Psychometric Validation of the Traditional Chinese Version of the Early Onset Scoliosis-24 Item Questionnaire (EOSQ-24)

Increased lengthening frequency does not adversely affect the EOSQ scores in magnetically controlled growing rod surgeries in 133 subjects followed to final fusion

PURPOSE

Magnetically Controlled Growing Rod (MCGR) allows frequent outpatient rod lengthening when treating Early Onset Scoliosis (EOS) patients. But there is lack of expert consensus on the optimal MCGR lengthening interval. EOS 24-Item Questionnaire (EOSQ) is validated for assessing health-related quality of life (HrQOL), family burden, and satisfaction. This is the first study assessing how MCGR lengthening intervals affects patient-perceived outcomes.

METHODS

This is a multicentred cohort study with subjects recruited from 2012 to 2018 and followed till fusion. EOS subjects who underwent MCGR surgeries were grouped into high, medium or low lengthening interval subgroups based on 16 and 20 week cut-offs. Repeated measure analysis was performed on EOSQ's specified 12 domains. EOSQ results were taken: before index surgery, after index surgery, and prior to definitive treatment. Demographic, clinical and radiographic data were included in model adjustment.

RESULTS

133 subjects with mean follow-up of 3.5 (± 1.3) years were included, with 60 males and 73 females; 45 idiopathic, 23 congenital, 38 neuromuscular, and 27 syndromic patients. Mean Cobb angle at surgery was 67° (± 22°) with mean age of 8.3 (± 2.5) years. Between groups, clinical and radiographic parameters were comparable. Higher EOSQ scores in medium lengthening interval subgroup was present in fatigue (p = 0.019), emotion (p = 0.001), and parental impact (p = 0.049) domains, and overall score (p = 0.046). Trendline contrast between subgroups were present in general health (p = 0.006) and physical function (p = 0.025) domains.

CONCLUSION

Patient-perceived outcome improvements appear similar between lengthening interval subgroups. All MCGR lengthening intervals were tolerated by patients and family, with no negative impact observed.

LEVEL OF EVIDENCE

Prognostic Level III.

Reliability and validity of the adapted Finnish version of the early onset scoliosis questionnaire (EOSQ-24)

BACKGROUND

EOSQ-24 is a disease specific patient-reported outcome score used to assess the quality of life in patients with early-onset scoliosis. The aim of this study was to translate and cross-culturally adapt the English version of the EOSQ-24 to Finnish language and to assess the reliability and validity of the translation.

METHODS

Cross-cultural adaptation and cross-cultural validation were performed to the Finnish translation of the EOSQ-24. Patients and/or their caretakers were then recruited to assess the psychometric properties of the translation. We assessed the internal consistency, test-retest reliability, floor and ceiling effects, and discriminative abilities. One-hundred-and-three patients filled the questionnaire.

RESULTS

EOSQ-24 was successfully translated into Finnish. The translation showed excellent internal consistency (Cronbach alpha 0.94), satisfactory item-total correlations ranging from 0.6 to 0.9, and moderate to strong inter item correlations. Test-retest reliability ranged from 0.7 to 0.96 indicating good to excellent agreement. Patients with neuromuscular and syndromic scoliosis reported lower EOSQ-24 scores when compared to patients' idiopathic and congenital scoliosis. There was a significant negative correlation between major curve and EOSQ-24 scores in patients with idiopathic early onset scoliosis.

CONCLUSION

The internal consistency and test-retest reliability of the measure were found to be satisfactory. A marked ceiling effect was observed, indicating a potential source of error.

Parent-patient Discrepancies in the Quality of Life Assessment of Early-onset Scoliosis: A Comparison Between 2 Questionnaires Completed on 2 Different Time Points - A Preliminary Report

BACKGROUND

EOSQ-24 is a parent proxy questionnaire designed to assess the health-related quality of life (HRQoL) of early-onset scoliosis (EOS) patients during their childhood years. EOSQ-SELF, a novel self-reported questionnaire, assesses HRQoL in older children (>8 y) and adolescents. So far, the same group of EOS patients has not been evaluated with both EOSQ-24 and EOSQ-SELF. The aim of this study was to evaluate how the same pathology was reflected in the parent and patient at different time points by comparing the answers to the common questions between EOSQ-24 and EOSQ-SELF.

METHODS

A group of otherwise healthy EOS patients whose parents filled out EOSQ-24 at the early phase of growth-friendly treatment was re-tested by the EOSQ-SELF questionnaire at the end of treatment. Both EOSQ-24 and EOSQ-SELF are validated in Turkish. Inclusion criteria were patients with EOS, independent ambulation, age of 8 years or older at EOSQ-SELF enrollment, literacy in Turkish, no apparent intellectual impairment, and a minimum of 24 months after graduation. The common questions between the 2 surveys with nearly identical phrasings were extracted. Common items from the 2 tests were compared with a Wilcoxon signed rank test.

