脊柱侧凸研究会-22问卷(SRS-22)中文版的信度及效度分析

目的 用中文版SRS-22问卷评估巾国青少年特发性脊柱侧凸患者的牛活质量,考察SRS-22问卷中文版的信度及效度.方法 根据国际生活质量评估计划的规定,将SRS-22问卷英文版译成中文,并由脊柱外科专家讨论后确定最终版本.共有126例青少年特发性脊梓侧凸患者完成了SRS-22问卷中文版测试,男35例,女91例;年龄10～20岁,平均14.5岁;Cobb角15°～58°,平均为33°.为了完成对该问卷重测信度的评估,35例患者1周后进行了第2次问卷调查.SRS-22问卷中义版各领域的内部一致性通过Cronbach'a系数榆验,使用相关性分析检验SRS-22中文版的重测信度并同时计算地板效应和天花板效应,最后对脊柱侧凸患者采用不同方式治疗后SRS-22问卷得分进行统计学分析.结果 SRS-22问卷中文版各领域的Cronbach'a系数分别为:功能状况/活动能力(0.49),疼痛(0.73),自我形象(0.67),心理状况(0.78),对治疗的满意度(0.48);重测信度分别为:功能状况/活动能力(0.80),疼痛(0.68),自我形象(0.82),心理状况(0.81),对治疗的满意度(0.78).SRS-22问卷中文版各领域均具有不同程度的天花板效应,术后患者功能状况/活动能力得分最低而对治疗的满意度得分较支具治疗高.结论 由于东西方医疗体制、人文文化及价值观等方面的差异,SRS-22问卷中义版仍存在一定的局限性,需要进行一定的改进以符合中国国情并进行更大规模的临床随访后方可用于中国青少年特发性脊柱侧凸患者生活质量的评估.     

Reliability and validity of the adapted Dutch version of the revised Scoliosis Research Society 22-item questionnaire

Background contextAs in other fields of medicine, there is an increasing interest among orthopedic surgeons to measure health-related quality of life in adolescent idiopathic scoliosis patients and to evaluate the burden of disease and the effectiveness of different treatment strategies. The development of the revised Scoliosis Research Society 22-item patient questionnaire (SRS-22r) enabled a comprehensive evaluation of health-related quality of life of these patients. Over the years, the SRS-22r gained wide acceptance and has been used in several different countries, languages, and cultures. The SRS-22r has not been translated into Dutch to date.PurposeTo translate the SRS-22r into Dutch and adapt it cross-culturally as outlined by international guidelines and to test its psychometric properties to measure health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands.Study design/settingA cross-sectional, multicenter validation study.Patient sampleA total of 135 adolescent idiopathic scoliosis patients (mean age 15.1 years old) of three major scoliosis centers in the Netherlands were enrolled in this study. Ninety-two (68%) subjects completed the Dutch SRS-22r, Child Health Questionnaire (CHQ)-CF87 (golden standard for adolescents), and Short Form (SF)-36 (golden standard for adults). Two weeks later, 73 (79%) of 92 respondents returned a second SRS-22r. Demographics, curve type, Risser stage, and treatment status were documented.Outcome measuresFloor and ceiling effects, internal consistency, reproducibility, concurrent validity, and discriminative ability of the Dutch version of the SRS-22r questionnaire.MethodsFor content analysis, SRS-22r domain scores (function, pain, self-image, mental health, and satisfaction with management) were explored and floor and ceiling effects were determined. Cronbach's α was calculated for internal consistency of each domain of the questionnaires and reproducibility was assessed by test-retest reliability analysis. Using Pearson's correlation coefficient, comparison of the domains of the Dutch SRS-22r with the domains of the SF-36 and Child Health Questionnaire-CF87 assessed the concurrent validity. Differences in SRS-22r domain scores between untreated patients with different curve severity determined the discriminative ability of the questionnaire.ResultsThe SRS-22r domains as well as the SF-36 and CHQ-CF87 domains demonstrated no floor effects, but the function, pain, and satisfaction with management domains had ceiling effects, indicating the proportion of subjects with the maximum score between 19.6% and 33.0%. Internal consistency was very satisfactory for all SRS-22r domains: Cronbach's α was between 0.718 and 0.852. By omitting question 15, the internal consistency of the function domain increased from 0.746 to 0.827. Test-retest reliability was ≥0.799 for all SRS-22r domains. The function, pain, mental health, and self-image domains correlated under the 0.001 significance level with the corresponding CHQ-CF87 and SF-36 domains. The satisfaction with management domain did not correlate with the other questionnaires. The SRS-22r had the ability to detect differences between groups with different curve severity; patients with a severe scoliotic curvature had significantly lower pain and self-image domain scores than patients with relatively mild scoliosis.ConclusionsThe Dutch SRS-22r had the properties needed for the measurement of patient perceived health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands. The Dutch SRS-22r could be used for the longitudinal follow-up of adolescent idiopathic scoliosis patients from adolescence to adulthood and for establishing the effects of conservative or invasive surgical treatment.     

