Scoliosis Research Society-Schwab Adult Spinal Deformity Classification A Validation Study
Scoliosis Research Society-Schwab Adult Spinal Deformity Classification A Validation Study
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DOI：
10.1097/brs.0b013e31823e15e2
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发表时间：
2012-05-20
期刊：
影响因子：
3
通讯作者：
Lafage, Virginie
中科院分区：
文献类型：
--
作者：
Schwab, Frank;Ungar, Benjamin;Lafage, Virginie
研究设计。比率间和比率内变异性研究。目的。在脊柱侧凸研究协会努力的基础上，本研究试图确定新的成人脊柱畸形（ASD）分类系统是否清晰可靠。背景资料摘要。成人ASD的分类可以有几个目的，包括临床实体的一致特征，比较不同治疗的基础，推荐治疗。虽然小儿脊柱侧凸的分类已经很好地建立了，但ASD的分类仍在发展中。Schwab等人先前开发的分类符合临床相关性，但不包括盆腔参数，而盆腔参数在最近的研究中显示与健康相关的生活质量指标有很大的相关性。该研究由脊柱侧凸研究学会成人畸形委员会发起，修订了先前发表的分类，纳入骨盆参数。使用来自成人畸形患者多中心数据库的与健康相关的生活质量分析来确定修饰因子的截止值。9位读者对21例预先标记的病例分别进行两次评分，间隔约1周。分别确定曲线类型和每个修饰符的内部和内部变异性和一致性。Fleiss kappa用于可靠性测量，0.00至0.20被认为是轻微的，0.21至0.40被认为是一般的，0.41至0.60被认为是中等的，0.61至0.80被认为是相当的，0.81至1.00几乎是完全一致的。曲线型的评分间kappa分别为0.80和0.87，修正值kappa分别为0.75和0.86,0.97和0.98，骨盆发生率减去腰椎前凸（PI-LL），骨盆倾斜（PT）和矢状垂直轴（SVA）分别为0.96和0.96。到第二次阅读时，所有读者一致识别曲线类型的比例为66.7%，PI-LL为71.4%，PT为95.2%，SVA为90.5%。在所有读者中，曲线型的评分者kappa平均为0.94，PI-LL为0.88，PT为0.97，SVA为0.97。本研究的数据表明，曲线类型和每个修正因子具有良好的内部和内部可靠性和一致性。高可靠性表明该分类系统的应用简单、一致。
Study Design. Inter- and intra-rater variability study.Objective. On the basis of a Scoliosis Research Society effort, this study seeks to determine whether the new adult spinal deformity (ASD) classification system is clear and reliable.Summary of Background Data. A classification of adult ASD can serve several purposes, including consistent characterization of a clinical entity, a basis for comparing different treatments, and recommended treatments. Although pediatric scoliosis classifications are well established, an ASD classification is still being developed. A previous classification developed by Schwab et al has met with clinical relevance but did not include pelvic parameters, which have shown substantial correlation with health-related quality of life measures in recent studies.Methods. Initiated by the Scoliosis Research Society Adult Deformity Committee, this study revised a previously published classification to include pelvic parameters. Modifier cutoffs were determined using health-related quality of life analysis from a multicenter database of adult deformity patients. Nine readers graded 21 premarked cases twice each, approximately 1 week apart. Inter-and intra-rater variability and agreement were determined for curve type and each modifier separately. Fleiss' kappa was used for reliability measures, with values of 0.00 to 0.20 considered slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 to 1.00 almost perfect agreement.Results. Inter-rater kappa for curve type was 0.80 and 0.87 for the 2 readings, respectively, with modifier kappas of 0.75 and 0.86, 0.97 and 0.98, and 0.96 and 0.96 for pelvic incidence minus lumbar lordosis (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), respectively. By the second reading, curve type was identified by all readers consistently in 66.7%, PI-LL in 71.4%, PT in 95.2%, and SVA in 90.5% of cases. Intra-rater kappa averaged 0.94 for curve type, 0.88 for PI-LL, 0.97 for PT, and 0.97 for SVA across all readers.Conclusion. Data from this study show that there is excellent inter-and intra-rater reliability and inter-rater agreement for curve type and each modifi er. The high degree of reliability demonstrates that applying the classification system is easy and consistent.