RESULTS

Twenty-one patients (15 females, 6 males) who previously filled out EOSQ-24 met the inclusion criteria. The mean age of the group was 10 (5 to 16) years at EOSQ-24 participation and 18 (13 to 24) at the final analysis. Fourteen questions were found common in 10 domains. The scores were significantly different in 5 questions of 4 domains. EOSQ-SELF had significantly less favorable scores in the pain/discomfort, pulmonary function, and fatigue/energy level domains. Scores in the parental burden/relationships domain were significantly higher (P<0.05).

CONCLUSIONS

The self-reported group had a general trend of worse results. Parents and caregivers may not accurately perceive the problems of EOS patients. Our findings indicate a disconnect between caregivers and the patients, as both parties underreported the other side in some domains. These findings suggest the challenges faced by EOS patients are not adequately reflected on proxy questionnaires that assess the HRQoL of children.

LEVEL OF EVIDENCE

Diagnostic Level I.

Longitudinal comparison of direct medical cost, radiological and health-related quality of life treatment outcomes between traditional growing rods and magnetically controlled growing rods from preoperative to maturity

Background

Magnetically controlled growing rods (MCGR) have replaced traditional growing rods (TGR) in the past decade, however, a comparison of their direct costs and treatment outcomes based on real longitudinal data is lacking. This study aims to compare the direct cost and treatment outcomes between TGR and MCGR, whilst incorporating complications, reoperations and changes in health-related quality of life (HRQoL) throughout the entire treatment course.

Methods

Patients with early onset scoliosis (EOS) who underwent initial growing rod surgery between 2003 and 2016 at a tertiary scoliosis clinic were studied with longitudinal data. Accumulated direct medical costs were calculated based on the unit cost of surgeries of each TGR and MCGR, costs incurred for any rod exchange or remedial surgery for post-operative complication. Treatment outcomes were evaluated via: Patient’s HRQoL using SRS-22r questionnaire, and radiological parameters (including major curve correction, spine length gains, spinal balance) throughout the treatment until maturity.

Results

A total of 27 EOS patients (16 MCGR, 11 TGR) were studied. Total direct cost of index surgery for MCGR was HKD$223,108 versus lower cost of HKD$135,184 for TGR (p < 0.001). At 2–3 years post-index surgery, accumulative total direct medical cost of MCGR and TGR became most comparable (TGR:MCGR ratio = 1.010) and had reached neutrality between the two groups since. Radiological parameters had no intergroup differences at maturity. For HRQoL, TGR group had shown the trend of less pain (domain score mean difference: 0.53, p = 0.024) post-index surgery and better self-appearance (domain score mean difference: 1.08, p = 0.017) before fusion. Higher satisfaction with treatment (domain score mean difference: 0.76, p = 0.029) was demonstrated by TGR patients at fusion/maturity. MCGR had negative (r_s = -0.693) versus TGR’s positive (r_s = 0.989) correlations (p < 0.05) of cost and SRS-22r total scores at 2–3 years post-index surgery.

Conclusions

From index surgery to maturity, TGR demonstrated better satisfaction with treatment by patients and comparable overall HRQoL with MCGR during the treatment course, as MCGR did not show apparent benefit despite less surgeries and cost neutrality between the two groups at 2–3 years post-index surgery.

Disease-Specific Outcome Measures Evaluating The Health-Related Quality Of Life Of Children And Adolescents With Idiopathic Scoliosis And Scheuermann's Kyphosis: A Literature Review

Adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) are the most common types of spinal deformities in adolescents, and both have substantial ramifications on health-related quality of life (HRQoL) parameters. Various questionnaires have been developed to assess HRQoL in age-group populations with spinal deformity. Nevertheless, there remains a lack of consensus across the literature as to which instrument is the most suitable for evaluating the HRQoL of this cohort. Thus, this literature review was conducted to present disease-specific questionnaires for children and adolescents with AIS and SK to provide their psychometric characteristics (validity, reliability, and responsiveness) across different languages. A literature search was performed in the Medline (PubMed), Scopus, EMBASE, and Google Scholar databases. Studies that outlined the development and application of questionnaires evaluating HRQoL of children and adolescents with spinal deformity were included, and data on their validity and reliability in different translated languages were collected. A total of 10 disease-specific questionnaires were identified. Except for one questionnaire that was a proxy-reported measure, the other questionnaires were self-reported. We determined that selecting the proper questionnaire for clinical and research purposes requires careful consideration of various factors including the type of treatment intervention planned as well as various patient demographic factors. For children with early-onset scoliosis, the ideal questionnaire to evaluate their HRQoL is the Early-Onset Scoliosis Questionnaire-24. For adolescents with AIS and SK who are potential candidates for surgical intervention, the use of Scoliosis Research Society-22, Scoliosis Japanese-27, and Quality of Life Profile Spinal Deformity questionnaires is appropriate. For patients who are under nonsurgical treatment, the Brace Questionnaire and Italian Spine Youth Quality of Life questionnaires can be utilized. Nonetheless, when the specific intent of a study is to evaluate the self-image perception of patients, the use of drawing-based questionnaires may be the optimal choice.

