Interobserver variations for measurements of the Cobb angle on
radiographs of patients who had kyphosis were comparable with those on the
radiographs of patients who had scoliosis. Four staff orthopaedists and one
physical therapist measured eight radiographs that showed scoliosis and
twenty that showed kyphosis. The measurements were made on two occasions
and in random order. For scoliosis, the average difference between readings
was 3.8 degrees, and 95 per cent of the differences were 8 degrees or less
(range, 0 to 10 degrees). These findings were in keeping with those of
other published reports. For kyphosis, the average difference between
readings was 3.3 degrees, and 95 per cent of the differences were 7 degrees
or less (range, 0 to 30 degrees). One investigator rated the kyphosis
radiographs with respect to clarity. There was a trend to less variation
with clearer radiographs, but this was not significant. The end-vertebrae
were pre-selected for some radiographs and were freely chosen by the
interpreter for others. Reliability was not significantly improved when the
end-vertebrae of the curve had been pre-selected. Using the statistical
method called tolerance limits, we determined that if one were to be 95 per
cent confident that a measured difference represented a true change, the
difference would have to be 10 degrees for scoliosis radiographs and 11
degrees for kyphosis radiographs. The probability that a measured
difference is due to measurement error alone (that is, a false-positive
reading) was calculated.