title: A meta-analysis of the clinical effectiveness of school scoliosis screening.
abstract: METHODS
  A meta-analysis that systematically reviewed the evaluation studies of a scoliosis screening program reported in the literature.
  
  
  OBJECTIVE
  To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported.
  
  
  METHODS
  Data sources included 3 databases, namely, PubMed, Google scholar, CINAHL database, and the references from identified reviews and studies. Studies were included if: (1) they adopted a retrospective cohort design; (2) were screened using either the forward bending test (FBT), angle of trunk rotation, or Moiré topography; (3) reported results of screening tests and radiographic assessments; (4) screened adolescents only; (5) reported the incidence of curves with a minimum Cobb angle of 10 degrees or greater; and (6) reported the number of referrals for radiography. Reviews, comments, case studies, and editorials were excluded.
  
  
  RESULTS
  Thirty-six studies, including 34 from the 775 initially identified studies and 2 from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive values for detecting curves > or =10 degrees , curves > or =20 degrees , and treatment were 28.0%, 5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that programs using the FBT alone reported a higher referral rate (odds ratio [OR] = 2.91) and lower positive predictive values for curves > or =10 degrees (OR = 0.49) and curves > or =20 degrees (OR = 0.34) than programs using other tests. Only one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the specificity was not reported. No severe publication bias was noted.
  
  
  CONCLUSIONS
  The use of the FBT alone in school scoliosis screening is insufficient. We need large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening.
authors.affiliation: Department of Nursing Studies, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
authors.forename: Daniel Yee Tak
authors.initials: DY
authors.lastname: Fong
authors.forename: Chun Fan
authors.initials: CF
authors.lastname: Lee
authors.forename: Kenneth Man Chee
authors.initials: KM
authors.lastname: Cheung
authors.forename: Jack Chun Yiu
authors.initials: JC
authors.lastname: Cheng
authors.forename: Bobby Kin Wah
authors.initials: BK
authors.lastname: Ng
authors.forename: Tsz Ping
authors.initials: TP
authors.lastname: Lam
authors.forename: Kwok Hang
authors.initials: KH
authors.lastname: Mak
authors.forename: Paul Siu Fai
authors.initials: PS
authors.lastname: Yip
authors.forename: Keith Dip Kei
authors.initials: KD
authors.lastname: Luk
mesh_terms: D000293:Adolescent; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000379:methods / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011859:Radiography; D011871:Radiology / Q000379:methods / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012574:Schools / Q000706:statistics & numerical data*; D012600:Scoliosis / Q000175:diagnosis* / Q000628:therapy; D013131:Spine / Q000000981:diagnostic imaging*