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Europa Medicophysica 2000 December;35(4):191-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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.

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