Agreement Between Adolescents, Parents, and An Expert In Visual Assessments of Adolescent Posture: An Exploratory Pilot Study

Makaleler > Tam Makale · 2026

Yazarlar: Dilek BAYRAKTAR, ÖZGE BAYKAN ÇOPUROĞLU, Eda ER, Tahsin Oğuz BAŞOKÇU, Anıl Murat ÖZTÜRK

Journal of Turkish Spinal Surgery, ESCI İndekslerine Giren Dergi, Uluslararası, Emerging Sources Citation Index (ESCI), 2026, cilt 37, ss 185-194

DOI: 10.4274/jtss.galenos.2026.85547

Özet

<p>Objective:&nbsp;This&nbsp;exploratory&nbsp;pilot&nbsp;study&nbsp;examined&nbsp;agreement&nbsp;among&nbsp;visual&nbsp;classifications&nbsp;of&nbsp;adolescent&nbsp;posture&nbsp;made&nbsp;by&nbsp;adolescents,&nbsp;parents,&nbsp;and&nbsp;an&nbsp;expert&nbsp;using&nbsp;the&nbsp;same&nbsp;standardized&nbsp;reference&nbsp;images.&nbsp;It&nbsp;also&nbsp;explored&nbsp;whether&nbsp;adolescent-expert&nbsp;agreement&nbsp;differed&nbsp;between&nbsp;adolescents&nbsp;with&nbsp;mild-to-moderate&nbsp;adolescent&nbsp;idiopathic&nbsp;scoliosis&nbsp;(AIS)&nbsp;and&nbsp;healthy&nbsp;controls.&nbsp;Materials&nbsp;and&nbsp;Methods:&nbsp;Forty&nbsp;adolescents&nbsp;aged&nbsp;10-18&nbsp;years&nbsp;(20&nbsp;with&nbsp;AIS&nbsp;and&nbsp;20&nbsp;healthy&nbsp;controls)&nbsp;and&nbsp;one&nbsp;parent&nbsp;per&nbsp;adolescent&nbsp;participated.&nbsp;Adolescents,&nbsp;parents,&nbsp;and&nbsp;one&nbsp;expert&nbsp;independently&nbsp;selected&nbsp;one&nbsp;of&nbsp;five&nbsp;standardized&nbsp;images&nbsp;for&nbsp;each&nbsp;of&nbsp;the&nbsp;following&nbsp;regions:&nbsp;head,&nbsp;shoulders,&nbsp;upper-back,&nbsp;and&nbsp;lumbar/waist.&nbsp;Pairwise&nbsp;and&nbsp;three-rater&nbsp;agreement&nbsp;were&nbsp;assessed&nbsp;using&nbsp;Cohen’s&nbsp;κ,&nbsp;Fleiss’&nbsp;κ,&nbsp;and&nbsp;Krippendorff’s&nbsp;α.&nbsp;Exact&nbsp;agreement&nbsp;proportions&nbsp;were&nbsp;reported&nbsp;with&nbsp;Wilson&nbsp;95%&nbsp;confidence&nbsp;intervals&nbsp;(CIs).&nbsp;Region-specific&nbsp;adolescent-parent&nbsp;comparisons&nbsp;were&nbsp;performed&nbsp;using&nbsp;exact&nbsp;McNemar&nbsp;tests&nbsp;with&nbsp;Holm-Bonferroni&nbsp;adjustment&nbsp;for&nbsp;the&nbsp;four&nbsp;regional&nbsp;comparisons.&nbsp;AIS-control&nbsp;comparisons&nbsp;were&nbsp;considered&nbsp;exploratory.&nbsp;Results:&nbsp;Adolescent-expert&nbsp;agreement&nbsp;ranged&nbsp;from&nbsp;κ=0.30&nbsp;to&nbsp;κ=0.43&nbsp;and&nbsp;was&nbsp;highest&nbsp;for&nbsp;the&nbsp;head&nbsp;(κ=0.43,&nbsp;95%&nbsp;CI,&nbsp;0.24-0.62).&nbsp;Exact&nbsp;adolescentexpert&nbsp;agreement&nbsp;was&nbsp;62.5%&nbsp;(95%&nbsp;CI,&nbsp;47.0-75.8)&nbsp;for&nbsp;the&nbsp;head,&nbsp;60.0%&nbsp;(44.6-73.7)&nbsp;for&nbsp;the&nbsp;shoulders,&nbsp;and&nbsp;45.0%&nbsp;(30.7-60.2)&nbsp;for&nbsp;both&nbsp;the&nbsp;upper-back&nbsp;and&nbsp;lumbar/waist&nbsp;regions.&nbsp;Parent-expert&nbsp;agreement&nbsp;ranged&nbsp;from&nbsp;κ=-0.01&nbsp;to&nbsp;κ=0.26,&nbsp;with&nbsp;exact-agreement&nbsp;proportions&nbsp;ranging&nbsp;from&nbsp;25.0%&nbsp;to&nbsp;40.0%.&nbsp;Adolescents&nbsp;showed&nbsp;greater&nbsp;exact&nbsp;agreement&nbsp;than&nbsp;parents&nbsp;only&nbsp;in&nbsp;the&nbsp;head&nbsp;region&nbsp;(62.5%&nbsp;vs.&nbsp;37.5%;&nbsp;p=0.031),&nbsp;but&nbsp;this&nbsp;difference&nbsp;did&nbsp;not&nbsp;remain&nbsp;significant&nbsp;after&nbsp;Holm-Bonferroni&nbsp;adjustment&nbsp;(adjusted&nbsp;p=0.124).&nbsp;No&nbsp;statistically&nbsp;significant&nbsp;AIS-control&nbsp;differences&nbsp;were&nbsp;detected&nbsp;in&nbsp;total&nbsp;adolescent-expert&nbsp;agreement&nbsp;scores&nbsp;(p=0.151)&nbsp;or&nbsp;parent-expert&nbsp;agreement&nbsp;scores&nbsp;(p=0.306).&nbsp;Conclusion:&nbsp;Agreement&nbsp;with&nbsp;the&nbsp;expert’s&nbsp;visual&nbsp;classification&nbsp;varied&nbsp;across&nbsp;anatomical&nbsp;regions&nbsp;and&nbsp;was&nbsp;generally&nbsp;moderate.&nbsp;No&nbsp;evidence&nbsp;of&nbsp;equivalence&nbsp;between&nbsp;the&nbsp;AIS&nbsp;and&nbsp;control&nbsp;groups&nbsp;can&nbsp;be&nbsp;inferred&nbsp;from&nbsp;this&nbsp;pilot&nbsp;sample.&nbsp;The&nbsp;findings&nbsp;represent&nbsp;expert-referenced&nbsp;agreement&nbsp;rather&nbsp;than&nbsp;objective&nbsp;recognition&nbsp;accuracy&nbsp;and&nbsp;do&nbsp;not&nbsp;establish&nbsp;the&nbsp;visual&nbsp;approach&nbsp;as&nbsp;valid,&nbsp;reliable,&nbsp;or&nbsp;clinically&nbsp;applicable.&nbsp;Larger&nbsp;studies&nbsp;incorporating&nbsp;multiple&nbsp;assessors,&nbsp;repeated&nbsp;measurements,&nbsp;and&nbsp;independent&nbsp;reference&nbsp;methods&nbsp;are&nbsp;required.</p>

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