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Intra- and inter-rater reliability of spinal flexibility measurements using ultrasonic (US) images for non-surgical candidates with adolescent idiopathic scoliosis: a pilot study

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Abstract

Purpose

This study aimed to determine the intra- and inter-rater reliabilities of spinal flexibility measurements using ultrasound imaging on non-surgical candidates with adolescent idiopathic scoliosis (AIS).

Methods

Twenty-eight consecutive consented AIS subjects (25 F; 3 M) were recruited; 24 subjects’ data were used for analysis. This study explored curve magnitude differences between standing, prone and voluntary maximum side-bending postures to assess the reliability of spinal flexibility (SF). Two raters were included in this study. Four flexibility indices, PRSI, BRPI, B-PRSI, BRSI, based on the postural changes from standing to prone and from prone to bending position were defined. The reliability analysis was evaluated using the intra-class correlation coefficient (ICC) [1, 2] and the standard error of measurements (SEM).

Results

The ICC [1, 2] values of the intra-rater (R2 only) and inter-rater (R1 vs R2) reliabilities of the measurements (PRSI, BRPI, B-PRSI, BRSI) were (0.82, 0.64, 0.78, 0.91) and (0.78, 0.76, 0.84, 0.94), respectively. Among the four indices, the BRPI had the highest SEM values 1.42, and 0.73 for intra- and inter-raters results, respectively, while BRSI had the lowest SEM 0.04 and 0.02 for intra- and inter-rater, respectively.

Conclusions

The BRPI, BRSI and B-PRSI could be measured reliably on US images when the Cobb angle at prone position was not close to zero. Using these three indices, information may provide more comprehensive information about the SF. Validity of spinal flexibility measurements still needed to be confirmed with a clinical study with more subjects.

Graphical abstract

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Abbreviations

B-PRSI:

The difference between BRSI and PRSI indices

BRPI:

Bending Relative to Prone Index

BRSI:

Bending Relative to Standing Index

ICC:

Intra-class correlation coefficient

L:

Lumbar

MAD:

Mean absolute difference

MT:

Main Thoracic

PA:

Posteroanterior

PRSI:

Prone Relative to Standing Index

R1:

Rater 1

R2:

Rater 2

SD:

Standard Deviation

SEM:

Standard error of measurements

SF:

Spinal flexibility

T1:

Trial 1

T2:

Trial 2

TL:

Thoracolumbar

US:

Ultrasonic

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada

    Mahdieh Khodaei, Lawrence H. Le & Edmond H. M. Lou

  2. Department of Electrical and Computer Engineering, 11-371 Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 St, Edmonton, AB, T6G 1H9, Canada

    Edmond H. M. Lou

  3. Department of Surgery, University of Alberta, Edmonton, Canada

    Doug Hill & Rui Zheng

Authors
  1. Mahdieh Khodaei
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  2. Doug Hill
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  3. Rui Zheng
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  4. Lawrence H. Le
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  5. Edmond H. M. Lou
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Correspondence to Edmond H. M. Lou.

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Khodaei, M., Hill, D., Zheng, R. et al. Intra- and inter-rater reliability of spinal flexibility measurements using ultrasonic (US) images for non-surgical candidates with adolescent idiopathic scoliosis: a pilot study. Eur Spine J 27, 2156–2164 (2018). https://doi.org/10.1007/s00586-018-5546-8

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  • DOI: https://doi.org/10.1007/s00586-018-5546-8

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