Developments, Focuses, and Trends in Early-Onset Scoliosis From 2005 to 2020: A Systematic Bibliometric Analysis

OBJECTIVE

Although several studies have been reported on early-onset scoliosis (EOS), a bibliometric analysis is still lacking. A systematic bibliometric analysis will enable researchers to understand the scope of the research topics, identify research focuses and key literature, and predict future research directions.

METHODS

Literature data were retrieved from the Web of Science Core Collection database. The Web of Science Results Analysis and Citation Report were used to analyze the reported studies in different views. CiteSpace and VOSviewer were used for further analysis, including a cooperation network analysis of the authors, institutions, countries and/or regions, discipline and journal analysis, reference co-citation analysis, and keyword co-occurrence analysis.

RESULTS

The final analysis included 674 relevant studies reported from 2005 to 2020. During the study period, the field of EOS has expanded rapidly. Multiple cooperation was found among the authors, institutions, and countries and/or regions, with some making great contributions. The results of the reference co-citation analysis showed that the studies had several main focuses, including the growing rod (GR), magnetically controlled GR, an EOS 24-item questionnaire, and a growth evaluation.

CONCLUSIONS

From 2005 to 2020, surgical treatment has remained the focus of research in the EOS field. The magnetically controlled GR is the latest research focus, which might become more comprehensive in the future. The Gr has remained the most popular topic, and potential new surgical techniques might require improvement to become the favored techniques. In addition, assessing the health-related quality of life and growth parameters of patients with EOS have become a popular topic.

Validation of the Brazilian Portuguese Version of the 24-Item Early-Onset Scoliosis Questionnaire

STUDY DESIGN

Multicenter prospective study.

OBJECTIVES

To validate the Early-Onset Scoliosis 24 Questionnaire (EOSQ-24) questionnaire for the Brazilian Portuguese language, a widely used tool for assessing the impact of different treatments and interventions in EOS patients.

METHODS

The EOSQ-24 questionnaire was cross-culturally adapted following guidelines already published. After language adjustments by a group of experts, the final version of the Brazilian Portuguese EOSQ-24 was applied to a group of 76 patients (35 male and 41 female). Internal consistency was evaluated using the Cronbach α coefficient and item-total correlations. Continuous variables were recorded as median values and interquartile ranges and categorical variables as percentages.

RESULTS

In the study group, 76 patients were evaluated. The total EOSQ-24 Cronbach α coefficient was 0.883, indicating excellent reliability. The internal consistency of EOSQ-24 was assessed in 3 domains: patient quality of Life, parental burden, and satisfaction (Cronbach α: 0.816-0.934). The range across all subdomains was 0.473 to 0.934. Floor effects for the 24 items were between 1.3% and 43.4% and ceiling effects, between 3.9% and 42.1%.

CONCLUSIONS

The Brazilian Portuguese adaptation of the EOSQ-24 shows excellent reliability and can be a valid tool for psychometric assessment of children with EOS.

Cross-Cultural Adaptation and Validation of the Persian Version of the 24-Item Early-Onset Scoliosis Questionnaire

Study Design

Cross-sectional study.

Purpose

To translate and culturally adapt the original English version of the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) to the Persian language as well as assess its reliability and validity.

Overview of Literature

Early-onset scoliosis (EOS) patients with progressive curves require active treatments, such as serial elongation–derotation–flexion casting, bracing, and surgery, which are stressful and expensive. In order to evaluate the impact of EOS and its treatment strategies, it is important to consider the patients and their parents’ quality of life as the clinical and radiological parameters. The EOSQ-24 is a parent-based measure that evaluates the health-related quality of life of patients with EOS and their caregivers/parents. Similar to other widely used questionnaires, EOSQ-24 needs to be translated into other languages to make it usable in populations from different cultures and societies.

Methods

We evaluated the translation and back translation of the EOSQ-24 and made the required revisions as per the analysis performed by the expert committee and an international guideline to adapt it for use in this study. Thereafter, we recruited 100 EOS patients in order to evaluate its reliability and validity. The reliability was assessed with internal consistency. Convergent validity was assessed by comparing the scores of the EOSQ-24 and the 22-item Scoliosis Research Society Questionnaire (SRS-22r). Finally, the known groups validity was assessed as per patient’s sex, curve magnitude, and treatment type.

Results

The Persian EOSQ-24 demonstrated very good internal consistency (Cronbach’s α=0.88). All the items had an acceptable corrected item-total correlation (>0.3). Further, the EOSQ-24 and the SRS-22r scores (p<0.001) were significantly correlated. The EOSQ-24 could discriminate patients with different curve magnitudes.

Conclusions

The Persian EOSQ-24 can serve as a disease-specific instrument with strong validity and reliability in the evaluation of EOS patients. Its applicability in other Persian-speaking countries and regions of the world needs to be investigated further.

Reliability and Validity of the Simplified Chinese Early-onset Scoliosis Quality of Life 24-item Questionnaire

STUDY DESIGN

Questionnaire translation and validation.

OBJECTIVE

The aim of this study was to translate the Early-Onset Scoliosis 24-Item Questionnaire (EOSQ-24) into simplified Chinese and to evaluate the reliability and validity of this questionnaire in children with early-onset scoliosis (EOS) in mainland China.

SUMMARY OF BACKGROUND DATA

The EOSQ-24 is a validated quality of life questionnaire in children with EOS and has been translated into multiple languages and used worldwide. However, there is currently no simplified Chinese version available for use in mainland China.

METHODS

The English version of the EOSQ-24 questionnaire was translated into simplified Chinese based on the recommendations of the International Quality of Life Assessment (IQoLA) group. The reliability of the scale was evaluated using test-retest reliability and internal consistency, and construct validity was examined through factor analysis. Hundred childrenwith EOS were enrolled in the study. To assess the test-retest reliability of the scale, the parents or caregivers of 38 of participants repeated the questionnaire after 2 weeks.

RESULTS

Test-retest reliability was excellent overall (intraclass correlation coefficient [ICC] = 0.935) and ranged from moderate to excellent for each domain (ICC = 0.681-0.945). The overall internal consistency was excellent (Cronbach α = 0.893) and had a variable range for each domain (Cronbach α = 0.560-0.889). Factor analysis was performed, and seven principal components were extracted that accounted for 70.1% of the variance.

CONCLUSION

The simplified Chinese version of the EOSQ-24 scale has acceptable reliability and construct validity, and it can be used for the assessment of health-related quality of life (HRQL), caretaker burden, and satisfaction for children with EOS in mainland China.Level of Evidence: 3.

Is Growth-friendly Surgical Treatment Superior to One-stage Posterior Spinal Fusion in 9- to 11-year-old Children with Congenital Scoliosis?

BACKGROUND

The distraction-based growth-friendly technique has become a mainstay of treatment for young children with long-spanned congenital scoliosis. However, in patients who are 9 years to 11 years old, the choice is much less clear, and posterior spinal fusion is also a potential option.

QUESTIONS/PURPOSES

Comparing growth-friendly scoliosis surgery and posterior spinal fusion, which technique (1) provides greater correction of spinal deformity, (2) is associated with more surgical complications, and (3) results in greater improvement in pulmonary function tests, health-related quality of life scores, other patient-reported outcomes?

METHODS

Between 2009 and 2017, one spinal center performed 212 spinal interventions for scoliosis in patients aged between 9 years and 11 years old and who had open triradiate cartilage, including 40 patients with growth-friendly approaches (34 with growing-rod technique and six with a vertical expandable prosthetic titanium rib) and 172 with one-stage posterior spinal fusion, respectively. During this period, our general indications for using growth-friendly surgery were patients with open triradiate cartilage, major curve higher than 40°, and upper and lower end vertebrae involving at least eight segments. Twelve patients with a median (range) age of 9.3 years (9 to 11) treated with growth-friendly surgery met the following inclusion criteria: (1) had at least two lengthening procedures before definitive spinal fusion along with 2 years of follow-up after definitive spinal fusion; (2) had been followed until skeletal maturity (Risser grade ≥ 4); and (3) with complete radiographic and clinical data (health-related quality of life (HRQoL) and pulmonary function test results) preoperatively and at the latest follow-up. A group of patients between 9 years and 11 years old and underwent one-stage posterior spinal fusion was selected from our database of patients with congenital scoliosis. Our general indications for using one-stage posterior spinal fusion were patients with a major curve greater than 40°, and with thoracic height higher than 18 cm. Sixty-two patients who had open triradiate cartilage and had been followed until skeletal maturity (Risser grade ≥ 4) were accounted for. In this retrospective, controlled study, we matched patients in the posterior spinal fusion group to those 12 patients who had growth-friendly surgery by age, sex, pathologic findings, major curve size, and location of the apex of the major curve (2:1 matching provided 24 patients in the control group). The median (range) age was 9.8 years (9 to 11). We then compared the groups in terms of magnitude of correction and postoperative complications. Surgical complications, including infection, implant-related complications, and alignment-related complications were evaluated and classified using the surgical complications grading system. Pulmonary function tests and HRQoL were also compared between groups. Pulmonary function tests were performed at the same center with a spirometer. HRQoL were assessed by questionnaire, including the 24-item Early-onset Scoliosis questionnaire for parent-reported outcomes and the Scoliosis Research Society-22 questionnaire for patient-reported outcomes. All patients involved in this study gave their informed consent.

RESULTS

The posterior spinal fusion group achieved a greater correction magnitude at the latest follow-up (median [range] 46% [28 to 70] versus median 34% [9 to 58], difference of medians = 11%; p < 0.001) than the growth-friendly group. A higher proportion of patients in the growth-friendly group had complications than in the posterior spinal fusion group (7 of 12 versus 4 of 24; p = 0.03). There were no between-group differences in terms of pulmonary function tests. Few differences were found between the groups in terms of 24-item Early-onset Scoliosis parental impact (median [range] 60 [44 to 83] for the growth-friendly group versus median 71 [55 to 87] for the posterior spinal fusion group, difference of medians = 13; p = 0.001), financial burden (median 44 [30 to 55] for the growth-friendly group versus median 62 [53 to 75] for the posterior spinal fusion group, difference of medians = 16; p < 0.001) and the Scoliosis Research Society-22 self-image scores (median 3.8 [3.2 to 4.3] for the growth-friendly group versus median 4.4 [4.1 to 4.6] for the posterior spinal fusion group, difference of medians = 0.5; p = 0.006) at the latest follow-up, and those differences that were observed all favored the posterior spinal fusion group.

CONCLUSIONS

In light of the superior deformity correction and fewer observed complications with posterior spinal fusion, and the absence of important differences in validated outcomes scores or pulmonary function tests, posterior spinal fusion might be a better choice for 9- to 11-year-old children with long-spanned congenital scoliosis and limited growth potential in the intended instrumentation area.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Reliability and validity of the simplified Chinese version of the Early Onset Scoliosis-24-Item Questionnaire (EOSQ-24)

BACKGROUND

It is important to use standard assessment tools to quantify the impact of early-onset scoliosis (EOS) on the health-related quality of life of these children and their caregivers. In this study we aimed to translate and validate the simplified Chinese version of the Early Onset Scoliosis Questionnaire-24 (EOSQ-24) in order to assess the health-related quality of life (HRQoL) and caregiver burden among patients with EOS from mainland China.

METHODS

EOSQ-24 was forward-and-backward translated according to standard protocols, culturally adapted, and administered to patients fulfilling specific inclusion criteria and recruited between February and December 2015. Response distribution was assessed by their median and standard deviation. Floor and ceiling effects were calculated. Reliability was established using Cronbach's α and discriminative validity was determined using the Mann-Whitney U test and the Kruskal-Wallis test.

RESULTS

A total of 63 children and their parents participated in this study. Most responses were left skewed towards normal physical and psychosocial well-being. No floor effect was observed but ceiling effect was found in questions regarding pain and pulmonary function. Cronbach's α for all questions and all domains was 0.950, and 0.927, respectively. EOSQ-24 scores were negatively correlated with curve severity and ambulatory status. Based on these preliminary results, EOSQ-24 could be used to distinguish patients in these regards.

CONCLUSIONS

The simplified Chinese version of EOSQ-24 is a reliable and valid tool for HRQoL assessment among caregivers (parents) of children with EOS in mainland China. It could potentially be incorporated into routine clinical care in this patient population and as a standard assessment tool for research purposes.

Health-related quality of life in early-onset-scoliosis patients treated with growth-friendly implants is influenced by etiology, complication rate and ambulatory ability

BACKGROUND

Progressive Early-Onset Scoliosis (EOS) in children may lead to surgical interventions with growth-friendly implants, which require repeated lengthening procedures in order to allow adequate growth. Quality of life was studied using the validated German version of the EOS-Questionnaire (EOSQ-24-G) in surgically treated EOS children with different lengthening modalities.

METHODS

EOSQ-24-G and the KINDLR questionnaire were given to families with EOS children who had been treated by either vertical expandable prosthetic titanium rib implants and repetitive lengthening surgeries every 6 months or children who had received a magnetically expansion controlled implant, which was externally lengthened every 3 months. Results were compared according to differences between the two tests, and with possible influencing factors such as surgical method, severity of scoliosis, relative improvement of curvature, etiology, weight, age, travelling distance, complications, ambulatory ability and others.

RESULTS

56 children with an average curve angle of 69° corrected to 33° (52%; average age 5.6 yrs) answered the EOSQ-24-G and the KINDLR after an average follow-up of 3.9 years. Health-related quality of life (HRQoL) was not affected by the initial scoliosis correction, the number of surgeries or the implant type. However, there was a negative correlation with non-ambulatory status, complications during treatment and for children with a neuromuscular scoliosis.

CONCLUSION

Using the validated EOSQ-24-G, no statistically significant differences were found between the group of children receiving repetitive surgeries and children with external lengthening procedures without surgery. However, results were influenced by the etiology, complication rate or ambulatory ability.

LEVEL OF EVIDENCE/CLINICAL RELEVANCE

Therapeutic Level IV.

Reliability and Validity of the Adapted Dutch Version of the Early-Onset Scoliosis-24-Item Questionnaire (EOSQ-24)

STUDY DESIGN

Translation and validation of the Early Onset Scoliosis-24 Questionnaire (EOSQ-24).

OBJECTIVE

To cross-culturally adapt the English version of the EOSQ-24 to the Dutch language and to assess the questionnaire's reliability and validity.

SUMMARY OF BACKGROUND DATA

Early-onset scoliosis (EOS) has a profound impact on health-related quality of life. The EOSQ-24 is health-related quality of life questionnaire filled in by parents of children with EOS. The EOSQ-24 was already translated into multiple languages and its application was confirmed in clinical studies. However, the EOSQ-24 is not yet translated and validated for the Dutch population.

METHODS

The adaption of the EOSQ-24 for the Dutch population was done in three steps: 1) translation to the Dutch language, 2) cross-cultural adaptation, and 3) cross-cultural validation. To ensure that the Adapted Dutch EOSQ-24 is applicable for clinical use, the measurement properties were tested in four steps: 1) floor and ceiling effects, 2) validation, 3) reliability, and 4) discriminative ability. One hundred three parents completed the Adapted Dutch EOSQ-24, the Child Health Questionnaire (CHQ-28 PF), and the Scoliosis Research Society Questionnaire (SRS-22r). A second EOSQ-24 was completed for test-retest reproducibility.

RESULTS

The EOSQ-24 was successfully translated, adapted, and validated for the Dutch language. Almost all response items showed a normal distribution. The EOSQ-24 showed excellent reliability (Cronbach α of 0.950). The EOSQ-24 was successfully validated against the CHQ-28-PF and the SRS-22r. Test-retest was excellent (ICC ≥ 0.8). Finally, The EOSQ-24 was found capable to discriminate patients with different curve severities (P = 0.003), diagnosis (P = 0.006), and ambulatory status (P < 0.001).

CONCLUSION

The current Dutch EOSQ-24 proved to be a valid and reliable quality of life assessment tool for patients with EOS. Currently, long follow-up studies using the EOSQ-24, including the Dutch EOSQ-24, are lacking and are needed to fully validate the EOSQ-24 for use in a clinical setting.

LEVEL OF EVIDENCE

2.

A head-to-head comparison of five-level (EQ-5D-5L-Y) and three-level EQ-5D-Y questionnaires in paediatric patients

PURPOSE

The aim of this study was to assess the psychometric properties of a youth version of the EQ-5D five-level questionnaire (5LY) and its three-level version (3LY) in a sample of Chinese paediatric patients.

METHODS

A consecutive sample of idiopathic scoliosis patients were recruited from a referral outpatient scoliosis center at Hong Kong, China in October 2017 and completed the two versions of EQ-5D-Y. Redistribution properties in each dimension of EQ-5D-Y were analyzed between 5LY and 3LY by logistics regressions. Absolute reduction and relative reduction in ceiling effects from the 3LY to the 5LY were calculated. Test-retest reliability was assessed by examining the Gwet's agreement coefficient (Gwet's AC) for five individual dimension responses over the 2-week period.

RESULTS

A total of 129 idiopathic scoliosis patients completed the two versions of EQ-5D-Y at baseline assessment, among which 70 patients completed the test-retest interview in 2-3 weeks after baseline assessment. For redistribution properties, the proportion of inconsistency was low in all the dimensions, ranging from 0.0% ("Usual activities") to 3.9% ("Pain/discomfort"). Ceiling effects were reduced in four dimensions. "Usual activities" dimension showed significant reduction (absolute and relative reductions: 3.9% and 4.3%; p = 0.025) and the "worried/sad/unhappy" dimension showed the largest significant reduction in ceiling effects (absolute and relative reductions: 7.8% and 9.8%; p = 0.012). The 3LY and 5LY showed very good agreement (> 80%) of individual dimension responses between two assessments, except for the "worried/sad/unhappy" dimension in 3LY.

