Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire--Scoliosis Version

Implications of Cardiac Scarring on Body Image Disturbance Among Young Adults With Congenital Heart Defects

BACKGROUND

Many individuals with congenital heart disease (CHD) undergo open heart surgery, resulting in prominent scarring. However, little research has assessed the impact of surgical scarring on body image in this population.

OBJECTIVE

Within this cross-sectional study, associations between body image concerns, anxiety and depression symptoms, and health-related quality of life among individuals with CHD were evaluated.

METHODS

Young adults with CHD (N = 138) completed the Body Image Disturbance Questionnaire along with other patient-reported outcome measures.

RESULTS

Scores on the Body Image Disturbance Questionnaire were lower (mean, 1.3 ± 0.5) than populations with diabetes amputations, craniofacial conditions, idiopathic scoliosis, and clinical controls. Higher Body Image Disturbance Questionnaire scores were reported among women ( P = .003) and were associated with greater anxiety ( P = .000) and depression ( P = .13) after controlling for sex.

CONCLUSIONS

Body image concerns related to cardiac surgery scarring are especially prominent in women and associated with greater emotional distress, suggesting potential clinical relevance for evaluating body image concerns in persons with CHD.

Assessing the Efficacy of Cognitive-Behavioral Therapy on Body Image in Adolescent Scoliosis Patients Using Virtual Reality

Background/Objectives: Adolescents with idiopathic scoliosis require emotional support to change their experience of their desired body shape and to feel optimistic about the cosmetic results of surgical treatment. Recently, the use of virtual reality in psychological assessment and treatment has given specialists a technology that appears particularly well-suited for addressing body image disorders. The study objectives were two-fold. Firstly, we aimed to evaluate changes within the body image of scoliosis patients pre- and postoperatively. Secondly, we aimed to investigate if differences in body image exist in scoliosis females after implementing cognitive-behavioral therapy. Methods: Thirty-six total scoliosis patients participated in the 1st and 2nd study phases. The psychotherapy took place before and after surgery and during the patient's stay in the hospital. Body image was assessed using a virtual reality-based application, "Avatar Scoliosis 3D". Results: Regarding body image dissatisfaction evaluated via virtual tasks, the difference between the desired by patients and actual (based on the radiographic parameters) body shape is significant preoperatively in both scoliosis samples: with and without therapy (p < 0.000001 and p < 0.000001, respectively). Conclusions: The results of the present study may have important implications for developing standards for body image disorder treatments in scoliosis patients. We revealed that irrespective of received therapeutic support, scoliosis patients accurately estimate their body shape pre- and postoperatively, and they feel dissatisfied with their body preoperatively but not postoperatively.

Curve Progression and Clinical Outcomes in Pregnant Females with Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

BACKGROUND

Prior reviews investigating the impact of pregnancy on adolescent idiopathic scoliosis (AIS) have reached different conclusions and a meta-analysis of curve progression among pregnant females with AIS and its effects on clinical outcomes has not previously been performed.

METHODS

A comprehensive search of major bibliographic databases (PubMed, Embase, and Scopus) was conducted for articles pertaining to spinal curve progression during pregnancy among patients with AIS. Patient demographics, scoliotic curve outcomes, and patient-reported quality of life measures were extracted.

RESULTS

Ten studies, including 857 patients with a mean age of 28.7 years, were included. Before pregnancy, 42.1% had undergone spinal fusion and 59.0% had a thoracic curve. Based on prepregnancy and postpregnancy radiographs, the curve increased from 33.9°-38.5°, and meta-analysis revealed a curve progression of 3.6° (range = -5.85 to 1.25, P = 0.003), primarily arising from loss of correction in the unfused group (Unfused = -5.0, P = 0.040; Fused = -3.0, P = 0.070). At the same time, 45.9% patients reported increased low back pain and many reported a negative body self-image and limitations in sexual function. However, 5 studies noted that pregnancy and number of pregnancies were not associated with curve progression, and multiple studies identified similar quality of life-related changes in non-pregnant patients with AIS.

CONCLUSIONS

Among unfused pregnant females with AIS, the spinal curvature increased significantly by 5.0° from before to after pregnancy. However, these changes may be independent of pregnancy status and occur with time. Such curve progression can contribute to a negative body self-image, low back pain, and functional limitations irrespective of pregnancy state.

Self-image in spinal deformity: a state-of-the-art review

PURPOSE

To review the current literature surrounding the assessment of self-image in pediatric and adult spinal deformity.

METHODS

The literature were reviewed for studies examining patient-reported outcome measurements (PROM) and self-image in pediatric and adult spinal deformity. PROM performance metrics were collected and described. The relationships between self-image PROM and patient outcomes, including satisfaction, were described.

RESULTS

Several self-image PROM exist, including the Scoliosis Research Society-22r (SRS-22r) self-image domain, the Body Image Disturbance Questionnaire (BIDQ), and the Spinal Appearance Questionnaire (SAQ). The most commonly used is the self-image domain of the SRS-22r. It is validated in adult and pediatric spinal deformity and is correlated with patient desire for surgery and satisfaction after surgery. This domain is limited by floor and ceiling effects.

CONCLUSION

Self-image assessment is critical to both pediatric and adult spinal deformity surgeries. The SRS-22r self-image domain is the most frequently reported PROM for this health domain. While valid in both surgical cohorts, this PROM is affected by floor and ceiling effects which limits the ability to discriminate between health states. Given the overall importance of this domain to patients with spinal deformity further efforts are needed to improve discrimination without gross increases in PROM question burden, which may limit broad acceptance and use.

Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion

PURPOSE

Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT.

METHODS

In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest-posttest designs were used to compare procedure type on post-operative outcomes.

RESULTS

Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ2(1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance.

CONCLUSION

While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2-3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF.

Evaluation of the changes in waistline asymmetry using digital photography in adolescents with idiopathic thoracolumbar/lumbar scoliosis after corrective surgery

PURPOSE

Waist line asymmetry is a major cosmetic concern in patients with adolescent idiopathic scoliosis (AIS). The primary surgical goal in patients with AIS is to correct spinal deformities and prevent further progression while maintaining global alignment. Additionally, an important objective of surgical treatment is to address physical appearance by reducing asymmetry. This study aimed to evaluate changes in waistline asymmetry using digital photographs in adolescents with thoracolumbar/lumbar (TL/L) scoliosis who underwent corrective surgery.

METHODS

We retrospectively analyzed the data of patients with Lenke types 5C and 6C AIS who underwent posterior fusion surgery with at least 2 years of follow-up. Waist line asymmetry was assessed using digital photography. The waist angle ratio (WAR), waist height angle (WHA), and waistline depth ratio (WLDR) were measured pre- and postoperatively. Radiographic parameters and the revised 22-item Scoliosis Research Society Questionnaire (SRS-22r) were also evaluated.

RESULTS

Forty-two patients (40 females and 2 males; 34 with type 5C and 8 with type 6C) were included in the study. The WAR, WHA, and WLDR significantly improved after surgery (0.873 → 0.977, - 2.0° → 1.4°, and 0.321 → 0.899, respectively). Every waistline parameter moderately correlated with the apical vertebral translation of the TL/L curve (WAR: r =  - 0.398, WHA: r =  - 0.442, and WLDR: r =  - 0.692), whereas no correlations were observed with the TL/L curve magnitude. No correlations were observed between the photographic parameters and SRS-22r scores.

CONCLUSION

Lateral displacement of the apical vertebra on the TL/L curve correlated with waistline asymmetry. Preoperative waistline asymmetry improved with scoliosis correction.

LEVEL OF EVIDENCE

Level 4.

