The accuracy of clinical kyphosis examination for detection of thoracic vertebral fractures: comparison of direct and indirect kyphosis measures.
نویسندگان
چکیده
OBJECTIVE To compare the accuracies of two simple physical examination maneuvers for detecting the presence of thoracic vertebral fractures (VF) diagnosed by radiography: direct measurement of kyphosis angle (KA, in degrees) and indirect measurement using wall-occiput distance (WOD, in cm). METHODS Subjects were 280 women (average age, 54.5 years; range, 18-92) referred for assessment of osteoporosis. KA was measured from T4 to T12 using a digital inclinometer while WOD was measured with the patient in a standardized position. VF were diagnosed on radiographs using semi-quantitative morphometry. RESULTS KA and WOD were moderately correlated (r = 0.72, p<10(-11)). KA increased by 3.7(o) (95% CI, 2.6-4.8(o)) for each VF (p = 4x 10(-11)) and WOD rose 1.3 cm (95% CI, 0.8-1.7 cm) per VF (p = 2 x 10(-11)). The areas under the receiver operating characteristic curves were 0.72 (95% CI, 0.65-0.79) for KA and 0.76 (95% CI, 0.69-0.82) for WOD, which were not significantly different (p = 0.13). CONCLUSIONS Given similar performances of direct and indirect measures of kyphosis, we propose that WOD should be used in clinical practice, with a clinical threshold of WOD>4.0 cm as an indication to consider spine radiography. At this WOD threshold, sensitivity was 41% (95% CI, 31-52%) and specificity was 92% (95% CI, 87-95%). WOD should be considered for use in the clinical assessment of osteoporosis patients.
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ورودعنوان ژورنال:
- Journal of musculoskeletal & neuronal interactions
دوره 11 3 شماره
صفحات -
تاریخ انتشار 2011