Reliability measure of the rib cage deformity by a postural assessment software in patients with adolescent idiopathic scoliosis

Abstract Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that generates changes in the biomechanics of the rib cage. Digital photogrammetry enables the recording of subtle changes and the interrelationship between parts of the human body that are difficult to measure by other means. The aim of this study was to create angles and thoracic distances and to evaluate the interobserver and intraobserver reliability of these measurements using the Software de Avaliação Postural (SAPO) in patients with AIS. This cross-sectional study evaluated 30 individuals aged between 11 and 18 years with AIS. We used SAPO with the thoracic markers in the form of angles (A) and distances (D) with involves structures like acromion, manubrium, xiphoid process, lower angle of the scapula, last false rib, anterior iliac spine process. Two experienced observers (A and B) analyzed the photos and all followed the same routine of analysis. Intraobserver and interobserver reproducibility was assessed by the Bland-Altman plot and intraclass correlation coefficient (ICC), while intraobserver and interobserver reliability was assessed by the T-Test and Wilcoxon's Test. A high repeatability index was obtained among the evaluations, with twelve of the sixteen variables considered as reliable in all statistical tests. The interobserver analyzes presented excellent correlation coefficients (ICC), showing good reliability for six of the sixteen variables proposed. The SAPO method presented good reproducibility and reliability for most of the thoracic markers created, showing that photogrammetry may be a complementary tool in the evaluation of thoracic alterations in patients with AIS.

摘要 青少年特发性脊柱侧凸（Adolescent idiopathic scoliosis, AIS）是一类可引发胸廓生物力学改变的脊柱三维畸形。数字摄影测量技术能够记录人体各部位间难以通过其他手段测量的细微变化及其相互关系。本研究旨在借助姿势评估软件（Software de Avaliação Postural, SAPO），为AIS患者建立角度与胸廓距离测量指标，并评估此类测量的观察者内与观察者间信度。本横断面研究纳入了30名年龄介于11至18岁的AIS患者。研究采用SAPO软件，以角度（A）与距离（D）的形式设置胸廓标记点，涵盖的结构包括肩峰、胸骨柄、剑突、肩胛骨下角、最后一对假肋及髂前上棘。两名经验丰富的观察者（A与B）按照统一的分析流程对受试者照片进行评估。本研究通过布兰德-奥特曼图（Bland-Altman plot）与组内相关系数（intraclass correlation coefficient, ICC）评估观察者内与观察者间可重复性，通过t检验（T-Test）与威尔科克森检验（Wilcoxon's Test）评估观察者内与观察者间信度。结果显示，各项评估间具有较高的重复性指数，16项变量中有12项在所有统计检验中均被判定为可靠。观察者间分析呈现出优异的相关系数（ICC），其中6项拟定变量具备良好的信度。本研究表明，SAPO方法在多数拟定的胸廓标记点测量中展现出良好的可重复性与信度，提示数字摄影测量技术可作为AIS患者胸廓改变评估的补充工具。