Are current scoliosis school screening recommendations evidence-based and up to date? A best evidence synthesis umbrella review.
OBJECTIVE
Recommendations addressing school screening for adolescents with idiopathic scoliosis are contradictory. Consequently a critical evaluation of the methodological quality of available systematic reviews, including those upon which these recommendations are based, was conducted.


METHODS
Articles meeting the minimal criteria to be considered a systematic review were included for a best evidence synthesis, umbrella review of secondary studies. The primary outcome measure was "any recommendation addressing the continuation, or not, of school screening programs". Multiple general bibliographic databases, guideline registries, as well as websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology of included reviews. Venn diagrams were created to examine potential overlaps across included papers within different reviews.


RESULTS
Six reviews undertaken between 2002 and 2011, scored as moderate to low quality, were included. The 2012 US Preventive Services Task Force recommendation against screening was found to be based on an outdated (2004) low-quality review, whilst two higher quality and more recent (2009 and 2010) reviews support the continuation of school screening programs.


CONCLUSIONS
As the existing recommendations supporting screening are based on moderate quality evidence whilst the recommendations against screening are based on low-quality evidence, the latter recommendations appear to be both unconvincing and methodologically invalid.
Faculty of Physical Education in Biała Podlaska, Institute of Physiotherapy, Warsaw University School of Physical Education, ul. Akademicka 2, 21-500, Biała Podlaska, Poland, maciej.plaszewski@awf-bp.edu.pl.
Maciej
M
Płaszewski
Josette
J
Bettany-Saltikov
D000293:Adolescent; D019317:Evidence-Based Medicine; D006801:Humans; D008403:Mass Screening; D012572:School Health Services; D012600:Scoliosis / Q000175:diagnosis*