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647
Original Article
Reliability of the original Lehnert-Schroth (LS) scoliosis classification in physiotherapy practice
1) Orttech-plus Rehabilitation Service, Ukraine2) Nan Xiaofeng’s Spinal Orthopedic Workshop, China3) Orthopedic Rehabilitation Service: Alzeyer Str. 23, D-55457 Gensingen, Germany4) The London Orthotic Consultancy, UK5) Lomonosov Moscow State University, Russia
Abstract. [Purpose]The foundations of the scoliosis specific and evidence-based physiotherapyprogramac-cordingtoSchrothistheoriginaltheLehnert-Schroth(LS)classificationwhichisstillinusetoday.ThepurposeofthispaperistotestthereliabilityoftheLSclassificationsystem,usingclinicalandradiologicalimagesofscoliosispatientsasclassifiedbyspecialistexperiencedclinicians.[ParticipantsandMethods]Alistof40picturesofX-Raysandalistof40clinicalpictures(allposteriortrunkimages)ofpatientswithidiopathicscoliosiswereprovidedbythesecondauthor.ThreespecialistprofessionalphysiotherapistsororthotistsratedallclinicalandradiologicalpicturesaccordingtothesetwopatternsoftheLSclassification.[Results]Theintra-observerKappavaluewas0.90(clinical)and1.00(x-rays).Theinter-observerKappavaluesataveragewas0.65(clinical)and0.71(x-rays).[Conclusion]FortheapplicationofclassifyingthepatientswhenprescribingposturaladviceandexercisesfromtheSchrothprogramtheLS-classificationseemsaneasytouseandhighlyreliabletool.Thistestdemonstratedsufficientreliabilitywithrespecttothex-rays,butthetestsoftheclinicalpicturesalone,demonstratedfairlevelsofreliability,whichindi-catesthatitisanappropriatetoolforphysiotherapistswhenanx-rayisnotavailable.Key words:Scoliosis,Physiotherapy,Classification
(This article was submitted Feb. 1, 2020, and was accepted Jul. 17, 2020)
TheoriginalSchrothmethodfirststartedin1921onanin-patientbasisandhassincebeendevelopedfurther3,19).Whilethe original Schrothmethod programwasmainly used for large single thoracic curves (over 60 degreesCobb angle atdiagnosis)inthelate1970stheintermediatedevelopmentalsoincludedmajorlumbarcurvaturesandthiswasthebeginningofthepatternspecificphysiotherapytreatmentofscoliosisandtheseparationof3and4curveclassificationpatterns3,19).Lehnert-Schrothtermedthemajorthoraciccurves(functional)3-curvepatterns(3C)andthemajorlumbaranddoublemajorcurves(functional)4-curvepatterns(4C)3,19,20).
ThemostrecentdevelopmentoftheSchrothmethodtodayistheSchrothBestPracticeprogram3), also including correc-tionsofthesagittalplanedeformityaswellastheoriginalaugmentedcorrectivemovementsandpatternspecificactivitiesofdailyliving(ADLs)startingwiththefirstpublicationsin200621, 22).ThismorerecentdevelopmentalsoencompassesthesimpleLehnert-Schroth(LS)classificationdistinguishingbetween3Cand4Cpatterns3).
Someotherclassificationshavebeendevelopedsincethe1980ssupportingpatternspecificapproachesofsurgery23, 24) and bracetreatment3, 25–27),howeverforphysiotherapytreatmentofanidiopathicscoliosistheLSclassificationwiththesetwodistinctivepatternsisthemostsimplifiedversionandisstillusedworldwidetoday3,19).ThepurposeofthispaperistotestthereliabilityoftheLSclassificationwithrespecttotheclinicalandtheradiologicalaspectsofscoliosispatients.
PARTICIPANTS AND METHODS
DescriptionoftheLS-classification:AccordingtoSchrothterminology3,19),patternspecificphysiotherapyneedstodis-tinguishbetween‘functional3-curvescoliosis’and‘functional4-curvescoliosis’,foritbespecific(Fig.1).Withfunctional3-curvescoliosis, theshoulder-necksection, the thoracicsection,and the lumbo-pelvicsectionare twistedandaskewinfrontal,sagittal,andtransverseplanes(Fig.2).
Anethics approval and consent toparticipatewasnot applicable.Noanimalswereused for studiesof this research.Writteninformedconsentforparticipationinthisstudyhasbeenobtainedfromboththepatientsandtheirparents;Consentforpublication:Writteninformedconsentforpublicationofthepatient’sinformation(X-rays,photos,records,etc.)hasbeenobtainedfromboththepatientsandtheirparents.
In this test the intrarater reliabilityof theLS-classificationwas excellentwith respect to clinicalpictures andx-rays.Interraterreliabilityataveragewasexceedingthelevelofacceptability.Theclassificationhasshowntohaveafairtogoodreliabilityclinicallyandradiologically29,30).Thiscurvepatternspecificclassificationisusedtoprescribeexercisetreatmentapproachesforindividualpatients3,6,19).Accordingtotheresultsfromthisstudytheuseofthisclassificationcanberecom-mendedforspecialistSchrothcertifiedphysiotherapists in thefunctional rehabilitationusing thepatternspecificSchrothmethod.Thistestdemonstratedsufficientreliabilitywithrespecttothex-rays,butthetestsoftheclinicalpicturesalonealsodemonstratedfairlevelsofreliability,whichindicatesthatitisanappropriatetoolforphysiotherapistswhenanx-rayisnotavailable.Althoughitisalwayswisetogainanimageofthex-raytoconfirmboththediagnosisandthepattern.