Reliability and validity of Turkish version of the Scoliosis Japanese Questionnaire- 27 in patients with adolescent idiopathic scoliosis

BackgroundThe aim of this study was to evaluate the reliability and validity of an adapted Turkish version of the Scoliosis Japanese Questionnaire- 27 (SJ- 27).MethodsTranslation and retranslation of the English version of the SJ- 27 was conducted, and all steps of the cross-cultural adaptation process were performed. The Turkish version of the SJ- 27, the Scoliosis Research Society-22 (SRS- 22) questionnaire and the Short Form-36 (SF- 36) were performed to 139 patients with AIS. Reliability was assessed using the test–retest method (Pearson's correlation coefficient); internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the SJ- 27 with the SRS- 22 questionnaire and SF- 36.ResultsThe mean Cobb angles were 23.2 ± 8.3° and 19 ± 5.9° for thoracic and lumbar regions, respectively. The SJ- 27 showed excellent test/retest reliability with an Intraclass correlation coefficient of 0.99. Internal consistency of the SJ- 27 was found to be very good (Cronbach's alpha = 0.991). The SJ- 27 demonstrated very good construct validity with the SRS- 22 total score (r = 0.61). The similar domains of the SJ- 27 and SF- 36 questionnaire was correlated also in the study.ConclusionsThe Turkish version of the SJ- 27 to measure health related quality of life in adolescent idiopathic scoliosis was found to have very good validity, excellent reliability, and high internal consistency.     

Effect of clinical and radiological parameters on the quality of life in adult patients with untreated adolescent idiopathic scoliosis: a cross-sectional study

Purpose

The aim of this study is to evaluate the factors that affect health-related quality of life (HRQoL) in untreated adolescent idiopathic scoliosis (AIS) patients in adulthood. We investigate the effect of clinical and radiological parameters on the SRS-22 results.

Methods

A total of 286 untreated adolescent idiopathic scoliosis patients at adult age between April 2021 and April 2022 who were admitted to our clinic were included in the study. Rotational deformities were evaluated with a scoliometer. Cobb angles, coronal balance, clavicle angle, coronal pelvic tilt, trunk shift, and apical vertebral translation were measured in standing anteroposterior X-rays. The effect of each clinical and radiological parameter on SRS-22 results was evaluated.

Results

No correlation was found between gender, age, curve type, presence of gibbosity or diagnosis time, and SRS-22 scores. A negative correlation was found between the BMI of the patients and the self-image scores (r =  − 0.246, p < 0.01) and function scores (r =  − 0.193, p < 0.05). Main thoracic (MT) gibbosity negatively correlates with self-image and total SRS-22 scores. Also, negative correlations were found between lumbar/thoracolumbar (LTL) gibbosity, function, and pain scores. MT Cobb angle magnitude was negatively correlated with self-image, mental health, and total SRS-22 scores. There were negative correlations between clavicle angle and mental health score, coronal pelvic tilt and self-image score, and apical vertebral translation and pain score.

Conclusion

BMI, MT gibbosity, LTL gibbosity, MT Cobb angle, clavicle angle, coronal pelvic tilt, and apical vertebral translation were negatively correlated with SRS-22 domains in untreated AIS patients in adulthood.

     

Cross-cultural French-Canadian adaptation and psychometric assessment of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire

BACKGROUND CONTEXTIdiopathic scoliosis (IS) can significantly alter the quality of life of adolescents. Some of the available questionnaires in French measuring the quality of life in this population show weak psychometric properties. The newly developed Italian Spine Youth Quality of Life (ISYQOL) questionnaire promises better properties.PURPOSETo provide a French-Canadian version of the ISYQOL and to verify its psychometric characteristics.STUDY DESIGNProspective validation of a cross-cultural adaptation of the ISYQOL questionnaire.PATIENT SAMPLEA total of 111 participants with idiopathic scoliosis (77.5% female, 10–18 years old, mean Cobb angle=28°) were included in the study.OUTCOME MEASUREThe French-Canadian version of the Italian Spine Youth Quality of Life (ISYQOL-F) questionnaire.MATERIALS AND METHODSThe ISYQOL was translated into French using a forward-backward approach. We then verified the understanding of the translated items with two scoliosis experts and 10 adolescents. Afterward, 111 adolescents with IS were recruited by convenience at the scoliosis clinic and they completed the ISYQOL on three occasions (before seeing the specialist, 1 week, and 2 weeks after). Cronbach's alpha, intra-class (ICC), and Pearson correlation coefficients were used to respectively determine internal consistency, test-retest reliability, and concurrent validity with the SRS-22r and SF-12. The standard error of measurement (SEM) and 95% confidence minimal detectable change (MDC₉₅) were also calculated. The ceiling effect was quantified as the percentage of participants who scored the maximum on ISYQOL-F.RESULTSThe ISYQOL-F showed good internal consistency with a Cronbach alpha of 0.81 and 0.85 respectively for items 1–13 (n=55; ISYQOL-F mean score ± SD = 63.9±13.5) and 1–20 (n=56; ISYQOL-F mean score ± SD=60.7±10.3). Test-retest reliability was excellent (ICC_3,1=0.94). The SEM is 3.1 and the MDC₉₅ is 8.6. Correlations between ISYQOL-F and SRS-22r and between ISYQOL-F and SF-12 were moderate for total scores (r=0.56 and 0.50 respectively, p<.001), but low for each domain (between 0.20 and 0.48, p<.05). No significant ceiling effects were observed for ISYQOL-F (≤2.5%). In contrast, ceiling effects ranged from 3.6% to 30.6% for SRS-22r and 0%–68.5% for SF-12.CONCLUSIONSThe internal consistency and reliability of ISYQOL-F are good. The total score correlates moderately with the SRS-22r and SF-12. Unlike SRS-22r, the ISYQOL-F does not appear to have a ceiling effect. The ISYQOL–F may thus be suitable to assess quality of life in a population of French-Canadian adolescents with IS.     

中文版脊柱外观问卷在青少年特发性脊柱侧凸患者外观评价中的初步运用

目的建立简体中文版脊柱外观问卷（spinal appearance questionnaire,SAQ）并测验其用于评价青少年特发性脊柱侧凸患者外观的信度和效度。方法根据国际标准化指南对英文版SAQ问卷进行翻译和文化调适后建立简体中文版SAQ。共纳入95例青少年特发性脊柱侧凸患者完成简体中文版SAQ问卷与SRS-22问卷,随机选取50例患者间隔7 d完成第二次简体中文版SAQ问卷并计算组内相关系数（intraclass coefficient correlation,ICC）、Bland-Alt-man一致性以评价重测信度。对95例患者各维度内的条目得分进行Spearman相关分析评价维度内一致性;对SAQ总分与SRS-22外观维度得分进行Pearson相关分析完成聚合效度评价,通过对SAQ总分与最大Cobb角的Pearson相关分析,以及不同角度组、不同治疗组间的SAQ总分差异的方差分析完成区分效度评价。结果 SAQ各条目间一致性系数范围为0.521～0.792（P〈0.01）,重测ICC为0.965,Bland-Altman一致性测验显示良好的测量一致性。聚合效度分析提示SAQ总分与SRS-22外观维度的相关系数为r=-0.326（P〈0.01）;区分效度分析提示SAQ总分与最大Cobb角的相关系数为0.779（P〈0.01）,SAQ总分在不同最大Cobb角亚组间、不同推荐治疗组间差异有统计学意义（P〈0.01）。结论简体中文版SAQ对于测量中国青少年特发性脊柱侧凸患者外观具有良好的信度与效度。     

