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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2000 December;35(4):191-6
The level protractor: a new simple instrument to measure Cobb angle and back hump. A validation study
D'Osualdo F., Schierano S., Iannis M. Righini E.
Rehabilitation Centre for Infants, ASL 4 “Medio Friuli”, Udine, Italy
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BACKGROUND: The aim of the study was to validate the Level Protractor, a simple instrument for measuring Cobb’s angle on radiographs and back hump on scoliotic patients. The measurements performed with the instrument were compared with the traditional Cobb method using a ruler and the protractor on X-rays, and Bunnel’s scoliometer on the patient.
METHODS: The study is in two parts: a) Inter-observer error measurement on radiographs. Three different examiners evaluated 109 radiographs: 2 using a Level Protractor and 1 using the traditional Cobb method. b) Back hump measurement on 30 patients with scoliosis of varying severity (back rotation 4° to 18°) comparing the Level Protractor with Bunnel’s scoliometer.
RESULTS: The inter-observer error on X-rays was within the range reported by other authors with mean differences in the comparison Level Protractor versus Level Protractor, and Level Protractor versus Cobb’s method of 0.71 (CI 0.16 – 1.25), 0.36 (CI –0.59 – 1.31) and 0,33 (CI –1.23 – 0.57), respectively. The standard deviation of the differences were smaller when comparing Level Protractor versus Level Protractor (2.85°), with matching values in the other two comparisons (SD 4.98∞ and 4.74∞, respectively). Variance analysis showed a significantly lower absolute inter-observer difference in the comparison Level Protractor versus Level Protractor than Level Protractor versus Cobb’s method. In measuring back hump, the Level Protractor yielded values that matched Bunnel’s scoliometer (diff = 0; r =1).
CONCLUSIONS: The Level Protractor appears to be a practical and reliable instrument when applied to X-ray and back hump measurements. It can be useful for minimising measurement errors and simplifies both procedures by using a single instrument.