai SM, Burton D, Manna B. The influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses. Spine. 2004;29:861–868. doi: 10.1097/00007632-200404150-00008.
    1. Turner-Smith AR, Harris JD, Houghton GR, Jefferson RJ. A method for analysis of back shape in scoliosis. J Biomech. 1988;21:497–509. doi: 10.1016/0021-9290(88)90242-4.
    1. Grivas TB, Vasiliadis ES. Cosmetic outcome after conservative treatment of idiopathic scoliosis with a dynamic derotation brace. Stud Health Technol Inform. 2008;135:387–392.
    1. Kotwicki T, Kinel E, Stryla W, Szulc A. Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis. Scoliosis. 2007;2:18. doi: 10.1186/1748-7161-2-18.
    1. Cochran T, Irstam L, Nachemson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine. 1983;8:576–584. doi: 10.1097/00007632-198309000-00003.
    1. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527–1537. doi: 10.1016/S0140-6736(08)60658-3.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere