Cost effectiveness of school screening for scoliosis: A systematic review
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
IntroductionAdolescent idiopathic scoliosis, a deformity that consists of a lateral deviation and axial rotation of the spine, has a prevalence of 1-3% among children aged 10-16 years (1,2). Progression of the scoliosis curve particularly during the adolescent growth spurt can lead to severe deformity affecting both physical and psychosocial aspects of health. The use of braces to prevent curve progression during adolescence may avert the need for surgery (3). Thus, screening for scoliosis may be useful in order to detect those who may benefit from early treatment and prevent progression and the need for surgery.School screening programs for scoliosis vary with respect to the personnel involved (doctors, nurses, lay-persons), ages of children screened (ranges between 6-13 years), and screening tests used (one- tiered or two-tiered programs). The standard screening test used is the Adams Forward Bending Test; some programs use a scoliometer in conjunction with this test to quantify the degree of axial trunk rotation instead of relying on purely subjective observation (4-7). Moire topography has also been used as a second tier screen (5).School screening for scoliosis remains controversial with both Canadian and American Task Forces recommending against wide-based school screening programs (8,9) while professional organizations support school screening (American Academy of Orthopedic Surgeons, Scoliosis Research Society, American Academy of Pediatrics, Pediatric Orthopedic Society of North America) (10). Two main reasons contributing to this controversy are the lack of firm evidence supporting the efficacy of bracing as well as the low positive predictive values of the scoliosis school screening programs and by implication, questionable cost-effectiveness (11).When analyzing cost-effectiveness, one typically uses a cost-effectiveness ratio to compare costs (net expenditure of health care resources) and net improvement in health (a non-monetary measure) (12). Diamond and Kaul (13) contend that consumer protection principles are more relevant: i.e. determining the total magnitude of the expected benefit in the target population (e.g. in life-years, or quality-adjusted life years); the total cost (in per capita dollars); and a plan on how the program will be paid for. One can argue that in the case of scoliosis screening, the expected benefit in the target population would be prevention of surgical intervention. The underlying assumption is that appropriate conservative treatment at the right time can prevent progression of scoliosis and thereby avert the need for surgery.The objective of this paper was to examine the literature in terms of cost and cost-effectiveness for school screening for scoliosis and to synthesize the current evidence on this subject.MethodsThe systematic review of cost-effectiveness was part of a larger project that covered four main topics: technical efficacy of screening, clinical effectiveness, program effectiveness and costs and cost- effectiveness. An extensive literature search independently done by two research assistants and validated by a librarian included examination of four databases: Medline (1950-July 2010), Embase (1980- July 2010), CINAHL (1980-July 2010), EBM Reviews, including Cochrane Central Registry of Controlled Trials (until 2nd quarter 2010). Keywords included costs, cost-effectiveness linked with scoliosis, spinal deformities, back asymmetry, child, adolescent, screening, bending test, Moire topography. We identified 13 articles which were each reviewed by two persons (one orthopedist and one epidemiologist) using a standardized data extraction form. This form included a description of the population, the intervention, measures of effect/outcomes, key messages, the authors' conclusions, critical appraisal of the paper (strengths, weaknesses, validity of methodology and conclusions). The articles were then scored according to the Downs and Black method (14), which consists of a checklist assessing methodological quality of randomized and non-randomized health care interventions. …
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it