Observer reliability between juvenile and adolescent idiopathic scoliosis in measurement of stable Cobb's angle

Abstract

It is a measurement of Cobb's angles between adolescent (AIS) and juvenile (JIS) idiopathic scoliosis who had stable curves (variation < 5 degrees) in more than three visits. Main objective of this paper is to measure inter- and intra-observer reliability of measurements between AIS and JIS who had stable curves in regular follow-up. Twenty-nine JIS and 44 AIS patients who had stable curves without bracing were identified using PACS system. Two observers independently measured Cobb's angle twice on first, during follow-up and final radiogram using computer-based digital radiogram. Both observers were given pre-decided level of upper and lower end plates. Inter- and intra-observer reliability of the measurement was calculated using Pearson correlation-coefficient test between JIS and AIS group. There was no significant difference in Cobb's angle in all measurements by both observers either in JIS (p = 0.756, range 0.706-0.815; ANOVA) or AIS (p = 0.871, range 0.795-0.929; ANOVA) group which suggested that there is no significant difference in Cobb's angle in repeated measurements. Intra-observer reliability for JIS (r = 0.600, range 0.521-0.751; Pearson test) was less than AIS (r = 0.969, range 0.943-0.984; Pearson test); and similarly, inter-observer reliability for JIS (r = 0.547, Pearson test) was also less than AIS (r = 0.961, Pearson test) which indicates that Cobb's angle measurement is less reliable in patients who have juvenile idiopathic scoliosis. Using the identical condition for measurements in both the groups, we could find only one reason for less reliability in JIS group and that is poor demarcation of the vertebral end-plates in this group. This poor inter- and intra-observer reliability in JIS due to ill-defined endplates can be reduced by measuring all previous curves along with latest curves at the same time during the follow-up of patients with JIS to decide about the progression of curves and treatment options.