Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients Evaluation of segmental postural characteristics during quiet standing in control and Idiopathic Scoliosis patients. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Braces for Idiopathic Scoliosis in Adolescents Objective Assessment of the Cardiorespiratory Function of Adolescents With Idiopathic Scoliosis Through the Six-Minute Walk Test A Multicenter Study of the Outcomes of the Surgical Treatment Of Adolescent Idiopathic Scoliosis Using the Scoliosis Research Society (SRS) Outcome Instrument Curvature progression in patients treated with scoliosis in-patient rehabilitation--a sex and age matched controlled study. Impact of a physical rehabilitation program on the respiratory function of adolescents with idiopathic scoliosis. Reliability of photogrammetry in the evaluation of the postural aspects of individuals with structural scoliosis. The Spinal Appearance Questionnaire: Results of Reliability, Validity, and Responsiveness Testing in Patients With Idiopathic Scoliosis Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial The role of measured resistance exercises in adolescent scoliosis. Incidence of curvature progression in idiopathic scoliosis patients treated with scoliosis in-patient rehabilitation (SIR): an age- and sex-matched controlled study Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle.
OBJECTIVE To determine overall , test-retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis . DESIGN A reliability study using two raters and two test sessions . SETTING Tertiary care paediatric centre . PARTICIPANTS Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis ( Cobb angle 15 to 60 ° ) were recruited from the scoliosis clinic . MAIN OUTCOME MEASURES Based on the XY co-ordinates of natural reference points ( e.g. , eyes ) as well as markers placed on several anatomical l and marks ,  32 angular and linear posture indices taken from digital photographs in the st and ing position were calculated from a specially developed software program . Generalisability theory served to estimate the reliability and st and ard error of measurement ( SEM ) for the overall , test-retest and inter-rater design s. Bl and and Altman 's method was also used to document agreement between sessions and raters . RESULTS In the r and om design , dependability coefficients demonstrated a moderate level of reliability for six posture indices ( ϕ=0.51 to 0.72 ) and a good level of reliability for 26 posture indices out of 32 ( ϕ≥0.79 ) . Error attributable to marker placement was negligible for most indices . Limits of agreement and SEM values were larger for shoulder protraction , trunk list , Q angle , cervical lordosis and scoliosis angles . The most reproducible indices were waist angles and knee valgus and varus . CONCLUSIONS Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis . Despite the good reliability of marker placement , other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time Objective : To compare the efficacy of three-dimensional ( 3D ) Schroth exercises in patients with adolescent idiopathic scoliosis . Design : A r and omised-controlled study . Setting : An outpatient exercise-unit and in a home setting . Subjects : Fifty-one patients with adolescent idiopathic scoliosis . Interventions : Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups . Schroth ’s 3D exercises were applied to the first group in the clinic and were given as a home program for the second group ; the third group was the control . Main Measures : Scoliosis angle ( Cobb method ) , angle of rotation ( scoliometer ) , waist asymmetry ( waist – elbow distance ) , maximum hump height of the patients and quality of life ( QoL ) ( SRS-23 ) were assessed pre-treatment and , at the 6th , 12th and 24th weeks . Results : The Cobb ( -2.53 ° ; P=0.003 ) and rotation angles ( -4.23 ° ; P=0.000 ) significantly decreased , which indicated an improvement in the clinic exercise group compared to the other groups . The gibbosity ( -68.66 mm ; P=0.000 ) and waist asymmetry improved only in the clinic exercise group , whereas the results of the other groups worsened . QoL did not change significantly in either group . Conclusion : According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups ; additionally , we observed that scoliosis progressed in the control group , which received no treatment The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis ( AIS ) was investigated . Sixteen ( 16 ) AIS patients with progressing or high-risk curves ( Cobb 's angle between 25 ° and 35 ° at start and reducible by lateral bending ) were fitted with a device with tone alarm for poor posture . In the first 18 months of application , 3 patients defaulted and 4 showed curve progression > 10 ° ( 2 changed to rigid spinal orthoses and 2 underwent surgery ) . The curves for the other 9 patients were kept under control ( within ±5 ° of Cobb 's angle ) and 5 of them have reached skeletal maturity and terminated the application . The remaining 4 patients