Using Photogrammetry to Analyze Anatomical Changes in the Nipple in Juvenile and Adolescent Scoliosis Patients

BACKGROUND

The need for an objective set of anterior trunk measurements, such as nipple and clavicular shoulder joints, is essential to quantify the anterior asymmetry present in scoliosis. This study aims to characterize breast asymmetry (BA) in young individuals with scoliosis using photogrammetry.

METHODS

Digital photographs of the anterior trunk of the 51 scoliosis patients aged 4-20 years were taken from an anterior perspective. These images were then transferred to a computer. Ten parameters were measured using the ImageJ software. The positions of patients' nipples were classified into 6 types based on ratios on the x-axis.

RESULTS

The majority of patients had a right breast that was larger, intensifying the apparent BA due to trunk rotation. The apical vertebra level in patients was found at T8 in 23.6% and T9 in 45.1%. In 92.5% of the patients, the right breast was consistently larger. The lengths between the lateral boundaries and nipples of the right and left breasts and between the medial boundary and nipple of the right breast were statistically significantly higher in males than in females (p < 0.05). Significant differences were found when comparing the values of the lengths between the medial boundaries and nipples of the right and left breasts, the difference in length between the right and left acromioclavicular joint lines, and the angles of the nipple and acromioclavicular joint with the degrees of scoliosis in juvenile and adolescents (p < 0.05). Pearson regression analysis revealed a significant correlation between BA differences and the Cobb angle with a correlation coefficient of 0.901. Factors related to breast aesthetics, like differences in the height of nipples and the distance from the sternal notch to the nipple, represent 30% of the overall score.

CONCLUSION

The study concluded that there is a significant correlation between the severity of scoliosis and BA differences. Augmentation mammaplasty for BA not only decreased the breast difference but also leveled the nipple disparities. Photogrammetry is considered to be an alternative to other methods and is believed to contribute to the follow-up of BA.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Depression Screening in Pediatric Orthopedic Surgery Clinics and Identifying Patients At-Risk

BACKGROUND

Up to 25% of youth experience a depressive episode by 18 years of age, leading the US Preventive Services Task Force to recommend depression screening within this population. This study aimed to understand the prevalence of depression identified within pediatric orthopedic clinics compared with primary care clinics after the implementation of a screening program and present data on the prevalence of moderate-severe depression across specific pediatric orthopedic clinics, characterizing and identifying specific populations at higher risk.

METHODS

A retrospective review was performed to identify all patients screened using the 2-item and 9-item versions of the Patient Health Questionnaire (PHQ-2/PHQ-9) and the Columbia-Suicide Severity Rating Scale over a 2-year period (October 2018 to January 2021) within pediatric primary care and orthopaedic clinics. Demographic and clinical characteristics were collected. Statistical analysis was performed to compare scores between orthopedic and primary care clinics, as well as between the different pediatric orthopedic subspecialties and included χ 2 test, ANOVA, and logistic regression.

RESULTS

There were 32,787 unique adolescent patients screened in primary care clinics, with an additional 14,078 unique adolescent patients screened in orthopaedic clinics, leading to a 30% increase in the overall number of patients receiving depression screening. 5.2% of patients in primary care pediatric clinics screened positive for moderate-severe depression versus 2.0% in pediatric orthopaedic clinics ( P <0.001). 2.7% of primary care patients were at risk of self-harm compared with 0.8% of orthopedic patients ( P <0.001). Within orthopaedic subspecialty clinics, the spine patients were at the highest risk of moderate-severe depression (3.5%), significantly higher than both the sports (1.4%, P =0.006) and patients with acute fracture (1.3%, P <0.001).

CONCLUSIONS

This study demonstrates the high incidence of patients screening positive for depression in pediatric and adolescent orthopaedic clinics. By identifying high-risk clinics and patient groups, health care systems can apply a more practical approach and appropriately deploy behavioral health specialists for timely counseling and treatment discussions.

LEVEL OF EVIDENCE

Level-III.

