A Meta-Analysis of the Clinical Effectiveness of School Scoliosis Screening

STUDY DESIGN: A meta-analysis that systematically reviewed the evaluation studies of a scoliosis screening program reported in the literature. OBJECTIVE: To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported. METHODS: Data sources included 3 databases, namely, PubMed, Google scholar, CINAHL database, and the references from identified reviews and studies. Studies were included if: (1) they adopted a retrospective cohort design; (2) were screened using either the forward bending test (FBT), angle of trunk rotation, or Moiré topography; (3) reported results of screening tests and radiographic assessments; (4) screened adolescents only; (5) reported the incidence of curves with a minimum Cobb angle of 10 degrees or greater; and (6) reported the number of referrals for radiography. Reviews, comments, case studies, and editorials were excluded. RESULTS: Thirty-six studies, including 34 from the 775 initially identified studies and 2 from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive values for detecting curves > or =10 degrees , curves > or =20 degrees , and treatment were 28.0%, 5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that programs using the FBT alone reported a higher referral rate (odds ratio OR = 2.91) and lower positive predictive values for curves > or =10 degrees (OR = 0.49) and curves > or =20 degrees (OR = 0.34) than programs using other tests. Only one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the specificity was not reported. No severe publication bias was noted. CONCLUSION: The use of the FBT alone in school scoliosis screening is insufficient. We need large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening.