Reliability and validity study of measurements on digital photography to evaluate shoulder balance in idiopathic scolios
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RESEARCH
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Reliability and validity study of measurements on digital photography to evaluate shoulder balance in idiopathic scoliosis Antonia Matamalas1*, Juan Bagó1, Elisabetta D’Agata2 and Ferran Pellisé1
Abstract Objective: To determine the validity of digital photography as an evaluation method for shoulder balance (ShB) in patients with idiopathic scoliosis. Material and methods: A total of 80 patients were included (mean age 20.3 years; 85% women). We obtained a full x-ray of the vertebral column and front and back clinical photography for all patients. For antero-posterior x-rays we measured the proximal thoracic curve angles (CPT). To evaluate radiological shoulder balance we calculated the clavicle-rib intersection angle (CRIA) and T1-tilt. For clinical photography we measured shoulder height angle (SHA), axilla height angle (AHA) and the left right trapezium angle (LRTA). We analyzed the reliability of the different photographic measurements and the correlation between these and the radiological parameters. Results: The mean magnitude of PTC, CRIA and T1-tilt were 19°, −0.6° and 1.4° respectively. Mean SHA from the front was −1.7°. All photographic measurements revealed an excellent-near perfect intra and inter-observer reliability in both photographic projections. No correlation was found between the ShB and the magnitude of the PTC. A statistically significant correlation was found between clinical balance of the shoulders and radiological balance (r between 0.37 and 0.51). Conclusions: Digital clinical photography appears to be a reliable method for objective clinical measurement of ShB. The correlation between clinical and radiological balance is statistically significant although moderate/weak. Keywords: Cosmetic, Idiopathic scoliosis, Photography, Shoulders balance
Introduction Cosmetic disorder is one of the main reasons to treat Idiopathic Scoliosis patients (SOSORT Consensus) [1]. Shoulder balance (ShB) has been considered a characteristic of the deformity in idiopathic scoliosis [2-4]. According to Raso, this represents 75% of the perceived deformity of the trunk, together with asymmetry of the scapulae and shoulder girdle [2]. To be able to evaluate this balance correctly, reliable tools are necessary. Different evaluation methods ranging from radiological, clinical and topographical have been proposed over the years. Hong et al. [5] recently evaluated the reliability and validity of the different radiological * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, Hospital Vall d’Hebron, P Vall d’Hebron, 119, 08035 Barcelona, Spain Full list of author information is available at the end of the article
methods to evaluate ShB and concluded that, in general, all outcomes have reliable intra and inter-observer reliability. Nonetheless, radiological balance does not appear to optimally correspond with clinical balance, which suggests that clinical parameters should be a complement to radiological outcomes [6]. Different methods have been proposed to assess
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