女性青少年特发性脊柱侧凸患者自我形象评估的相关影响因素分析

目的:探讨女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者自我形象评估的影响因素。方法:回顾性分析2010年9月～2011年3月在我院就诊的252例女性AIS患者,年龄12～18岁,平均14.5±1.8岁。均摄取患者站立位全脊柱正侧位X线片,并独立填写一份简体中文版SRS-22问卷。在站立位全脊柱正侧位X线片上测量Cobb角、顶椎旋转度、胸椎后凸角、腰椎前凸角、脊柱冠状面力线偏移及脊柱矢状面力线偏移等参数。采用相关分析研究各临床指标与自我形象评分的相关性。结果:患者平均Cobb角35.5°±12.8°;平均顶椎旋转度2.0°±0.7°;平均胸椎后凸角16.2°±9.0°;平均腰椎前凸角51.3°±9.8°;平均脊柱冠状面力线偏移1.2±0.7cm;平均脊柱矢状面力线偏移2.4±1.5cm;平均体重指数18.3±2.2;平均自我形象评分16.7±2.8分。胸弯和胸腰弯/腰弯的自我形象评分均与主弯Cobb角有相关性(r分别为-0.171,-0.225,P均<0.05);其中大角度胸弯组呈显著相关(r=-0.484,P=0.005)。而其他参数与患者自我形象评估均无明显相关性(P均>0.05)。结论:女性AIS患者的自我形象主要受主弯Cobb角的影响,其中大角度胸弯患者的自我形象受主弯Cobb角的影响最大。     

Discriminative validity of the Scoliosis Research Society 22 questionnaire among five curve-severity subgroups of adolescents with idiopathic scoliosis

Background contextPrevious studies of the Scoliosis Research Society (SRS) 22 discriminative validity have lacked sufficiently matched study groups and were limited to a comparison with three or fewer subgroups of disease severity.PurposeTo evaluate the discriminative validity of SRS-22 by assessing the questionnaire's ability to discriminate among five groups of pretreatment adolescent idiopathic scoliosis (AIS) patients with increasing curve severity.Study designRetrospective review of prospectively administered surveys.MethodsTwo hundred eighty-six SRS-22 questionnaires were issued to two AIS pretreatment patient populations: 67 nonoperative and 219 preoperative. Study subjects were separated into five subgroups depending on the major Cobb angle (nonoperative 0°–19° and 20°–40° and preoperative 41°–50°, 51°–60°, and >60°). Each group (n=31) was matched for age (within 1 year) and sex (23 females and 8 males), resulting in a total of 155 study subjects. Analysis of variance was used to determine statistically significant differences (p<.05) between the five subgroups' domains and total scores.ResultsSignificant differences between study groups were found within two of the four domains (pain and image) and the total score. Both nonoperative groups (0°–19° and 20°–40°) demonstrated significantly less pain than the preoperative group (41°–50°) and significantly better self-image than all three preoperative groups. Both nonoperative groups' total scores were significantly higher than all three preoperative groups' scores, with the exception of the 20° to 40° subgroup versus the >60° subgroup. No significant differences were found between groups within the same planned treatment category.ConclusionsThe SRS-22 questionnaire demonstrated good discriminative validity between small nonoperative curves and larger surgical curves within the pain, image, and total domains. However, SRS-22 lacked the ability to differentiate between small intervals of curve magnitude, suggesting a limitation to the questionnaire's discriminative capacity. The discriminative validity of the Scoliosis Research Society (SRS) 22 has not been clearly defined. Our analysis of 155 adolescent idiopathic scoliosis patients evaluates the instrument's discriminative validity among five age- and sex-matched curve-severity subgroups. The SRS-22 questionnaire lacked the ability to differentiate between small intervals of curve magnitude, suggesting a limit to the questionnaire's discriminative capacity.     