Translation, Transcultural Adaptation, and Validation of the Brazilian Portuguese Version of the Body Image Disturbance Questionnaire for Scoliosis (BR-BIDQ-S)

Objective  The Body Image Disturbance Questionnaire for Scoliosis (BIDQ-S) for scoliosis derives from the Body Image Disturbance Questionnaire (BIDQ) with specific adaptation for scoliosis patients. Despite its significance and applicability, this instrument has never been translated into Brazilian Portuguese. The current study aimed to translate, transculturally adapt, and validate the BIDQ-S into Brazilian Portuguese. Methods  BIDQ-S was translated and culturally adapted into Brazilian Portuguese using the American Association of Orthopedic Surgeons (AAOS) criteria. The questionnaire validation relied on internal consistency and comparison with the Cobb angle, Pediatric Quality of Life Inventory (PedsQL), and Scoliosis Research Society (SRS-22). The Brazilian version (BR-)BIDQ-S validation occurred in a sample of 35 adolescents with scoliosis waiting for specialized treatment. Results  Internal consistency of the BR-BIDQ-S was 0.899 according to the Cronbach's index (i.e., virtually perfect). Although BR-BIDQ-S did not correlate with the Cobb angle, it presented correlations with the Physical, Emotional, and Social domains from the PedsQL and the Function/Activity domain from the SRS-22. Conclusion  BR-BIDQ-S was reliable in evaluating the body image of adolescents with scoliosis, presenting an internal consistency of 0,899 (virtually perfect). Moreover, similar to the original instrument, it correlated with PedsQL and SRS-22.

Development, validity and reliability of patient perception of scoliosis-specific physiotherapy (physio-is) questionnaire

PURPOSE

To develop a questionnaire for adolescent idiopathic scoliosis (AIS) patients undergoing physiotherapeutic scoliosis-specific exercises (PSSE) and to evaluate its content validity, structural validity, and reliability.

METHODOLOGY

Seven PSSE treatment experts checked the content validity of the Patient's Perception of Scoliosis-Specific Physiotherapy Questionnaire (Physio-IS). For each Physio-IS item, the content validity indexes must be ≥ 90%. Regarding structural validity and reliability 52 adolescents (ages 10-17) with AIS completed the questionnaire. Structural validity was assessed through exploratory factor analysis. Reliability was verified through internal consistency.

RESULTS

Physio-IS content was validated in three evaluation rounds, obtaining 100% expert agreement. About structural validity we identified four domains (cumulative explained variance = 68.2%): (1) specific knowledge (seven questions on understanding their scoliosis condition); (2) social repercussion (five questions about social relationship implications); (3) pain (two questions about scoliosis-associated pain); and (4) associated concern (apprehension/expectations regarding the future). The Physio-IS demonstrated very good internal consistency (Cronbach's alpha = 0.76-0.92).

CONCLUSION

The Physio-IS is a valid and reliable tool for assessing AIS patients undergoing PSSE and helping physiotherapists identify aspects requiring more attention, thus facilitating intervention strategies, as knowing the patient's perception of their condition or treatment is fundamental to AIS treatment success.

From PHQ-2 to SRS-22: how a depression screening tool relates to SRS scores in patients with adolescent idiopathic scoliosis

PURPOSE

The aim of our study was to determine the relationship between Patient Health Questionnaire (PHQ) scores-a simple, validated depression screening tool-and Scoliosis Research Society (SRS)-22 questionnaire scores in patients with idiopathic scoliosis (IS).

METHODS

IS patients screened for depression with the PHQ-2 who completed the SRS-22 over a 2-year period were reviewed. If PHQ-2 scores were positive (> 3), the more comprehensive PHQ-9 was administered. Median SRS-22 scores between positive and negative PHQ screens were compared. Nonparametric correlation between PHQ and SRS-22 Mental Health (MH) domain was performed. The ability of the MH domain to discriminate between patients with positive versus negative screens and patients with moderate-severe depression risk versus no-mild risk was evaluated with ROC analysis.

