Background
Year(s) | Institution | Statement | Type | Reference |
---|---|---|---|---|
1970s–80s | School screening mandatory/voluntary in the USA | [4] | ||
1979 | CTFPHE | ? | EB | [26] |
1993/1996 | USPSTF | ? | EB | |
1994 | CTFPHE | ? | EB | [29] |
2002 | NHMRC | NO | EB | [3] |
2004 | USPSTF | NO | EB | [30] |
2005 | Italian guidelines | YES | CB | [18] |
2007 | SOSORT | YES | CB | [19] |
2007 | Californiaa
| YES | EC | [15] |
2008 | SRS, AAOS, POSNA, AAP | YES | CB | |
2009 | MaHTAS | YES | EB (SR/HTA) | [16] |
2010 | Meta-analysis: YES | [32] | ||
2011 | AANP | YES | CPE | [33] |
2011 | AAFP | NOb
| EB | [23] |
2011 | ICSI | NO/YESc
| EB/CB | [34] |
2011 | SOSORT | YES | CB/EBd
| [20] |
2012 | UK NSC | NO | EB | [21] |
2012 | USPSTF | NO | EBe
| |
2013 | SRSf
| YES | CB/EB | [2] |
Methods
Criteria for inclusion in the review
Types of studies
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | School children, both girls and boys, with no geographical or other (e.g. societal, racial, cultural) restrictions, in age period associated with the risk of development of AIS, typically 10–12 years of age; however, no strict age criteria were defined | Papers including other populations of children, e.g. with co-morbidities, such as Duchenne muscular dystrophy |
Exposure or issue | Any reviews addressing ‘school screening for AIS’ | Papers addressing other screening programs, that did not exclusively address screening tests for adolescent idiopathic scoliosis, e.g. general health examinations; screening programs for other types of scoliosis were also excluded (e.g. adult scoliosis) |
Outcomes | Primary outcome: any recommendation that stated to recommend screening or not to recommend screening, i.e. a “yes” or “no” with regard to the authors` recommendations; also any secondary outcomes, if analyzed in the retrieved reviews | Not specified |
Search strategy
Databases of systematic reviews, guideline registries and databases with separate indexing of systematic reviews and guidelines
|
The Centre for Reviews and Dissemination databases—DARE, HTA, NHSEED, Cochrane Database of Systematic Reviews (CDSR), Joanna Briggs Institute, Campbell Library, Cochrane Effective Practice and Organisation of Care (EPOC) Group, the AHRQ databases and resource lists from USPSTF, AHRQ Evidence-based Practice Centers (EPC Reports) and National Guideline Clearinghouse, PEDro, INAHTA, TRIP |
Websites of institutions
|
USPSTF, CTFPHC, NHMRC, UK Screening Portal/ UK NSC Policy Database, Scottish Intercollegiate Guideline Network (SIGN), National Institute for Clinical Excellence, UK (NICE) |
General bibliographic databases
|
MEDLINE through PubMed, Web of Science and SportsDiscus through EBSCO, Google Scholar |
Gray literature—registered protocols, reviews in progress, guidelines in development and registered titles
|
PROSPERO, CDSR, the USPSTF registry of the topics in progress, the CTFPHC protocols, HSR Project Database, NICE, AHRQ EPC Reports database (for the EPC Reports in Progress), HSRProj Database, the NHMRC website and the Systematic Review Data Repository (SRDR) database, the Conference Proceedings Citation Index—Science from the Web of Knowledge |
Study selection
Methodological assessment
Findings
Search results
Reference | Question(s)/objective(s)/issue(s) of interest | Searches | Included studies | AMSTAR scorea/overall quality | ||
---|---|---|---|---|---|---|
Sources of data | Time frame of the query/limits/eligibility criteria | Type and number | Quality assessment | |||
[3] | Specified characteristics of a screening test, and criteria for a screening program; effectiveness of therapies (bracing, surgery) and burden of suffering | CDSR, DARE, CINAHL, ClinPSYC, Medline, HealthStar, “Cochrane database of RCTs”, “Best Evidence”; search of specialized websites and registries (list), contacting authors of ongoing studies2
| 1993–2000 and limited pre-1993 search; search for SRs, then RCTs, then literature reviews, well designed studies (e.g. cohort studies) and articles on tests accuracyb
| Four studies of screening program assessed for quality; two of screening tests not assessed; 13 publications total, discussed narratively; 1 SR, not appraised | Y—using systems for appraising SRs, RCTs and NHMRC evaluation guidelines for other studies; 4 out of 13 included studies appraised | 6/moderate |
[29] | “New direct evidence of the benefits and harms of screening and treating”; key questions (abridged): does screening lead to better outcomes than not screening; does minor scoliosis lead to health problems later in life; how valid and accurate are screening tests; do treatments, if applied at early stage, lead to better outcomes? | MEDLINE, Cochrane Library, National Guideline Clearinghouse; | 1994–2002; English language; RCTs, meta-analyses, systematic reviews, well-designed observational studies, editorials, commentaries; exclusion criteria: if not inclusion criteria met or not relevant for a key question | 4 prospective and 4c retrospective cohort studies; 1 RCT; 1 case series meta-analysis | Laconic description of the quality of included studies, no ratings/tool stated | 2/low |
