The PUMCH Conservative Classification System for Young Idiopathic Scoliosis Patients

  Objective  To establish a new method of scoliosis specific exercise(SSE) classification foryoung idiopathic scoliosis(IS) patients and evaluate its clinical practicability.

  Methods  This study consists of two parts, the first part, a retrospective analysis, aimed at establishing Peking Union Medical College Hospital(PUMCH) conservative classification system for young IS patients and evaluating its reliability and repeatability. The research subjects were young IS patients in PUMCH from January 2013 to June 2020. The standing X-ray(A-P and lateral) and clinical appearance (bending and standing) were analyzed. The PUMCH conservative classification system was established based on PUMC surgical classification system, and the consistency test was conducted for the inter group reliability and intra group repeatability of the observers. The second part, an ambispective cohort study, aimed at verifying the role of PUMCH conservative classification system in guiding clinical treatment and evaluating its clinical practicability. The research subjects were young IS patients(4 to 17 years old) who received conservative treatment in PUMCH from July 2020 to August 2020. According to the wishes of patients and their families, they were divided into training group and control group. The control group only had regular reexamination without clinical intervention, while the training group conducted SSE based on PUMCH conservative classification system (continuous treatment for 1 year). Cobb angle difference and patient satisfaction were compared between the two groups after 1 year.

  Results  (1) A total of 899 young IS patients who met the inclusion and exclusion criteria were selected for the retrospective study. PUMCH conservative classification system finally included 4 types and 9 subtypes after revising the single-curve(type Ⅰ), double-curve(type Ⅱ) and triple-curve(type Ⅲ) in PUMC surgical classification, and adding a micro-curve (type 0). The mean inter-observer reliability was 88.23%, with Kappa coefficient 0.862, while mean intra-observer repeatability was 92.78%, with Kappa coefficient 0.908. (2) Ambispective cohort study included 90 young IS patients who met the inclusion and exclusion criteria. There were 51 cases in the training group and 39 cases in the control group. The Cobb angle of the training group decreased from (16.61±2.88)°to (12.16±9.97)° after 1 year of treatment(P=0.002), while the Cobb angle of the control group increased from (15.74±2.75)° to (17.64±5.60)° after 1 year(P=0.014). There was clinical significance between the two groups(Cobb angle difference≥5°). After 1 year, the satisfaction score of the training group increased from 3(3, 3) to 5(3, 5)(P≤0.001), while that of the control group decreased from 3(3, 3) to 3(1, 3) (P=0.004).

  Conclusions  A new conservative classification system for young IS patients is established. The PUMCH conservative classification system not only has good reliability and repeatability, but also has clinical practicability in guiding SSE.