were still using the devices until skeletal maturity or curve progression . The curve control rate was 69 % . A long-lasting active spinal control could be achieved through the patient 's own spinal muscles . Nevertheless , before the postural training device could become a treatment modality , a long-term study for more AIS patients was necessary . This project is ongoing in the Duchess of Kent Children 's Hospital , S and y Bay , Hong Kong BACKGROUND The complex skeletal deformations that accompany Idioapthic Scoliosis pose a challenge to the clinician to non-invasively discriminate Idiopathic Scoliosis patients from children with no pathology . Therefore , the focus of this study is to non-invasively evaluate the position and amplitude of displacement of the pelvis , shoulders and thorax during quiet st and ing of Idiopathic Scoliosis patients and control subjects . METHODS The quiet st and ing posture of 18 healthy adolescent females and 22 Idiopathic Scoliosis subjects was evaluated using an Optotrak 3020 position sensor over a period of 120 s , with 4 repeat trials . Outcome measures included the mean position , root mean square amplitude and range over the duration of 120 s trials for both linear and angular measures of the pelvis , thorax and shoulders . Appropriate sample times were chosen and evaluated for stability over the 120 s period , and between trial reliability was evaluated . FINDINGS There was a significant difference between groups for the mean position of the shoulder blade rotation in reference to the base of support and to the pelvis . The Idiopathic Scoliosis patients had a significantly larger root mean square amplitude of anterior-posterior displacement of the T1 and S1 spinous processes in reference to the base of support . There was no difference between the sample duration s to estimate the mean position of the body segments , however the root mean square increased significantly . INTERPRETATION This study demonstrates that postural abnormalities are evident during quiet st and ing in Idiopathic Scoliosis patients BACKGROUND CONTEXT Three-dimensional ( 3D ) deformations of the spine are predominantly characterized by two-dimensional ( 2D ) angulation measurements in coronal and sagittal planes , using anteroposterior and lateral X-ray images . For coronal curves , a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice , and these methods have been shown to exhibit good-to-excellent reliability and reproducibility , carried out either manually or by computer-based tools . Recently , an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column . PURPOSE Comparison of accuracy , correlation of measurement values , intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting . STUDY DESIGN / SETTING Retrospective nonr and omized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009 . PATIENT SAMPLE In total , 201 individuals ( 170 females , 31 males ; mean age , 19.88 years ) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis ( 175 cases ) , adult degenerative scoliosis ( 11 cases ) , and Scheuermann hyperkyphosis ( 5 cases ) .  Overall range of coronal curves was between 2.4 ° and 117.5 ° . Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation : 0 ° to 10 ° ( Group 1 , n=36 ) , 10 ° to 25 ° ( Group 2 , n=25 ) , 25 ° to 50 ° ( Group 3 , n=69 ) , 50 ° to 75 ° ( Group 4 , n=49 ) , and more than 75 ° ( Group 5 , n=22 ) . METHODS Coronal and sagittal curvature measurements were determined by three experienced examiners , using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions . Manual measurements were performed three times , and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner . Means comparison t test , Pearson bivariate correlation analysis , reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software ( IBM Corp. , Armonk , NY , USA ) . No funds were received in support of this work . No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article . RESULTS In comparison with manual 2D methods , only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data . Intraobserver reliability was excellent for both methods , and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations . CONCLUSIONS This is the first clinical report on EOS 2D/3D system ( EOS Imaging , Paris , France ) and its sterEOS 3D software , documenting an excellent capability for accurate , reliable , and reproducible spinal curvature measurements Study Design . A Cochrane systematic review . Objective . To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments , on quality of life , disability , pulmonary disorders , progression of the curve , psychological , and cosmetic issues . Summary of Background Data . Idiopathic scoliosis is a three-dimensional deformity of the spine . The most common form is diagnosed in adolescence . Although adolescent idiopathic scoliosis ( AIS ) can progress during growth and cause a surface deformity , it is usually not symptomatic . Methods . We search ed CENTRAL , MEDLINE , EMBASE , five other data bases , and two trials registers up to February 2015 . We also checked reference lists and h and search ed grey literature . R and omized controlled trials ( RCTs ) and prospect i ve controlled cohort studies comparing braces with no treatment , other treatment , surgery , and different types of braces for adolescent with AIS . We used st and ard method ological procedures expected by the Cochrane Collaboration . Results . We included seven studies . Five were planned as RCTs , two as prospect i ve controlled clinical trials . One RCT failed completely , another was continued as an observational study . There was very low quality evidence from one small RCT that quality of life ( QoL ) during treatment did not differ significantly between rigid bracing and observation . Conclusion . Two studies showed that bracing did not change QoL during treatment , and QoL , back pain psychological and cosmetic issues in the long term ( 16 years . ) All articles showed that bracing prevented curve progression . The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject r and omization of their children . Level of Evidence : Study Design . Clinical prospect i ve , r and om study . Objective . Analyze the results of the six-minute walk test ( 6MWT ) in patients with adolescent idiopathic scoliosis . Summary of Background Data . Although it is widely believed that Adolescent Idiopathic Scoliosis ( AIS ) causes cardiorespiratory dysfunctions , there is no report in literature of objective measurements of this restriction in the ventilatory performance during physical exertion . Methods . One hundred twenty-six adolescents matched by gender and age were prospect ively studied at a tertiary teaching institution : 40 patients without spine deformities ( group I – controls ) , and 86 patients with AIS with a spine curve ranging from 45 ° to 138 ° ( group II ) . All patients underwent radiographic evaluations and the 6MWT . Results . Normal controls presented significantly lower mean heart rate and Borg scores , as well as higher oxygen saturation and walked longer distances on the 6MWT . Conclusion . The 6MWT effectively demonstrated the cardiorespiratory restrictions presented by patients with AIS Study Design . A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society Question naire ( SRS 24 ) . Objective . To evaluate the patient based outcome of the surgical treatment of adolescent idiopathic scoliosis . Summary of Background Data . A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of adolescent idiopathic scoliosis . To our knowledge , no prospect i ve outcome study on this topic thus far exists . Methods . Using the SRS 24 question naire , seven scoliosis centers agreed to prospect ively assess outcome for surgically treated patients with adolescent idiopathic scoliosis . Data were collected before surgery and at 24 months after surgery . Data were analyzed using paired and independent sample s t test for all seven SRS 24 question naire domains ( Pain , General Self-Image , Postoperative Self-Image , Postoperative Function , Function From Back Condition , General Level of Activity , and Satisfaction ) using Statistical Package for Social Science . The domains were analyzed with respect to the total cohort , gender , curve magnitude , and type of surgery using independent- sample s t tests . Results . A total of 242 patients were included in our analysis . A baseline preoperative pain level of 3.68 of 5 was found . This improved to 4.63 after surgery , representing an improvement of 0.95 points . Surgical intervention was associated with improving outcome when compared with preoperative status . Pain , General Self-Image , Function From Back Condition , and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status ( P < 0 . 001 ) . Overall , patients were highly satisfied with the results of surgery . Conclusion . Preoperative pain exists in our adolescent scoliosis population . Pain scores were improved in our study population at the 2-year postsurgical follow-up . Statistically significant improvements were likewise seen in the General Self-Image , Function From Back Condition , and Level of Activity domains . The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with adolescent idiopathic scoliosis The aim of this study is to test the hypothesis that physiotherapy-based intervention can reduce incidence of progression in children with IS because progression of spinal curvature in patients with idiopathic scoliosis ( IS ) is of paramount concern in treatment strategies . Follow-up of the outcome of two prospect i ve studies using the outcome parameter , incidence of progression ( > or = 5 degrees ) , in treated and untreated patient groups matched by age , sex , and degree of curvature at diagnosis . A six-week scoliosis in-patient rehabilitation ( SIR ) program offering patient-specific physiotherapy including intensive therapist-assisted exercise in diagnosis-matched groups . A followup home therapy regime is design ed for each patient . Incidence of progression in groups of