CONCLUSION

Through this head-to-head comparison, the 5LY had significant improvements in ceiling effects in two dimensions when compared to 3LY but other measurement properties of 3LY and 5LY performed similar in the idiopathic scoliosis patient group.

Validation of the German version of the 24-item Early-Onset Scoliosis Questionnaire

OBJECTIVE

During childhood, early-onset scoliosis (EOS) may show severe progressive deformity, which consequently leads to aggressive treatment strategies, such as serial casting, long-term bracing, or surgical interventions. The latter usually includes repeated surgeries for implant lengthening every 6 months in order to allow sufficient growth of the thorax and spine. In 2011, the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) was introduced to measure health-related quality of life for this patient group and their families. Since then, cross-culturally adapted versions of the EOSQ-24 have been published in Spanish, Turkish, traditional Chinese, and Norwegian. The purpose of the study was to transculturally adapt the original English version of the EOSQ-24 into the German language and evaluate the reliability of the German version.

METHODS

After adaptation and forward/backward translation, the German version of the EOSQ-24 was given to the parents or caregivers of 67 EOS patients (33 male, 34 female) Data quality was evaluated by mean, standard deviation, percentage of data missing, and extent of ceiling and floor effects. Reliability was estimated by internal consistency using Cronbach α and item-total correlations.

RESULTS

In the study group (n = 67), 12 children were either observed (n = 7) or treated with a brace (n = 5). The other 55 patients were treated surgically with growth-friendly implants. The item response to the German EOSQ-24 was high with a minimum of missing data (1.7%). All items showed very good to excellent internal consistencies (0.879-0.903). Floor effects for the 24 items were between 0% and 31% and ceiling effects between 9% and 78%. The calculated Cronbach α for the 24-item scale was 0.9003, indicating excellent reliability.

CONCLUSIONS

The German adaptation of the EOSQ-24 shows excellent reliability and therefore is a valid tool to measure objective health-related quality of life in children with EOS.

Reliability and validity of the Arabic version of the Early Onset Scoliosis 24 Items Questionnaire (EOSQ-24)

Introduction: Early Onset Scoliosis (EOS) is a complex pathology that covers a variety of etiologies, with onset before the age of 10 years. Surgical treatment of EOS should have the objectives of fulfilling maximum pulmonary function, spine length, with minimal hospitalizations, complications, and family burden. Radiographic parameters are an important standard in assessing treatment outcomes. However, the Early Onset Scoliosis Questionnaire-24 (EOSQ-24) was developed to measure the wider dimensions of outcomes involving the quality of life of patients and caregivers post-treatment. The aim of this study was to evaluate the validity and reliability of culturally adapted Arabic version of the EOSQ-24.

Methods: Translation and cross-cultural adaptation, based on published guidelines, were performed on the original English EOSQ-24 by a committee. The Arabic version of EOSQ-24 was applied to the caregivers of all 58 EOS patients who were treated surgically after signing a consent form. Reliability was assessed using Cronbach’s α and item-total statistics for the whole questionnaire initially and for the each domain separately. Data quality was assessed by mean, median, percentage of missing data, ceiling and floor effects. Discriminative validity was examined using non parametric tests.

Results: The response for all items was excellent with only 1.7% (0–1) of responses missing. The floor effect ranged from 0% to 36.2% of patients and the ceiling effect ranged from 0 to 46.6%. Cronbach’s α test reliability was found excellent (0.919), as was the internal consistency of all domains, with Cronbach α ranging from 0.903 to 0.918. Corrected item-total correlations were good for all domains (>0.3). Only one item (Question 21) showed low corrected item-total correlations (r = 0.222). However, Cronbach’s α did not increase significantly when this item was deleted (0.920).

Conclusion: The first adapted Arabic version of EOSQ-24 is found to have good validity and reliability, and it can be used to assess children in Arab societies with EOS.

Reliability of Rod Lengthening, Thoracic, and Spino-Pelvic Measurements on Biplanar Stereoradiography in Patients Treated With Magnetically Controlled Growing Rods

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To assess the inter- and intraobserver reliability of thoracic, spino-pelvic, and rod lengthening measurements made on biplanar spinal stereoradiography (EOS imaging) in children treated with magnetically controlled growing rod (MCGR).

SUMMARY OF BACKGROUND DATA

MCGR treatment aims to gain spine length while gradually correcting the spinal deformity. Monitoring thoracic and spino-pelvic parameters is crucial for successful management. EOS imaging is widely used for diagnosis and monitoring of children with Early Onset Scoliosis. However, there is a paucity of literature on the reliability of thoracic and spino-pelvic parameters on EOS imaging in children treated with MCGR.

