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TRACE (Trunk Aesthetic Clinical Evaluation), a new everyday clinical tool to assess adolescent idiopathic scoliosis patients aesthetics

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Evaluate the repeatability of a new everyday clinical tool developed to increase Aesthetic Index results: TRACE (Trunk Aesthetic Clinical Evaluation).

Study design

TRACE is based on four sub-scales: shoulders (0–3), scapulae (0–2), hemithorax (0–2) and flanks (0–4): each point is fully described and gives an ordinal scale for increasing asymmetry; TRACE 1 was given by the sum of the sub-score, while TRACE2 by a percentage weighting each single sub-score. 160 PA photographs of the trunk of adolescent idiopathic scoliosis patients were scored two times independently by four observers. We used the Kappa statistics for Agreement [1] whose values give the following agreements: 0–0.2 poor, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 good, 0.8–1.0 very good. We looked also at the 95% level of agreement, to identify the minimum clinically significant change to be considered between two different clinical exams. TRACE2 was evaluated for repeatability according to Bland-Altman.


See Table 1.

Table 1 Results.


These results are provisional, because a longer practice on TRACE is needed, mainly for inter-raters data. Widening the scales of the Aesthetic Index to develop TRACE increased sensitivity, and this is better in clinical everyday practice.


  1. 1.

    Altman DG: Practical Statistics for Medical Research. 1991, London: Chapman and Hall

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Author information

Correspondence to Stefano Negrini.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Negrini, S., Zaina, F., Monticone, M. et al. TRACE (Trunk Aesthetic Clinical Evaluation), a new everyday clinical tool to assess adolescent idiopathic scoliosis patients aesthetics. Scoliosis 2, S47 (2007).

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  • Public Health
  • Clinical Evaluation
  • Percentage Weighting
  • Adolescent Idiopathic Scoliosis
  • Idiopathic Scoliosis