Draft Research Plan

Adolescent Idiopathic Scoliosis: Screening

October 01, 2015

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The figure shows the analytic framework for screening for adolescent idiopathic scoliosis. On the left side, the population represented is asymptomatic children and adolescents ages 10 to 18 years. In the direct pathway, Key Question 1 has an arrow from screening to a) the intermediate outcome of Cobb angle measurement and b) the health outcomes of morbidity, mortality, quality of life, and functioning. In the indirect pathway, Key Question 2 has an arrow from the population to “idiopathic scoliosis,” which represents screening test accuracy. Treatment has a line to a) the intermediate outcome and b) health outcomes (Key Question 3). The harms Key Questions are represented with curved arrows at the bottom of the figure: “harms of screening” (Key Question 5) and “harms of treatment” (Key Question 6).

Text Description.

The figure shows the analytic framework for screening for adolescent idiopathic scoliosis. On the left side, the population represented is asymptomatic children and adolescents ages 10 to 18 years. In the direct pathway, Key Question 1 has an arrow from screening to a) the intermediate outcome of Cobb angle measurement and b) the health outcomes of morbidity, mortality, quality of life, and functioning. In the indirect pathway, Key Question 2 has an arrow from the population to “idiopathic scoliosis,” which represents screening test accuracy. Treatment has a line to a) the intermediate outcome and b) health outcomes (Key Question 3). The harms Key Questions are represented with curved arrows at the bottom of the figure: “harms of screening” (Key Question 5) and “harms of treatment” (Key Question 6).

  1. Does screening for adolescent idiopathic scoliosis improve: a) health outcomes and b) the degree of abnormal spinal curve in childhood or adulthood?
  2. What is the accuracy of screening for adolescent idiopathic scoliosis?
  3. Does treatment of adolescent idiopathic scoliosis with a Cobb angle of less than 50° at diagnosis improve: a) health outcomes and b) the degree of spinal curve in childhood or adulthood?
  4. What is the association between Cobb angle measurement in adolescence and health outcomes in adulthood?
  5. What are the harms of screening for adolescent idiopathic scoliosis?
  6. What are the harms of treatment of adolescent idiopathic scoliosis with a Cobb angle of less than 50° at diagnosis?

The proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

  Include Exclude
Populations KQs 1, 2, 5: Asymptomatic children and adolescents ages 10 to 18 years

KQs 3, 6: Persons with adolescent idiopathic scoliosis diagnosed at ages 10 to 18 years with a Cobb angle of 10° to 50° detected through screening

KQ 4: Persons with adolescent idiopathic scoliosis diagnosed at ages 10 to 18 years with a Cobb angle of 10° to 50°		 Persons with scoliosis of:
  • Neuromuscular etiology (e.g., cerebral palsy, myelomeningocele, muscular dystrophy, spinal muscular atrophy, spina bifida, spinal cord injuries)
  • Congenital etiology (e.g., hemivertebrae, failure of segmentation)
  • Mesenchymal/syndromic etiology (e.g., Marfan syndrome, mucopolysaccharidosis, osteogenesis imperfecta, inflammatory diseases, postoperative)
  • Early-onset idiopathic etiology (infantile [ages 0 to 3 years] or juvenile [ages 4 to 9 years])
Settings
  • Primary care or generalizable to primary care
  • School-based screening programs
  • Countries categorized as “High” on the Human Development Index (as defined by the United Nations Development Programme)
 Specialty care (e.g., surgical clinics and clinics for conditions known to be associated with scoliosis) and other settings with a symptomatic population
Screening tests KQs 1, 2, 5: Forward bend test (with or without scoliometer/inclinometer), surface topography, or other methods (e.g., back-contour device), followed by x-ray for confirmation  

KQ 2: Studies with a reference standard

 KQs 1, 2, 5:
  • X-ray alone
  • Selective screening
Treatments KQs 3, 6:
  • Surgery
  • Nonoperative treatment, including but not limited to: bracing, physical therapy/exercise therapy, and electrical muscle stimulation
  
Comparison KQs 1, 2, 5: Usual care

KQs 3, 6: Observation, usual care

 KQs 1, 2, 5: Studies with no comparator

KQs 3, 6: Comparative effectiveness studies
Harms KQ 5: Any screening harms, including but not limited to: labeling, radiation exposure

KQ 6: Any treatment harms, including but not limited to: psychosocial harms, physiological harms, functioning, or pain

 KQs 5, 6: Studies with no comparator
Outcomes Intermediate outcomes: Cobb angle measurement

Health outcomes:

  • Morbidity (e.g., pulmonary symptoms, hypertension, lumbar radiculopathy)
  • Quality of life
  • Functional outcomes (e.g., pain, musculoskeletal function, activity restriction)
  • Mortality
  
Study design KQs 1–4: Randomized, controlled trials; controlled trials; cohort studies

KQs 5, 6: Randomized, controlled trials; controlled trials; cohort studies; case series

 All KQs: Studies rated as poor quality

KQs 1–4: Case series, cost-effectiveness studies, qualitative study designs