Scoliosis is a lateral curvature of the spine that could affect life function if complications such as back pain, lung and heart problems occur (Mayo Clinic, 2016). Idiopathic Scoliosis, the most common form, nearly always occur during the growth spurt affecting thirteen (13) to sixteen (16) years of age right before and during adolescence and may progress rapidly to significant cosmetic problems and functional disabilities. (S.L. Weinstein, 2003). Currently, the widely-used methods for screening are radiographic imaging, such as X-ray, and Adam's forward bending test, and assessing the angle of trunk rotation with the use of bunnell scoliometer (Knott et al, 2014) (T. Kotwicki, 2008) Adam's Forward Bending Test can be done in sitting or standing position. According to study conducted by T. Kotwicki, et al, year 2007, measuring of angle of trunk rotation in sitting forward bending does not have a significant difference in measurements in standing forward bending position using the traditional scoliometer device. The application that the researchers used is available for low cost compared to an actual scoliometer device aside from it being user friendly (B. Amirault, 2012). Since it is widely available, it is important to test its reliability when used by a professional physical therapist with better knowledge in the procedure and a volunteer parent. (K. Lau, 2016).
The scoliometer Smartphone application was used to measure three areas of interest: at upper thoracic (between T3-T4), mid thoracic (between T5-T12) and at the thoraco-lumbar are (between T12-L1). When performing Smartphone measurement, the examiners placed their thumbs between the patient and either end of the device to accommodate prominent spinous process. The patients were asked to bend forward, and then the examiners placed Smartphone at the three reference points mentioned above. Each examiner performed one measurement evaluation on the three points of reference for each respondent. One researcher for each examiner was assigned to assist raters, he/she obtained the data after the procedure.
The results by both testers showed disagreement and inconsistency and it showed almost the same deviation on the following landmarks: upper thoracic, main thoracic, and thoraco-lumbar. The intra-class correlation (ICC) indicated a poor reliability index, which corresponded to a significant difference in using the Scoliometer Smartphone application in measuring angle of trunk rotation between two testers. Testing the significance of the relationship (a=0.05), the p-value obtained was lesser than the level of significance (<0.05). Hence the null hypothesis was rejected which indicated that there was a significant difference between both testers in measuring the angle trunk rotation in sitting forward bending position.
The Scoliometer Smartphone application showed a poor inter-rater reliability measuring ATR in sitting forward position evident in the p value p<0.05 between two tester in measuring value of upper thoracic and lower thoracic landmark. The results indicated that there was an inconsistency (p<0.05) between both testers. Hence, the Scoliometer Smartphone applications is not reliable when used by two different testers and therefore cannot be recommended to be used by different testers when measuring ATR in sitting forward bending position.