title: Psychometric evaluation of spinal assessment methods to screen for scoliosis in children and adolescents with cerebral palsy.
abstract: BACKGROUND
  In cerebral palsy (CP) there is an increased risk of scoliosis. It is important to identify a progressive scoliosis early-on because the results of surgery depend on the magnitude of the curve. The Swedish follow-up program for cerebral palsy (CPUP) includes clinical examinations of the spine. The reliability and validity of the assessment method have not been studied. In this study we evaluate the interrater reliability of the clinical spinal examination used in CPUP and scoliometer measurement in children with CP and we evaluate their validity compared to radiographic examination.
  
  
  METHODS
  Twenty-eight children (6-16 years) with CP in Gross Motor Function Classification System levels II-V were included. Clinical spinal examinations and scoliometer measurements in sitting position were performed by three independent examiners. The results were compared to the Cobb angle as determined by radiographic measurement. Interrater reliability was calculated using weighted kappa. Concurrent validity was analyzed using the Cobb angle as gold standard. Sensitivity, specificity, area under receiver operating characteristic curves (AUC) and likelihood ratios (LR) were calculated. Cut-off values for scoliosis were set to ≥ 20° Cobb angle and ≥ 7° scoliometer angle.
  
  
  RESULTS
  There was an excellent interrater reliability for both clinical examination (weighted kappa = 0.96) and scoliometer measurement (weighted kappa = 0.86). The clinical examination showed a sensitivity of 75 % (95 % CI: 19.4-99.4 %), specificity of 95.8 % (95 % CI: 78.9-99.9 %) and an AUC of 0.85 (95 % CI: 0.61-1.00). The positive LR was 18 and the negative LR was 0.3. The scoliometer measurement showed a sensitivity of 50 % (95 % CI: 6.8-93.2 %), specificity of 91.7 % (95 % CI: 73.0-99.0 %) and AUC of 0.71 (95 % CI: 0.42-0.99). The positive LR was 6 and the negative LR was 0.5.
  
  
  CONCLUSIONS
  The psychometric evaluation of the clinical examination showed an excellent interrater reliability and a high concurrent validity compared to the Cobb angle. The findings should be interpreted cautiously until research with larger samples may further quantify the psychometric properties. Clinical spinal examinations seem appropriate as a screening tool to identify scoliosis in children with CP.
authors.affiliation: Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. mans.persson-bunke@skane.se.|Department of Orthopaedic, Skane University Hospital, SE 221 85, Lund, Sweden. mans.persson-bunke@skane.se.
authors.forename: Måns
authors.initials: M
authors.lastname: Persson-Bunke
authors.affiliation: National Competence Center for Quality Registers, Lund University, University Hospital, S-221 85, Lund, Sweden. tc@rcsyd.se.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czuba
authors.affiliation: Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. gunnar.hagglund@med.lu.se.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Hägglund
authors.affiliation: Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. elisabet.rodby_bousquet@med.lu.se.|Centre for Clinical Research, Uppsala University, County Hospital, S-721 89, Västerås, Sweden. elisabet.rodby_bousquet@med.lu.se.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Rodby-Bousquet
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D011594:Psychometrics; D011859:Radiography; D015203:Reproducibility of Results; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D013131:Spine / Q000000981:diagnostic imaging*