A STUDY OF THE DIAGNOSTIC-ACCURACY AND RELIABILITY OF THE SCOLIOMETERAND ADAMS FORWARD BEND TEST

Study Design. Study of the diagnostic accuracy and interexaminer relia bility of scoliosis diagnostic tests. Objectives. To estimate the sens itivity, specificity, and predictive value of the Scoliometer (Nationa l Scoliosis Foundation, Watertown, MA) and Adam's forward bend test in diagnosing scoliosis, and to determine the interexaminer reliability of the Scoliometer and Adam's forward bend test. Summary of Background Data, Exposure to diagnostic radiation in patients with adolescent id iopathic scoliosis may result in a small but significant increase in c ancer rates. The full-spine radiographic examination remains the stand ard procedure for the assessment of scoliosis. There is a need for a v alid and reliable noninvasive test to assess scoliosis. Methods. Two e xaminers independently assessed 105 patients presenting to a scoliosis clinic for trunk asymmetry with Adam's forward bend test and axial tr unk rotation with the Scoliometer. The Cobb method served as the gold standard. Results, The interexaminer agreement for the Scoliometer is excellent in the thoracic spine and substantial in the lumbar spine. T he interexaminer measurement error shows poor precision for thoracic a nd lumbar Scoliometer measurements. The interexaminer agreement for Ad am's forward bend test is substantial in the thoracic spine and poor i n the lumbar spine. Adam's forward bend test is more sensitive than th e Scoliometer in detecting thoracic curves measuring 20 degrees or mor e by the Cobb method. Receiver operating characteristic curve analysis suggests that the use of the Scoliometer marginally improves the abil ity of diagnosing a scoliosis in the thoracic spine. Conclusions. The Scoliometer and Adam's forward bend tests have adequate interexaminer reliability for the assessment of thoracic curves. The Scoliometer has better interexaminer agreement in the lumbar spine. However, the Scol iometer has a high level of interexaminer measurement error that limit s its use as an outcome instrument. Because Adam's forward bend test i s more sensitive than the Scoliometer, the authors believe that it rem ains the best noninvasive clinical test to evaluate scoliosis.