Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method.
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Date
2002
Citation
Burwell, R.G., Aujla, R.K., Cole, A.A., Kirby, A., Pratt, R.K. and Webb, J.K. (2002) ‘Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method’, in International Research Society of Spinal Deformities and T.B. Grivas (eds) Research into spinal deformities 4. Amsterdam ; Washington, D.C. : Tokyo: IOS Press : Ohmsha (Studies in health technology and informatics, v. 91).
Abstract
This paper evaluates a new real-time ultrasound method to assess the difference between axial spinal (laminal) rotation and rib rotation at the apex of the scoliosis curve. An Aloka SSD 500 portable ultrasound machine with a veterinary long (172mm) 3.5 MHz linear array transducer was used to assess the reproducibility of the method in 13 preoperative patients with AIS. With the subject in a prone position and her head supported, readings of laminal and rib rotation were made directly on the back at 18 and 12 levels respectively The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). All the readings were made by one observer (ASK). After plotting on graphs three levels of maximal difference between spine rotation and rib rotation about the apex were chosen visually by one observer (RGB) for which the mean apical spine-minus-rib rotation difference (SRRD) was calculated for each repeat. Findings for apical SRRDs. The mean apical SRRDs for the two repeats are 7.1 degrees and 6.9 degrees (range 2-18 degrees) with coefficients of variation of 49% and 62% respectively. Reproducibility. Graphic representation of spinal and rib rotation by 12 levels shows a fairly good agreement between repeats for most subjects. Spinal rotation is always greater than rib rotation. A paired t-test for the mean apical SRRD of the repeats shows no significant difference. Linear regression analysis of the mean apical SRRD repeats correlate significantly (r=0.70, P=0.008) with a residual mean square of 6.9 degrees (rms = 2.6 degrees). The technical error of the measurement (TEM) is 2.3 degrees and coefficient of reliability (R) 0.66. Conclusions. Real-time ultrasound can assess the difference between spinal and rib rotation about the apex of the scoliosis curve without the altered position detectably affecting the findings. The error (2-3 degrees) is high relative the mean apical SRRD (6-7 degrees). The apical SRRD findings have relevance to the pathogenesis of AIS.
Research evidence suggests that UK consumers are facingsignificant problems with goods and services and are inneed of information and advice to avoid or redress suchsituations. Consumers are not always aware of their rightsnor where they can access consumer advice services. In2000, the Department of Trade and Industry launched theConsumer Support Network (CSN) programme in Great Britainto improve consumer access to expert, accurate andtimely advice. One challenge faced by these Networks andmany other agencies is to assess the needs of consumersfor consumer information and advice services. A needsassessment is required as a key element in the effectiveplanning and development of services in each Network at alocal level. The focus of the needs assessment at the locallevel is to encourage Networks to consider suitable solutions to meet the needs of people in their communities. This paper provides a review of the development of Consumer Support Networks in Great Britain and discusses the importance of needs assessment to service providers such as CSNs and other agencies. It reveals the complexity associated with conducting effective needs assessments including the various aspects of needs, consumer segmentation and characteristics of consumer information and advice. Further research is being carried out at Queen Margaret University College, UK, with a view to the development of a scientific model for the assessment of need for consumer information and advice services.
Research evidence suggests that UK consumers are facingsignificant problems with goods and services and are inneed of information and advice to avoid or redress suchsituations. Consumers are not always aware of their rightsnor where they can access consumer advice services. In2000, the Department of Trade and Industry launched theConsumer Support Network (CSN) programme in Great Britainto improve consumer access to expert, accurate andtimely advice. One challenge faced by these Networks andmany other agencies is to assess the needs of consumersfor consumer information and advice services. A needsassessment is required as a key element in the effectiveplanning and development of services in each Network at alocal level. The focus of the needs assessment at the locallevel is to encourage Networks to consider suitable solutions to meet the needs of people in their communities. This paper provides a review of the development of Consumer Support Networks in Great Britain and discusses the importance of needs assessment to service providers such as CSNs and other agencies. It reveals the complexity associated with conducting effective needs assessments including the various aspects of needs, consumer segmentation and characteristics of consumer information and advice. Further research is being carried out at Queen Margaret University College, UK, with a view to the development of a scientific model for the assessment of need for consumer information and advice services.