The role of school medicine in the early detection and management of adolescent idiopathic scoliosis

Abstract

Objective To analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists. Methods Historical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation. Results In the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% ( P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls ( P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only. Conclusion While actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.

The Impact of Physical Activity on Adolescent Idiopathic Scoliosis

“…This study and earlier investigations [ 13 ] reveal an increasing prevalence rate of presumed AIS, mostly among inactive or just recreationally active pupils, particularly girls. Although presumed scoliosis prevalence was higher in certain sports, we could not establish the link between the predominant character of physical activity (e.g., asymmetrical vs. symmetrical) and scoliosis.…”

“…Therefore, our preventive strategies encourage physical activity. Another preventive tool in our country is continuous scoliosis surveillance, covering the main growth stages [ 9 , 13 ]. Even though FBT is not perfectly accurate, it proved its worth in screening large samples of schoolchildren [ 13 ].…”

“…Croatia has been performing the HBSC survey since 2002, and these gender and activity differences are constant. Following the decline in physical activity throughout the years [ 3 , 12 ], an increase in AIS prevalence over 10 years was noted, especially in girls [ 13 ]. Our findings, along with HBSC’s results among Croatian schoolchildren, should entice more engagement in physical activity promotion by our school doctors, particularly because growing numbers of children seek absolution from physical education in our schools, for which school doctors give permission.…”

“…This cross-sectional study included 18,216 elementary school pupils (5th, 6th, and 8th grades), aged around 11, 12, and 14 years, respectively, from four counties in Croatia. FBT, a simple and reliable screening test for AIS with a positive predictive value of 84.7% [ 13 ], is standard in our country. Children with a positive test determined by the school medicine specialists during routine systematic examinations ( n = 1053) were considered cases (presumed scoliosis).…”

“…Physical inactivity was observed more often in girls than in boys [ 12 ]. Accordingly, the latest research on the prevalence of AIS in Croatia showed an increase in the analyzed 10-year period from 4.9% to 5.8%, and its prevalence rocketed in girls [ 13 ].…”