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Study finds smartphone apps to be effective, accurate scoliosis screening tools

Two iPhone operating system applications designed to screen for scoliosis outperformed their Android counterparts in a recently presented study and according to investigators they offered similarly accurate outcomes when compared to the traditional method of scoliosis screening —a scoliometer.

“The Apple applications have the minimum bias, maximum precision and maximum accuracy. There was no difference between the most expensive application and the cheapest,” Ashish Patel, MD, of SUNY Downstate Medical Center, in Brooklyn, N.Y., said at the American Academy of Orthopaedics Surgeons Annual Meeting, where he presented results of the study.

“We think that we can use these scoliometer applications that you find on these smartphones for scoliosis screenings as part of a study or in the clinical office. The iPhone applications were found to be more superior to the Galaxy S3 (Samsung) applications. The applications are cheap and readily available,” Patel said.

Future of scoliosis screening
Investigators used five smartphone applications to measure rib hump angles during the Adam’s screening test for scoliosis; two applications with the Apple iPhone 5 and three applications used with the Samsung Galaxy S3 smartphone.
Research has shown that 84% of orthopedists use a smartphone and 53% of them use a smartphone during their clinical practice, Patel said.

Our primary objective was to investigate whether scoliometer applications on a smartphone could appropriately reproduce measurements from a scoliometer. Our secondary outcomes were to see if there were differences in performance between different apps and to compare Apple and Samsung apps,” he said.

Patel and colleagues randomized 18 angles between 0° and 30° and used calibrated cylinders to obtain the corresponding heights. The stacked cylinders were placed on top of sine bars and measurements of the angles were then made with each smartphone application. The investigators then compared the measurements with those of a traditional scoliometer.

A cheap and accurate option
The results of the study showed the two Apple applications outperformed the Android applications in accuracy, precision and bias. In fact, the Apple applications also outperformed the traditional scoliometer in all facets as well, based on the results.

Spearman’s rank correlation coefficient between bias and angle was 0.31 (P < 0.001), which meant the applications tended to overestimate for larger angles rather than smaller ones. Patel noted the square root of mean squared error showed the Apple applications were more accurate than the other apps used. “Taking a look at the calibration, closer to 1 in terms of slope means we have a complete unity between the application and the gold standard measurement. The Apple outperforms all other methods of measurement,” Patel said. The apps studied, which were the ScolioTrack, Scoligauge, scoliometer smartphone app, and Scoliosis Measurement app, ranged in price from no cost to $7.99, and a traditional scoliometer costs $40 to $50, Patel said. The ScolioTrack app is designed for use with both iPhone and Samsung devices, but Patel said the researchers could only get it to work for the iPhone. They also used the Scoligauge app with an iPhone in the study, but the remainder of the apps were used with Samsung devices. – by Robert Linnehan References:
Nazri Q. Paper #534. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
For more information:
Ashish Patel, MD, can be reached at SUNY Downstate Medical Center, 450 Clarkson Ave., Suite 30, Brooklyn, NY 11203; email:
Disclosure: Patel has no relevant financial disclosures.

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