[18] | “To draw up guidelines for the rehabilitation treatment of adolescents with spinal deformities”; screening tests, programs, conservative therapy (bracing, exercises) | MEDLINE, “internet sources”, handsearch of reference lists, contact with experts | Not reported | 21 papers in English or Italian, types not reported | Low quality of evidence reported, thus recommendations based on consensuses/expert opinion | 2/low |
[16] | “To assess the effectiveness and economic implications of school scoliosis screening programme”; policy question regarding screening as a part of Malaysian School Health Programme; studies on effectiveness, economic evaluation of the programs (cost/cost-effectiveness), diagnostic accuracy of screening tests, safety (X-ray), social, ethical, legal and organizational issues | MEDLINE, PubMed, EBM Reviews-Cochrane DSR, Cochrane Central, HTA databases, NHS Economic Evaluation Database, ACP Journal Club, DARE; Google, reference lists, handsearching of journals. “Further information (..) from unpublished report” | “No limit in the search”; inclusion criteria—(P) school children, (I) scoliosis screening using defined measures, (C) no screening, (O) number outcomes, (S) cross-sectional, cohort, case–control, RCT, SR; exclusion criteria: adult scoliosis, screening not in school | 1 case–control, 1 before and after, 7 cross-sectional diagnostic, 19 cross-sectional studies; 0 HTA reports, 0 RCTs, 0 SRs | Appraisal with CASP program, evidence graded based on guidelines from USPSTF or hierarchy of evidence for test accuracy studies, Centre for Reviews and Dissemination, York | 6/moderate; health technology assessment report |
[31] | “To systematically review the available retrospective cohort studies to assess the clinical effectiveness of school screening for adolescent idiopathic scoliosis” | PubMed, Google Scholar, CINAHL, reference lists of all identifies papers | No limits reported; eligible studies: retrospective studies considering screening programs using FBT, ATR or Moiré topography, reported results of tests and X-ray, in adolescents, incidence of curves ≥10° Cobb, and referrals for X-ray; excluded: reviews, comments, case studies, editorials | 36 retrospective cohort studies | No quality assessment of individual studies provided; overall information of some aspects of the quality of methodology and reporting | 6/moderate; meta-analysis of cohort studies |
[1] | Appraisal against UKNSC criteria for a screening program; 14 out of 22 criteria addressed, 5 not assessed, 3 interpreted not applicable | Medline (OvidSP), Embase, PsychINFO, CINAHL, Web of Science, Cochrane library—advanced search; simple search for ongoing trials in the metaRegister of Controlled Trials | Jan 2002 to Feb 2011 [44, 45] and re-search August 2011 [46]; SRs, RCTs, “large prospective controlled trials, studies addressing key areas of uncertainties”; the evidence referred to in the USPSTF 2004 review [28] “as a base line”, “observational evidence (..) if considered relevant for key areas”; non-English papers excluded | 470 papers listed in the appendices [44‐46], in categories (SRs and meta-analysis; guidelines and recommendations; non-SRs; the condition; the test; the treatment) some with subcategories; design of primary studies not labeled; 53 references in the paper (also from before 2002); SRs, guidelines, statements and designs of some primary studies reported | Criteria of quality assessment not provided/defined; selection of study types reported as a base for quality appraisal; quality of some discussed narratively | 4/low |
Gray literature
Quality analysis
Overlap across included reviews
Discussion
Brief summary of results
Searching process and selection of the reviews
Quality and recency of the reviews
Methodology issues
Discussion and critique of included reviews
Higher quality systematic reviews
Diagnostic and monitoring tests/diagnostic accuracy
|
The new (2011) Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence hierarchy (Levels of Evidence 2 [56] ) states that “systematic review of cross sectional studies with consistently applied reference standard and blinding” are step 1 (level 1) of evidence and consequently individual studies are level II evidence; |
The improved (2009) Australian NHMRC “Additional Levels of Evidence and Grades for Recommendations for Developers of Guidelines” document [55], providing hierarchy of evidence for different types of research questions, defines level II evidence as “a study of test accuracy with: an independent, blinded comparison with a valid reference standard, among consecutive persons with a defined clinical presentation”, and systematic reviews of level II studies are level I evidence; |
Both classifications list case–control studies (level IV—OCEBM, level III-3—NHMRC) but not retrospective cohort studies. |
Screening interventions (both OCEBM and NHMRC) |
Systematic reviews of prospective, randomized controlled trials (RCTs)—level I evidence; |
Individual RCTs—level II evidence; |