untreated patients ranged from 1.5-fold ( 71.2 % vs 46.7 % ) to 2.9-fold ( 55.8 % vs 19.2 % ) higher than in groups of patients treated with SIR , even when SIR-treated groups included patients with more severe curvatures . Statistically , the differences were highly significant . Postural imbalance is a component of spinal curvature and can be a causative mechanism . However , efforts to test the hypothesis that physical therapies addressing postural imbalance can be used effectively in the treatment of IS have been limited . The results of this study indicate that a supervised program of exercise-based therapies can reduce incidence of progression in children with IS BACKGROUND Idiopathic adolescent scoliosis ( AIS ) causes not only spinal deformities but rib cage abnormalities that lead to abnormal volumes and pulmonary capacity on pulmonary function testing ( PFT ) . The objective of this study was to analyze the impact of a physical rehabilitation program on respiratory function in surgical patients with AIS . METHODS From October 2003 to October 2004 , a total of 34 patients ( age range , 10 to 18 years ) presenting with AIS and a thoracic curvature between 45 degrees and 88 degrees were studied prospect ively at a tertiary academic hospital . The patients underwent clinical and radiographic evaluations of the  vertebral deformity , chest radiographs , PFT , evaluation of peak expiratory flow , and 6-min walk tests ( 6MWTs ) before and after joining a physical rehabilitation program for 4 months . RESULTS An improvement in FVC , inspiratory capacity , FEV(1 ) , expiratory reserve volume , and performance assessed by 6MWT were observed after rehabilitation . CONCLUSIONS Global conditioning improved after the rehabilitation program . This was expressed by both PFT and 6MWT results PURPOSE The purpose of this study was to investigate the reliability of photogrammetry in the measurement of the postural deviations in individuals with idiopathic scoliosis . METHODS Twenty participants with scoliosis ( 17 women and three men ) , with a mean age of 23.1 ± 9 yrs , were photographed from the posterior and lateral views . The postural aspects were measured with CorelDRAW software . RESULTS High inter-rater and test-retest reliability indices were found . It was observed that with more severity of scoliosis , greater were the variations between the thoracic kyphosis and lumbar lordosis measures obtained by the same examiner from the left lateral view photographs . A greater body mass index ( BMI ) was associated with greater variability of the trunk rotation measures obtained by two independent examiners from the right , lateral view ( r = 0.656 ; p = 0.002 ) . The severity of scoliosis was also associated with greater inter-rater variability measures of trunk rotation obtained from the left , lateral view ( r = 0.483 ; p = 0.036 ) . CONCLUSIONS Photogrammetry demonstrated to be a reliable method for the measurement of postural deviations from the posterior and lateral views of individuals with idiopathic scoliosis and could be complementarily employed for the assessment procedures , which could reduce the number of X-rays used for the follow-up assessment s of these individuals Study Design . Prospect i ve , sequential enrollment . Objective . We report the development and testing of the Spinal Appearance Question naire ( SAQ ) for reliability , validity , and responsiveness in patients with idiopathic scoliosis . Summary of Background Data . The SAQ was design ed to measure patients ’ and their parents ’ perception of their spinal deformity ’s appearance using st and ardized drawings and questions . This study was design ed to test the instrument ’s psychometric properties . Methods . The SAQ was administered as a test-retest to idiopathic scoliosis patients and parents for reliability and initial validity assessment ( Group I ) . It was then administered to patients before surgery and 1 year after surgery ( Group II ) for responsiveness and further validity testing . Finally , both the SAQ and SRS instruments were administered to adolescent idiopathic patients before surgery and 1 year after surgery ( Group III ) for comparison of the 2 instruments . Results . Group I : The individual scale items had good to excellent reliability ( Spearman ’s rho , 0.57–0.99 ) and high internal scale consistency ( Cronbach ’s alpha > 0.7 ) . The mean scale scores differentiated between curves greater than 30 ° and lesser curves ( P < 0.01 ) . Surgery improved scores compared with those with “ surgery recommended . ” Group II : The domains correlated with clinical and radiographic aspects of the deformity before surgery . All of the domains showed significant difference after surgery ( P < 0.0001 ) and large effect size for all domains except for the patient chest domain . Group III : Both the SAQ and the SRS instruments had significant improvement in all of their domains except for the SRS Activity scale . The relative efficiency of the SAQ domains to the SRS appearance domain ( the