Nada Mohamed

Introduction Adolescent idiopathic scoliosis (AIS) affects 2–3% of adolescents, causing spinal curvature and functional limitations. Traditional assessment using the Cobb angle may only partially capture patient concerns about aesthetics. The Schroth scoliosis-specific exercises (SSE), focusing on posture correction, have shown promise for reducing the Cobb angle and preventing progression, though research on its cosmetic impact is limited. Surface topography (ST) offers a radiation-free alternative to assess AIS, but determining what is a meaningful change for patients remains underexplored. The objective of this study is to determine the Minimal Clinically Important Changes (MCIC) in ST parameters in AIS after undergoing 6 months of Schroth SSE exercises. Methods This is a secondary analysis from a randomized controlled trial. Participants (n = 124) were recruited from a Scoliosis Clinic and randomized into standard care (observation or bracing) and Schroth intervention added to standard care groups (one-hour weekly supervised session, 30–40 min daily home exercises). A global Rating of Change (GRC) was self-reported after six months, and asymmetry parameters of root mean square (RMS) and maximum deviation (MaxDev) over the asymmetry patch corresponding to the spinal curve were obtained through surface torso scans captured at baseline and six months. Pearson correlation and receiver-operating characteristic (ROC) curve analysis were performed to determine the MCICs. Subgroup analyses were also conducted to ascertain MCICs for thoracic and lumbar curve types. Results GRC ratings correlated with changes in RMS (r=-0.510, p < 0.001) and MaxDev (r=-0.409, p < 0.001). Participants who reported improved (GRC ≥ 2) posture saw a 1.76 ± 2.9 mm and 3.29 ± 6.5 mm decrease in RMS and MaxDev, respectively. In contrast, RMS and MaxDev increased by 1.03 ± 3.0 mm and 1.26 ± 5.6 mm, respectively, among individuals who stated that their posture had deteriorated or not changed (GRC < 2). Using ROC analysis, MCICs for RMS and MaxDev were determined to be -0.27 mm (area under the curve (AUC) 0.746, sensitivity 67%, specificity 74%) and − 0.49 mm (AUC 0.717, sensitivity 64%, specificity 68%), respectively, for overall improvement perception. Having met both thresholds reduced sensitivity to 62% and achieved 74% specificity. MCICs for thoracic curve types were − 0.58 mm (AUC 0.618, sensitivity 60%, specificity 53%) for RMS and − 1.32 mm (AUC 0.632, sensitivity 73%, specificity 92%) for MaxDev. MCICs for lumbar curve types were − 0.26 mm for RMS (AUC 0.881, sensitivity 73%, specificity 92%) and − 0.61 mm for MaxDev (AUC 0.811, sensitivity 68%, specificity 83%). Conclusion Changes in RMS and MaxDev were aligned to GRC score reflecting perceived improvements in back condition. Stronger associations were observed between ST parameters and perceived improvement in lumbar than thoracic or combining all curves.

Background: Idiopathic scoliosis (IS) is a common spinal deformity affecting 0.5% to 5.2% of children worldwide, with a higher reported range in Spain (0.7–7.5%). Early detection through screening is crucial to prevent the progression of mild cases to severe deformities. Clinical methods such as the ADAM test and trunk rotation angle (TRA) are widely used, but the development of three-dimensional (3D) surface topography (ST) technologies has opened new avenues for non-invasive screening. The objectives of this study were (1) to perform clinical and ST-based scoliosis screening in a sample of healthy children involved in club sports, (2) to estimate the agreement between clinical and ST screening methods, (3) to describe the prevalence of scoliosis by sport, sex, and age, and (4) to evaluate the diagnostic performance of both screening approaches using available radiographs as a reference standard. Methods: A total of 343 children (58.7% males, 41.3% females; mean age 11.69 ± 2.05 years) were screened using both clinical and ST methods. Clinical screening included the ADAM test and TRA measurement, while ST screening was performed using BackSCNR^®, a markerless 3D scanning software. The children with positive screening results were recommended to obtain radiographs to confirm the diagnosis. Kappa agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for both screening modalities using radiographic results as the gold standard. Results: The prevalence of scoliosis was 3.2% (n = 11) based on radiographic confirmation. The prevalence by sport was highest in swimming (17.6%), with minimal differences by sex (males 3.6%, females 2.5%). The clinical screening showed a sensitivity of 73%, specificity of 97%, PPV of 47%, NPV of 99%, and accuracy of 96%. The ST screening showed a sensitivity of 36%, specificity of 99%, PPV of 80%, NPV of 97%, and accuracy of 97%. The kappa values indicate a moderate influence of chance for both methods (clinical κ = 0.55; ST κ = 0.48). The balanced accuracy was 84% for the clinical screening and 68% for the ST screening. Conclusions: The clinical screening method showed superior sensitivity and balanced accuracy compared to ST screening. However, ST screening showed higher specificity and PPV, suggesting its potential as a complementary tool to reduce the high positive predictive value. These results highlight the importance of combining screening methods to improve the accuracy of the early detection of IS in physically active children, with the radiographic confirmation of the positive screened cases remaining essential for accurate diagnosis.