马方综合征脊柱侧凸患者术前SRS-22、SF-36问卷心理健康评分分析:与青少年特发性脊柱侧凸患者的比较

背景:脊柱畸形不仅影响青少年的外观,还会影响患者的心理健康。但关于马方综合征脊柱侧凸(MSS)畸形对青少年心理健康影响的文献报道并不多。目的:分析接受矫形手术的MSS患者术前SRS-22问卷和SF-36问卷中的心理健康评分情况,并与青少年特发性脊柱侧凸(AIS)患者进行比较。方法:回顾分析2010年9月至2014年8月在我院接受手术治疗的28例MSS患者的SRS-22问卷及SF-36问卷结果,其中男7例,女21例;术时年龄11~19岁,平均14.8岁。选取同期收治的56例AIS患者的资料进行配比,男7例,女49例;年龄11~17岁,平均14.3岁。比较两组患者的临床及影像学参数、SRS-22问卷和SF-36问卷中的心理健康评分的差异。结果:MSS组与AIS组患者SRS-22问卷心理健康平均得分分别为3.6±0.5和3.8±0.6,总得分分别为17.8±2.7和19.2±3.0。MSS组与AIS组患者SF-36心理健康最终得分分别为66.3±11.4和71.9±10.3。上述SRS-22问卷及SF-36问卷心理健康得分组间比较差异均有统计学意义(P<0.05)。得分差异主要来自于SRS-22问卷的Q20和SF-36问卷的Q9.8,其他问题得分差异无统计学意义。MSS组患者的上述心理健康评分与患者年龄、身高、体重指数、术前剃刀背高度、主弯冠状面Cobb角、顶椎偏距、术前冠状面躯干平衡情况、术前双肩及骨盆失平衡情况和矢状面胸后凸均无显著相关性(P>0.05)。结论:手术治疗的MSS患者的心理健康状况评分低于AIS患者,这种差异主要来源于问卷中有关愉快感受方面。MSS患者的心理健康状况评分与患者侧凸的临床及影像学参数无明显相关性。     

Reliability and validity of an adapted Thai version of the Scoliosis Research Society-22 questionnaire

Purpose  

The Scoliosis Research Society-22 (SRS-22) questionnaire is a widely accepted questionnaire used to assess the health-related quality of life for scoliosis patients in the United States. However, its adaptation in other languages is necessary for its multinational use. A cross-sectional study was performed to evaluate the validity and reliability of an adapted Thai version of the SRS-22 questionnaire.     

Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

Purpose:To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis.Methods:In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data.Results:The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73).Conclusion:High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis.Level of Evidence:III     

Minimal important differences of the SRS-22 Patient Questionnaire following surgical treatment of idiopathic scoliosis