most responsive SRS domain ) was greater for 5 SAQ domains . Conclusion . The SAQ is reliable , responsive to curve improvement , and shows strong evidence of validity . It provides more detail than the SRS in the appearance domain , and provides explanation of spinal deformity ’s concerns and improvements BACKGROUND The feasibility of conducting a definitive r and omised controlled trial ( RCT ) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises ( SSEs ) for adolescent idiopathic scoliosis ( AIS ) is uncertain . OBJECTIVES The aim of this study was to assess the feasibility of conducting a large , multicentre trial of SSE treatment for patients with AIS , in comparison with st and ard care , and to refine elements of the study design . The objectives were to ( 1 ) up date a systematic review of controlled trials evaluating the efficacy of SSE in AIS ; ( 2 ) survey UK orthopaedic surgeons and physiotherapists to determine current practice , patient population s and equipoise ; ( 3 ) r and omise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites ; ( 4 ) develop , document and assess acceptability and adherence of interventions ; ( 5 ) assess and describe training requirements of physiotherapists ; and ( 6 ) gain user input in all relevant stages of treatment and protocol design . DESIGN Multicomponent feasibility study including UK clinician survey , systematic literature review and a r and omised feasibility trial . SETTING The r and omised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS . PARTICIPANTS The r and omised feasibility study recruited people aged 10 - 16 years with mild AIS ( Cobb angle of < 50 ° ) . INTERVENTIONS The r and omised study allocated participants to st and ard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan . Our choice of intervention was informed by a systematic review of exercise interventions for AIS . MAIN OUTCOME MEASURES The main outcome was feasibility of recruitment to the r and omised study . Other elements were to inform choice of outcomes for a definitive trial and included curve severity , quality of life , requirement for surgery/brace , adverse events , psychological symptoms , costs and health utilities . RESULTS A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services . It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study . A systematic review up date found five new studies that were generally of low quality but showed some promise of effectiveness of SSE . The r and omised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month , with acceptable 6-month follow-up ( currently 73 % ) . Adherence to treatment was variable ( 56 % of participants completed treatment offered ) . The qualitative study found the exercise programme to be highly acceptable . We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation , as well as practical elements such as scheduling of intervention sessions . CONCLUSIONS A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible . Such a RCT is a priority for future work in the area . There is a sufficiently large patient base , combined with willingness to be r and omised within specialist UK centres . Interventions developed during the feasibility study were acceptable to patients , families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning . TRIAL REGISTRATION Current Controlled Trials IS RCT N90480705 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 55 . See the NIHR Journals Library website for further project information Purpose To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life ( HRQL ) in patients with mild adolescent idiopathic scoliosis ( AIS ) ( Cobb angle < 25 ° ) . Methods This was a parallel-group , r and omised , superiority-controlled study in which 110 patients were r and omly assigned to a rehabilitation programme consisting of active self-correction , task-oriented spinal exercises and education ( experimental group , 55 subjects ) or traditional spinal exercises ( control group , 55 subjects ) . Before treatment , at the end of treatment ( analysis at skeletal maturity ) , and 12 months later ( follow-up ) , all of the patients underwent radiological deformity ( Cobb angle ) , surface deformity ( angle of trunk rotation ) and HRQL evaluations ( SRS-22 question naire ) . A linear mixed model for repeated measures was used for each outcome measure . Results There were main effects of time ( p < 0.001 ) , group ( p < 0.001 ) and time by group interaction ( p < 0.001 ) on radiological deformity : training in the experimental group led to a significant improvement ( decrease in Cobb angle of > 5 ° ) , whereas the control group remained stable . Analysis of all of the secondary outcome measures revealed significant effects of time , group and time by group interaction in favour of the experimental group . Conclusions The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS . The effects lasted for at least 1 year after the intervention ended Twenty adolescent patients ( 18 girls and 2 boys ) with scoliosis ranging from 15 