title: TRACE (Trunk Aesthetic Clinical Evaluation), a routine clinical tool to evaluate aesthetics in scoliosis patients: development from the Aesthetic Index (AI) and repeatability.
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.
  
  
  METHODS
  
  
  
  METHODS
  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).
  
  
  METHODS
  Posterior-anterior (PA) photographs of one hundred-sixty AIS patients.
  
  
  METHODS
  Each photograph was scored in two independent tests by four observers using AI, and subsequently TRACE.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: ISICO, Milan, Italy. fabio.zaina@isico.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Zaina
authors.forename: Stefano
authors.initials: S
authors.lastname: Negrini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Atanasio