The responsiveness of an instrument measuring health-related quality of life is an important indication of its construct validity. The SRS-22 Patient Questionnaire has become the most widely used patient-reported outcome instrument in the clinical evaluation of patients with idiopathic scoliosis. The responsiveness of the SRS-22 following surgical treatment in patients with idiopathic scoliosis has not been fully assessed. The aim of this study is to evaluate this factor by calculating the minimal important differences (MIDs) of the SRS-22 Questionnaire. The study included 91 patients with idiopathic scoliosis (77 females and 14 males), who underwent surgical treatment; mean age at the time of surgery was 18.1 years. Patients completed the SRS-22 questionnaire before surgery and at a follow-up visit (mean follow-up, 45.6 months). At follow-up, patients rated their overall situation as related to before surgery with a four-point Likert scale: 1—Worse, 2—Same, 3—Better, 4—Much Better. This evaluation represented the global perceived effect (GPE) and served as the anchor criterion for calculating the MID. MIDs were calculated using two approaches. The anchor-based MID (MID-A) was defined as the mean preoperative/follow-up difference in SRS-22 scores in the group of patients who stated they were much better than before surgery (GPE = 4). Using the same anchor criterion, the optimal cut-off value able to identify patients that had clearly improved was determined on a receiver operating characteristic (ROC) curve. In addition, the distribution-based MID (MID-D) was calculated by the standard error of measurement method. The MID-As found for the different subscales and the sum score were: pain 0.6, function 0.3, image 1.3, mental health 0.3, average sum score 0.6, and raw sum score 13.1. The cut-off values on the ROC curve were: pain 0.2, function 0.0, image 1.6, mental health 0.4, average sum score 0.4, and raw sum score 10. The MID-Ds were: pain 0.6, function 0.8, image 0.5, mental health 0.4, average sum score 0.5, and raw sum score 6.8. As was expected, the MID values differed according to the calculation method used. In light of the fact that the MID-As for the function and mental health subscales are below the measurement error of the instrument, it seems preferable to use the MID-D values for determining subscale changes. If the purpose is to analyze sum score changes (either the raw or average values), the MID-A is preferable because it includes the patient’s evaluation of the results of surgery.     

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment

For treatment of teenagers with progressive adolescent idiopathic scoliosis in an early stage, two options are generally considered: treatment with a brace or observation followed by surgery if necessary. Many doctors and patients prefer conservative treatment (i.e. brace treatment) to surgical treatment, because surgery of the spine is generally considered a drastic intervention. Because potential differences in health-related quality of life (HRQoL) after treatment between braced and surgically treated patients are not well explored, this study aimed to determine whether short-term differences exist in HRQoL between adolescents treated with a brace or treated surgically. A cross-sectional analysis of HRQoL was made of 109 patients with adolescent idiopathic scoliosis who, after completing treatment, filled out the Dutch SRS-22 Patient Questionnaire. All patients had been treated either with a brace or surgery, or with a brace followed by surgery. Patients treated surgically had significantly higher mean scores in the satisfaction with management domain than those treated with a brace. No other consistent differences in HRQoL were found between patients treated with a brace and patients treated surgically. Gender, curve type and curve size had no relevant effect on HRQoL. We conclude that short-term differences in HRQoL after treatment in adolescent patients with idiopathic scoliosis are negligible and cannot support preference of one treatment above the other. The NESCIO group: H.D. Been, MD, PhD, L.N.J.E.M. Coene, MD, PhD, H. Creemers, MD, A.J. de Gruijter, MD, PhD, A.A.J.M. Hazebroek-Kampschreur, MD, PhD, P. Klop, MD, H.J.A. Kruls, MD, PhD, P.J.M. van Loon, MD, L.C.F. Luttmer, MD, F. de Nies, MD, J.E.H. Pruijs, MD, PhD, L.W. van Rhijn, MD, PhD, M.P. Teeuwen, MD, P.A. Wiegersma, MD, PhD.     

Factors influencing the residual rib hump after posterior spinal fusion for adolescent idiopathic scoliosis with Lenke 1 and 2 curves

Background

Despite remarkable improvement in Cobb angle after surgery for scoliosis, many patients have a residual rib hump. We studied the factors responsible for this hump and their influence on patient satisfaction.

Methods

We recruited 2 men and 38 women (mean age 14.9 years) who underwent skip pedicle screw fixation combined with direct vertebral body derotation for adolescent idiopathic scoliosis with Lenke type 1 and 2 curves. Hump size was evaluated by measuring apical trunk rotation (ATR). Patients with postoperative ATR ≤10° were categorized as group A and those with postoperative ATR >10° as group B. We analyzed postoperative self-image and satisfaction subscores of the SRS-22 questionnaire. We also compared the rate of postoperative improvement in ATR between patients who underwent additional Ponte osteotomy and those who did not.