degrees-41 degrees in their major curve were treated with a progressive resistive training program for torso rotation . All patients demonstrated an asymmetry of rotation strength measured on specialized equipment , and surface electrode electromyograms showed inhibition of lumbar paraspinal muscles . Sixteen of 20 patients demonstrated curve reduction , and no patient showed an increase in curve The goal of this study is to test the hypothesis that physiotherapy-based intervention can reduce incidence of progression in children with IS . Two independent patient groups matched by age and sex at diagnosis were analysed using the outcome parameter , incidence of progression ( S 5 ° ) . One group was untreated and the other received  scoliosis in-patient rehabilitation ( SIR )  . Incidence of progression in groups of untreated patients ranged from 1.5-fold ( 71.2 % vs 46.7 % ) to 2.9-fold ( 55.8 % vs 19.2 % ) higher than in groups of patients treated with SIR , even when SIR-treated groups included patients with more severe curvatures . Statistically , the differences were highly significant . Efforts to test the hypothesis that physical therapies addressing postural imbalance can be used effectively in the treatment of IS have been limited . The results of this study are consistent with the possibility that a supervized programme of exercise-based therapies can reduce incidence of progression in children with IS BACKGROUND CONTEXT Evidence demonstrating the biomechanical effects of the Hueter-Volkmann principle on vertebral body growth in spinal deformities is lacking . Bracing a scoliotic curve should , in theory , unload the growth plates on the concave side of the vertebral bodies near the curve 's apex . Growth stimulation , leading to structural remodeling of the vertebral bodies , on the curve 's concave side may explain the improvement or lack of curve progression , as measured by Cobb angles , reported with successful brace management of adolescent idiopathic scoliosis ( AIS ) . PURPOSE To determine whether brace treatment stimulated asymmetric chondrogenesis in the apical three vertebral bodies . STUDY DESIGN A prospect i ve cohort of patients with AIS receiving brace treatment were followed from the initiation of brace treatment until skeletal maturity . Patients were then retrospectively divided into those with and without radiographic progression . This post hoc analysis was included to determine risk factors for curve progression . PATIENT SAMPLE Forty-one skeletally immature patients with AIS meeting criteria for brace treatment were followed until skeletal maturity . All patients were treated with thoracolumbosacral orthotics ( TLSOs ) . OUTCOME MEASURES The positional derotation of the TLSO on the spine was measured by comparing the initial radiograph with the first radiograph in a brace . The long-term structural changes of the vertebral bodies were determined by comparing the initial and final radiographs . Differences in initial radiographic parameters between the groups of patients with AIS with and without curve progression indicated predictive factors for successful brace treatment . METHODS Initial radiographic measurements were compared with those observed in a brace and those observed at final follow-up . The same analysis was retrospectively repeated comparing patients with AIS with and without radiographic progression . RESULTS Cobb measurements ( p=.0001 ) and concave-to-convex height ratios of the apical three vertebral bodies improved when the brace was initially applied ( p=.0035 ) . Structural remodeling or a rotational correction of the apical three vertebral bodies was appreciated only in patients with flexible curves ( p=.01 ) . CONCLUSION Brace application results in immediate positional derotations of the spine in patients with AIS . These positional derotations were maintained only in patients with flexible curves , at final follow-up . Brace treatment was not recommended in patients whose curves did not correct at least 20 % in a TLSO
iPhone measurements correlated well with scoliometer measurements .
2D photography results had a moderate to high correlation with 3D topography results .
Conclusions Overall , strong levels of evidence exist for iPhone and scoliometer measurements , with a high to very high reliability and moderate to very high validity .
Limited evidence exists for aesthetic tools TRACE and AI and 2D photography .
These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy setting s to assess postural asymmetry ; however , these only exist for measurement in the transverse plane , despite 3D characteristics of AIS .
Abstract Purpose As accurate and reproducible measurements of spinal curvature are crucial in the examination of patients with adolescent idiopathic scoliosis ( AIS ) , this systematic review aims to report on the reliability and validity of a range of inexpensive and easily administered anthropometric methods of postural asymmetry measurement in an AIS population , to inform practice in a clinical setting .