Validation and Reproducibility of an App for Continuous Measurement as an Assessment Tool for Idiopathic Scoliosis

(1) Background: Idiopathic scoliosis is a three-dimensional deformity, yet clinical and research decision-making still relies largely on radiographic Cobb angle measurements. As a radiation-free alternative, clinical assessment of transverse and sagittal plane deformities has gained importance. This study evaluated the concurrent validity and intra- and interrater reproducibility of continuous measurements of rib hump, thoracic kyphosis, and lumbar lordosis obtained using a smartphone application in adolescents with spinal deformities. (2) Methods: Adolescents aged 10-17 years with scoliosis (>10° Cobb) or hyperkyphosis (>50° Cobb) were recruited. Continuous measurements of angle of trunk rotation (ATR) during the Adams forward bend test and in standing position, as well as sagittal profile, were collected using the ISICO app mounted on a standardized plastic tool. Concurrent validity was assessed against a scoliometer using Spearman correlation, root mean square error, and Bland-Altman analysis, while reproducibility was evaluated using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. (3) Results: Thirty-two adolescents were included for validation and intrarater analyses and 34 for interrater analyses. ATR measured during the Adams test showed very high correlation with the scoliometer and minimal bias, while standing ATR showed moderate correlation. Reliability was excellent for rib hump during forward bending and moderate for sagittal parameters, with the lowest values observed for lumbar lordosis. (4) Conclusions: These findings support the clinical use of continuous app-based ATR assessment and suggest that sagittal measurements may be useful with appropriate examiner training.