Results

Preoperative ATR, preoperative apical translation, and preoperative and postoperative apical rotation significantly differed between groups A and B. In contrast, Cobb angles before and after surgery, Cobb angle correction rates, apical translation after correction, and postoperative self-image and satisfaction scores did not differ significantly between the groups. However, the rate of improvement in ATR showed a strong correlation with self-image (correlation coefficient 0.64) and satisfaction (correlation coefficient 0.52). This improvement rate did not differ significantly between subjects who underwent additional Ponte osteotomy and those who did not.

Conclusions

Preoperative apical rotation and ATR were clearly related to postoperative residual hump. For decreasing the postoperative rib hump, removal of the deformation by apical rotation was considered more important than correction of Cobb angle. Patient satisfaction and self-image scores were not significantly related to postoperative residual hump size, but they were influenced by improvement in ATR.     

Factor analysis of the SRS-22 outcome assessment instrument in patients with adult spinal deformity

Purpose

Designed for patients with adolescent idiopathic scoliosis, the SRS-22 is now widely used as an outcome instrument in patients with adult spinal deformity (ASD). No studies have confirmed the four-factor structure (pain, function, self-image, mental health) of the SRS-22 in ASD and under different contexts. Factorial invariance of an instrument over time and in different languages is essential to allow for precise interpretations of treatment success and comparisons across studies. This study sought to evaluate the invariance of the SRS-22 structure across different languages and sub-groups of ASD patients.

Methods

Confirmatory factor analysis was performed on the 20 non-management items of the SRS-22 with data from 245 American English-, 428 Spanish-, 229 Turkish-, 95 French-, and 195 German-speaking patients. Item loading invariance was compared across languages, age groups, etiologies, treatment groups, and assessment times. A separate sample of SRS-22 data from 772 American surgical patients with ASD was used for cross-validation.

Results

The factor structure fitted significantly better to the proposed four-factor solution than to a unifactorial solution. However, items 14 (personal relationships), 15 (financial difficulties), and 17 (days off work) consistently showed weak item loading within their factors across all language versions and in both baseline and follow-up datasets. A trimmed SRS (16 non-management items) that used the four least problematic items in each of the four domains yielded better-fitting models across all languages, but equivalence was still not reached. With this shorter version there was equivalence of item loading with respect to treatment (surgery vs conservative), time of assessment (baseline vs 12 months follow-up), and etiology (degenerative vs idiopathic), but not age (< vs ≥50 years). All findings were confirmed in the cross-validation sample.

Conclusion

We recommend removal of the worst-fitting items from each of the four domains of the SRS-instrument (items 3, 14, 15, 17), together with adaptation and standardization of other items across language versions, to provide an improved version of the instrument with just 16 non-management items.

     

Outcome assessment of bracing in adolescent idiopathic scoliosis by the use of the SRS-22 questionnaire

The SRS-22 questionnaire is specifically designed for the assessment of quality of life in spinal deformity patients. This study is the first to use it to assess the quality of life of adolescent idiopathic scoliosis patients under brace treatment and compares the results with an observational group matched by age and curve magnitude. Forty-six patients were enrolled into each group. Overall, it was found that patients under observation had a significantly better quality of life than braced patients. Specifically, the domains for function/activity and self-image were most affected. This effect was most apparent in those with a curve magnitude of under 20 degrees . The scores did not improve significantly with the duration of brace wear, suggesting little adaptation. This study has implications for treatment, and more attention will need to be given to those with mild but progressive curves to help improve patients' understanding of their treatment and hence their compliance and satisfaction.     

The Chinese language version of the abbreviated Burn Specific Health Scale: A validation study

Background

The Burn Specific Health Scale (BSHS) is designed to measure burn-specific, health-related quality of life (HRQoL). The aim of the present study was to evaluate the reliability and validity of the Chinese version of the abbreviated BSHS (BSHS-A).

Methods

The English version of the BSHS-A was translated into Chinese using a standardised procedure. The participants were 457 patients classified into three severity groups (mild, moderate and severe). All patients completed the Chinese BSHS-A questionnaire, the Short Form-36 (SF-36) and the EuroQol 5-Dimensions (EQ-5D). To evaluate clinical utility of the BSHS-A, we used Cronbach's alpha (internal consistency), intraclass correlation coefficients (ICCs; test–retest reliability) and construct validity (using the SF-36 and EQ-5D).

