Purpose: Effective communication with patients regarding long-term conservative treatment for idiopathic scoliosis necessitates an understanding of its natural history. Existing predictive models have limitations in this regard. Our study aimed to develop and evaluate the reliability and utility of the Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool. Methods: IS-GROWTH development and validation involved consecutive untreated patients with radiographs taken at and prior to the first consultation. To construct the model, we calculated the minimum and maximum progression of patients grouped by 10° Cobb angle range and growth phases. IS-GROWTH is developed for each patient, incorporating the expected progression of each growth phase into the preceding one. For temporal validation, we included patients whose data were obtained after the development of IS-GROWTH, comparing IS-GROWTH predictions with natural history. We calculated the percentage of correct predictions and applied the chi-square test. We also examined the distribution of natural history within IS-GROWTH. Finally, we piloted the tool's usefulness for communication with patients among a group of physicians using it for several years. Results: To develop IS-GROWTH, we analysed 3,184 radiographs from 1,818 participants, spanning from infancy to adolescence. For validation, we included 552 patients and found an accuracy of 95% (95% Confidence Interval, 93-97%) after adjusting for the 5° radiographic measurement error. Nineteen physicians (7.3±5.8 years’ experience) reported using IS-GROWTH in 30% of their patients (range 5-95%) and found it most useful during follow-up (84%) to motivate patients (79%). Conclusion: IS-GROWTH is reliable and useful. We now regularly use it to deepen our understanding of individual natural history and enhance communication with patients.
The "Idiopathic Scoliosis Graphical Representation of Worsening Trend of Natural History" (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth. 2025 SOSORT award winner
Negrini, Francesco
Secondo
Writing – Original Draft Preparation
;
2025-01-01
Abstract
Purpose: Effective communication with patients regarding long-term conservative treatment for idiopathic scoliosis necessitates an understanding of its natural history. Existing predictive models have limitations in this regard. Our study aimed to develop and evaluate the reliability and utility of the Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool. Methods: IS-GROWTH development and validation involved consecutive untreated patients with radiographs taken at and prior to the first consultation. To construct the model, we calculated the minimum and maximum progression of patients grouped by 10° Cobb angle range and growth phases. IS-GROWTH is developed for each patient, incorporating the expected progression of each growth phase into the preceding one. For temporal validation, we included patients whose data were obtained after the development of IS-GROWTH, comparing IS-GROWTH predictions with natural history. We calculated the percentage of correct predictions and applied the chi-square test. We also examined the distribution of natural history within IS-GROWTH. Finally, we piloted the tool's usefulness for communication with patients among a group of physicians using it for several years. Results: To develop IS-GROWTH, we analysed 3,184 radiographs from 1,818 participants, spanning from infancy to adolescence. For validation, we included 552 patients and found an accuracy of 95% (95% Confidence Interval, 93-97%) after adjusting for the 5° radiographic measurement error. Nineteen physicians (7.3±5.8 years’ experience) reported using IS-GROWTH in 30% of their patients (range 5-95%) and found it most useful during follow-up (84%) to motivate patients (79%). Conclusion: IS-GROWTH is reliable and useful. We now regularly use it to deepen our understanding of individual natural history and enhance communication with patients.
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