METHODS

Three independent reviewers independently read a random assortment of 20 whole spine posteroanterior and lateral radiographs from patients treated with MCGR. The measurements were repeated 4 weeks after the initial read. The following radiological parameters were measured: Cobb angle of the main and compensatory curves, coronal balance, coronal T1-S1 and T1-T12 length, chest width and depth at T6, pelvic inlet width, MCGR distracted lengths, global kyphosis, proximal and distal junctional angle, lordosis, sagittal balance, pelvic incidence, pelvic tilt and sacral slope. Statistical analysis was performed with paired t test and Cronbach alpha for inter- and intraobserver reliability.

RESULTS

All measurements had good or excellent intra- and interobserver reliability (α>0.8; P < 0.05), except measurements of the proximal junctional angle which showed only poor intra- and interobserver reliability for patients with an upper instrumented vertebra cranial to T4.

CONCLUSION

EOS imaging is reliable for diagnosis and monitoring of children with Early Onset Scoliosis treated with MCGR. EOS imaging is particularly excellent for assessment of MCGR lengthening. Diagnosis and interpretation of early proximal junctional kyphosis within the cervicothoracic junction should be made with caution.

LEVEL OF EVIDENCE

3.

Reliability and Construct Validity of the Adapted Norwegian Version of the Early-Onset Scoliosis 24-item Questionnaire

Background:

The Early-Onset Scoliosis 24-item Questionnaire (EOSQ-24) reflects issues important for patients with early-onset scoliosis (EOS) and their parents. The aim of this study was to translate the original EOSQ-24 into Norwegian and to evaluate the resulting questionnaire's reliability and construct validity.

Methods:

The EOSQ-24 was translated using a forward-backward translation method, followed by an expert review. One hundred parents of a heterogenic group of patients with EOS answered the EOSQ-24 and scored Numeric Rating Scales (NRSs) to evaluate the children's general health, pain, and physical function. Two weeks later, 55 parents (55%) answered the retest questionnaire. Data quality, internal consistency, and test-retest reliability were assessed, including the minimal detectable change. Construct validity was evaluated by predefined hypotheses and correlations with NRS scores.

Results:

There were considerable ceiling (19.0% to 63.0%) and floor effects (zero to 26.0%). The internal consistency was excellent (Cronbach α = 0.95). The minimal detectable change for the EOSQ-24 total score was 15.2 and ranged from 21.6 to 33.0 for the subdomains scores. The EOSQ-24 showed discriminate capabilities among patients with different etiology, treatment status, and severity of deformity. High correlations were found between the EOSQ-24 total score and the NRS scores for general health (r = −0.66), pain (r = −0.63), and physical function (r = −0.78).

Conclusion:

The Norwegian version of the EOSQ-24 has acceptable reliability and validity for measuring quality of life and caregiver burden among EOS children. The EOSQ-24 total score is acceptable for evaluation of these patients over time.

Level of Evidence:

Level III, diagnostic study

Health-Related Quality of Life in Early-Onset Scoliosis Patients Treated Surgically: EOSQ Scores in Traditional Growing Rod Versus Magnetically Controlled Growing Rods

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To compare quality of life and caregiver burden in traditional growing rod (TGR) and magnetic controlled growing rods (MCGR) patients.

SUMMARY OF BACKGROUND DATA

MCGR decrease surgical sessions associated with treatment of early onset scoliosis (EOS), hoping to minimize the burdens seen with repetitive invasive surgeries in TGR treatment. Although the clinical indications for these treatments have largely been agreed upon, there is a lack of understanding of their impact on patients' and families' quality of life.

METHODS

Inclusion criteria: ≤10 years of age at index procedure, major curve ≥30°, no previous spine surgery, minimum 1-year postoperative follow-up. The previously validated 24-item early onset scoliosis questionnaire (EOSQ-24) was utilized to assess quality of life. Statistic methods were applied to compare domain scores between TGR and MCGR patients.

RESULTS

Forty-four children with EOS were enrolled; 25 TGR and 19 MCGR. Groups were similar in sex and age at index surgery. Age at time of questionnaire and mean length of follow-up were significantly different; patients were older (14.0 vs. 8.8 yr) and had longer follow-up (101.3 vs. 34.3 mo) in TGR (P < 0.01). Deformity correction and complication rates were similar between groups. At the time of questionnaire, scores of economic burden and overall satisfaction in MCGR were significantly superior to those in TGR by univariate analysis. When controlled for duration of follow-up, some domain scores trended towards statistical significance, some remained stable, and others regressed to non-significance.

CONCLUSION

Health related quality of life data reveal superior outcomes in overall satisfaction and financial burden domains in the MCGR group. However, the positive effects of MCGR decrease when controlled for length of follow up, indicating that the MCGR is not yet a magic fix-all, and that the TGR remains an option in the treatment of EOS.

LEVEL OF EVIDENCE

3.