Results

Cronbach's alpha for all subscales was >0.80, demonstrating high internal consistency of the BSHS-A (Chinese version). The ICC was >0.70 for each patient group. Strong correlations were observed between the BSHS-A and SF-36 and EQ-5D scales. Neither floor nor ceiling effects were found.

Conclusion

The present study demonstrated that the BSHS-A (Chinese version) has good psychometric properties, showing suitable internal consistency and test–retest reliability. The BSHS-A may, thus, be useful for assessing HRQoL in Chinese burn victims. However, adaptations may be required to reduce its length.     

Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation

Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4±1.9 and mean follow-up period was 136.9±12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8°±17.5°. Major curves that were corrected by 38.7±22.1% in the bending radiograms, postoperatively achieved a correction of 64.0±15.8%. At the last follow-up visit, 10.3°±10.8° of correction loss was recorded in major curves in the frontal plane with 50.5±23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7°±7.4°, 37.0°±8.4°, 37.5°±8.7°, and 36.3°±8.5°, respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9° and 12.9° for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0.05). Although, none of the patients had completely balanced curves preoperatively, in 95.4% of the patients the curves were found to be completely balanced or clinically well balanced postoperatively. This rate was maintained at the last follow-up visit. Overall, four patients (3.7%) had implant failure. Early superficial infection was observed in three (2.8%) patients. Radiologically presence of significant consolidation, absence of implant failure, and correction loss, and clinical relief of pain were considered as the proof of a posterior solid fusion mass. About ten (9.2%) patients were considered to have pseudoarthrosis: four patients with implant failure and six patients with correction loss over 15° at the frontal plane. About four (3.7%) patients among the first 20 patients had neurological deficit only wake-up test was used for neurological monitoring of these patients. No neurological deficit was observed in the 89 patients for whom intraoperative neurological monitoring with SSEP and TkMMEP was performed. Overall, average scores of SRS-22 questionnaire for general self-image, function, mental status, pain, and satisfaction from treatment were 3.8±0.7, 3.6±0.7, 4.0±0.8, 3.6±0.8, and 4.6±0.3, respectively at the last follow-up visit. Results of about 10 years of follow-up these patients treated with TSRH instrumentation suggest that the method is efficient for the correction of frontal and sagittal plane deformities and trunk balance. In addition, it results in a better life-quality.     

Pre- and postoperative quality of life in patients treated for scoliosis

Background and purpose There have been few prospective reports on quality of life in patients treated surgically for scoliosis. We compared patients with idiopathic, congenital, and neuromuscular scoliosis.

Methods Data on 9- to 20-year-old patients were collected from the SweSpine registry. EQ-5D and (for a subset) SRS-22r were assessed preoperatively and after 1 and 2 years.

Results 211 patients had preoperative data: 168 with idiopathic, 11 with congenital, and 32 with neuromuscular scoliosis. Of the total, 158 patients responded to the 1-year follow-up and 149 responded to the 2-year follow-up. Preoperatively, the mean (SE) EQ-5D index was 0.76 (0.02) in the idiopathic group, 0.74 (0.07) in the congenital group, and 0.10 (0.06) in the neuromuscular group, and the SRS-22r index was 3.8 (0.1) in the idiopathic group, 4.0 (0.3) in the congenital group, and 3.3 (0.2) in the neuromuscular group. The mean EQ-5D increased by 0.06 points at 2 years in the idiopathic group, by 0.16 points in the congenital group, and by 0.15 points in the neuromuscular group. The mean SRS-22r index increased by 0.4 points at 2 years in the idiopathic group, by 0.4 points in the congenital group, and by 0.5 points in the neuromuscular group. The changes were statistically significant, with the exception of the congenital group. The number of patients who sustained at least 1 complication was 13 in the idiopathic group, 2 in the congenital group, and 9 in the neuromuscular group (p = 0.003).

Interpretation The general quality of life in the idiopathic and neuromuscular group improved after surgery.