The ethics of bracing (and PT) with a Scoliscore <41

[mamandcrm]

It seemed to me that the initial focus of the thread was just that, should it be the sole diagnostic criteria for kids with low scores and no other risk factors--meaning straight- up AIS. Low score = no brace. I personally don't think it's that simple but I thought that was the initial suggestion posed. I would not think the manufacturer would suggest in their literature that it should be the sole diagnostic tool as that would just open them up to lawsuits.

[hdugger]

Bracing and the scolioscore

I guess I had glossed over the fact that this was a retrospective study.

Given that, I can't see how they could have controlled for the effects of bracing. Either:

1) They picked children, even children with large curves, who had never been braced (which would have to be a less than random sampling of the available curves)

or

2) They included children who had been braced (which would be assumed to change their final curve.)

Is there some third choice I'm not seeing?

[hdugger]

It seemed to me that the initial focus of the thread was just that, should it be the sole diagnostic criteria for kids with low scores and no other risk factors--meaning straight- up AIS. Low score = no brace. I personally don't think it's that simple but I thought that was the initial suggestion posed. I would not think the manufacturer would suggest in their literature that it should be the sole diagnostic tool as that would just open them up to lawsuits.

Right, the manufacturer is not suggesting that. The idea that children with low scores should be unbraced based solely on their score has only been presented by Pooka, and not by test manufacturer.

[hdugger]

Actually, I just looked at the Lonner video, and he doesn't say that he took a child out of the brace based on the scolioscore. He says that he looked at a whole set of factors, and based on all of those factors, he made the decision.

[Pooka1]

Actually, I just looked at the Lonner video, and he doesn't say that he took a child out of the brace based on the scolioscore. He says that he looked at a whole set of factors, and based on all of those factors, he made the decision.

Did he say what the factors were? (Maybe I should just view the video again...)

[Pooka1]

Okay I watched the video. That girl has multiple family members on BOTH sides of the family affected by scoliosis and Lonner took her out of the brace.

My question then becomes who does he leave in a brace with a score of 16 if not her? I wonder if it is anyone at all.

He did say he relied on other factors but I would like to know what they are in this case. Either Scoliscore has a 100% prediction rate for AIS girls with small curves in the calibration set or it doesn't.

[hdugger]

I can't answer any of those questions. All I know is that the person who developed the test isn't saying that he's relying solely on its results. I'm guessing there's a reason for that.

[Pooka1]

Actually, I just looked at the Lonner video, and he doesn't say that he took a child out of the brace based on the scolioscore. He says that he looked at a whole set of factors, and based on all of those factors, he made the decision.

He did say that but he also made a remark that Scoliscore had the ability to be a game-changer (he didn't use that word but it was an equivalent word that I can't recall).

If scoliscore wasn't the reason he took that girl out of brace then the actual reason is not obvious from that video despite what he said.

[hdugger]

I'm guessing their hedging their bets until the *real* results of the scolioscore test - how it predicts curves going forward - are in. (See my notes above about bracing for one of many reasons why these results can't possibly be 100% solid for any score.)

That's supported by another quote I saw from him saying a child with a low score could have xrays "every 8 to 12 months instead of every 3 to 6 months."

I wonder if it's made clear to parents that their low scoring child's curve could increase 20 degrees (given that they came in with a 20 degree curve) and still be considered a complete success.

[skevimc]

I guess I had glossed over the fact that this was a retrospective study.

Given that, I can't see how they could have controlled for the effects of bracing. Either:

1) They picked children, even children with large curves, who had never been braced (which would have to be a less than random sampling of the available curves)

or

2) They included children who had been braced (which would be assumed to change their final curve.)

Is there some third choice I'm not seeing?

The genetic markers they are looking at/for are stable and thus bracing or any other type of treatment would not change over time.

[skevimc]

He did say he relied on other factors but I would like to know what they are in this case. Either Scoliscore has a 100% prediction rate for AIS girls with small curves in the calibration set or it doesn't.

It doesn't. Assuming I understand what you're asking or saying. The three cohorts they used to test/validate the AIS-PT were selected in order to model the standard populations. 1. those referred to the doctor by in-school screening. 2. those who are seen in an active spine surgery clinic. 3. Same as #2 but with males instead of females.

In the validation tests, group 1 had 0 severe curves with an AIS-PT <41. Groups 2 and 3 had a total of 5 with a severe curve and an AIS-PT <41.

You are wondering if the scoliscore has a 100% accuracy/prediction rate for small curves, but that's not what the study was about.

[Pooka1]

I'm guessing their hedging their bets until the *real* results of the scolioscore test - how it predicts curves going forward - are in. (See my notes above about bracing for one of many reasons why these results can't possibly be 100% solid for any score.)

Actually, in the BIOCHEMISTRY game, results CAN be 100%. This is molecules we are discussing.

That's supported by another quote I saw from him saying a child with a low score could have xrays "every 8 to 12 months instead of every 3 to 6 months."

Yes. I suspect all such comment are CYA - Cover Your Bases - when dealing with the group with 100% negative prediction in the calibration set. But all results are provisional still and they nee dot constantly accumulate data.

I wonder if it's made clear to parents that their low scoring child's curve could increase 20 degrees (given that they came in with a 20 degree curve) and still be considered a complete success.

I would be shocked if the test wasn't completely explained to them. Surgeons aren't trying to hide anything. They have no reason to do so and every reason not to do so.

[Pooka1]

It doesn't. Assuming I understand what you're asking or saying. The three cohorts they used to test/validate the AIS-PT were selected in order to model the standard populations. 1. those referred to the doctor by in-school screening. 2. those who are seen in an active spine surgery clinic. 3. Same as #2 but with males instead of females.

In the validation tests, group 1 had 0 severe curves with an AIS-PT <41. Groups 2 and 3 had a total of 5 with a severe curve and an AIS-PT <41.

You are wondering if the scoliscore has a 100% accuracy/prediction rate for small curves, but that's not what the study was about.

All I have at the moment is the abstract. Can you address what that says w.r.t. to what the article says?

[hdugger]

The genetic markers they are looking at/for are stable and thus bracing or any other type of treatment would not change over time.

I didn't mean that the markers would change with bracing, but rather that a braced child with a 35 degree curve and an unbraced child with a 35 degree curve would end up in same low risk pool when studied retrospectively, but they might have a very unequal risk when studied prospectively with bracing controlled for.

That is, the braced 35 degree child, if unbraced, might have ended up with a 50 degree curve, and thus would not be included with the low-risk group.

Am I missing something here?

[Pooka1]

I didn't mean that the markers would change with bracing, but rather that a braced child with a 35 degree curve and an unbraced child with a 35 degree curve would end up in same low risk pool when studied retrospectively, but they might have a very unequal risk when studied prospectively with bracing controlled for.

That is, the braced 35 degree child, if unbraced, might have ended up with a 50 degree curve, and thus would not be included with the low-risk group.

Am I missing something here?

I think we all have to read the paper. If Dr. McIntire is right, I have misunderstood the abstract. Completely.

(off to re-check that English is my first language...)