Evaluation of a Primary Health Care Scoliosis Screening Program: A 9-Year Follow-Up Study

Abstract

Background/Objectives: Scoliosis screening aims to detect spinal deformities early and prevent progression. The Programa de Atención a la Salud de Niños y Adolescentes (PANA) in Spain includes primary care screenings at ages 5-6, 10-11, and 13-14, but its effectiveness remains unverified. First, we evaluated attendance rates in each phase. Second, a nine-year follow-up was used to determine outcomes in adolescents who completed all three phases of PANA. Methods: A retrospective-prospective cohort study was conducted. The retrospective phase analyzed records of 881 schoolchildren screened at a primary healthcare center in Lorca, Spain. The prospective phase re-evaluated 127 adolescents (94.1% of those who completed all three phases) after nine years using a standardized forward bending test (FBT) with scoliometer quantification. Results: Attendance declined from 73.2%, at age 5-6, to 20.5%, at age 13-14. Only 15.3% completed all three phases. At age 13-14, 11.1% had a positive FBT by visual assessment. Non-quantified FBT had low sensitivity (5.9%) but high specificity (96.7%). Nine years later, mean scoliometer-measured vertebral rotation was 3.6 ± 1.7° (thoracic) and 2.5 ± 1.4° (lumbar). Scoliosis suspicion (FBT > 5°) was 15.1%, but applying the FBT > 7° threshold it was reduced to 4%. Conclusions: The PANA program has limited effectiveness due to low attendance and lack of scoliometer use. Visual FBT without quantification increases false positives, reducing diagnostic accuracy. It is recommended that preventive assessments be conducted in schools by primary care physicians. Training in the use of the scoliometer is essential to improve scoliosis detection.

Keywords: PANA program; adolescent health; primary care; scoliometer; scoliosis screening.

Figure 1

A 14-year-old adolescent with a scoliotic morphotype presenting with right scapular elevation, waist asymmetry, and protrusion of the right scapula and left thoracco lumbar region.

Figure 2

The same 14-years-old adolescent with a positive Forward Benting Test, showing a right thoracic rib prominence.

Figure 3

Sample flowchart.

Figure 4

FBT quantifiied with scolimeter, with left rib prominence of 6°.

Figure 5

Box-and-whisker plot of measures (in degrees) during FBT at thoracic and lumbar levels in adults after 9 years of the three phases of the screening program, indicating mean, Q1, Q3, and maximum and minimum values. On the vertical axis (ordinate), the distributions of measures in the Adams test are represented (in degrees). On the horizontal axis (abscissa), the four groups are displayed: A = Thoracic Right, B = Thoracic Left, C = Lumbar Right, and D = Lumbar Left. Below, the exact values for the four groups are shown (R = Right; L = Left). SEM = standard error of the mean. CI = confidence interval.