RESULTS

521 patients were included. Patients with + PHQ-2 screens had significantly lower total and individual domain SRS scores, especially within the MH domain (4.0 vs. 3.2). For those with moderate-severe depression risk, total and individual domain scores were also significantly lower (MH domain, 4.0 vs. 3.0, p < 0.05). A weak, but significant correlation was observed between the PHQ and MH domain scores (rho = 0.32, p < 0.001). A cut-off of ≥ 3.6 on the MH domain demonstrated sensitivity of 0.75 and specificity of 0.86 for identifying patients at no-mild risk for depression.

CONCLUSION

Recognizing mental health conditions is critical to successful IS treatment as psychosocial conditions can negatively affect treatment outcomes. IS patients scoring < 3.6 on the SRS-22 MH domain should be considered for depression screening due to an increased risk of moderate-severe depression.

Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery

STUDY DESIGN

Observational case control.

OBJECTIVE

The objective of this study was to evaluate the prevalence of opioid use two years after surgical correction of adolescent idiopathic scoliosis (AIS) and its association with preoperative mental health.

SUMMARY OF BACKGROUND DATA

Studies of opiate use have reported that up to 80% of users began their addiction with misuse of prescription opioids. Identifying opioid use and those at risk in the AIS population is critical for optimal outcomes.

MATERIALS AND METHODS

A query of a multicenter prospective AIS surgical fusion registry was performed to identify patients of all curve types with responses to question 11 on the Scoliosis Research Society-22 questionnaire at two years postoperative. Question 11 asks about pain medication usage for the patient's back with five specific responses: narcotics daily, narcotics weekly or less, non-narcotics daily, non-narcotics weekly/less, or none. Ordinal regression was used to evaluate the association between preoperative Scoliosis Research Society-22 Mental Health (MH) domain scores and two-year postoperative pain medication usage.

RESULTS

A total of 2595 patients who underwent surgery from 2002 to 2019 met inclusion. The average primary curve was 56±12°, average age 14.7±3 years, and 81.5% were female. Forty (1.5%) patients reported utilizing opioids two years after surgery, and a significant difference in preoperative MH scores was observed. Patients taking daily opioids postoperatively had the lowest median preoperative MH score (3.75), followed by non-narcotic group (4), and no medication (4.2, P <0.001). Three patients reporting opioid use postoperatively reported preoperative usage. The rate of two-year postoperative medication use based on the year of surgery demonstrated a small linear decrease in opioid use over time, with a slight increase in nonopioid daily use.

CONCLUSIONS

Less than 2% of patients reported taking opioids for back pain two years after surgical correction of AIS. A lower MH score before surgery may place a patient at increased risk for opioid use two years after surgery. An analysis of the year of surgery suggests that changes in prescription practices over time may be occurring.

LEVEL OF EVIDENCE

4.

Translation and validation of the French version of the adolescent idiopathic scoliosis Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ)

PURPOSE

Scoliosis is an abnormality which causes anterior trunk asymmetry. The Truncal Anterior Asymmetry Scoliosis Questionnaire-adolescent idiopathic scoliosis (AIS) (TAASQ) measures the feeling about anterior trunk appearance in girls with AIS. It comprises 14 questions which evaluate frontal asymmetry of breasts, shoulders, and waist as well as behavioral attitude. There is currently no validated questionnaire in French to evaluate truncal asymmetry in AIS girls. The aim of this study was to translate and validate the French version of the TAASQ (TAASQ-VF).

METHODS

The study reports the translation and transcultural adaptation of the TAASQ into French. The translation was tested on 20 patients to verify comprehension and modify if necessary. To assess the reliability of the translated version, each domain as well as the total measure were tested for internal consistency. Convergent validity was evaluated on 63 patients and test-retest on a sample of 15.

RESULTS

The translation and content validation process resulted in a French version of the TAASQ. Internal consistency was over 0.80 for each item, over 0.70 for each domain, and 0.88 for the total scores. SAQ were used to perform convergent validity with TAASQ-VF. The TAASQ-FV correlated well with many of the SAQ domains (p < 0.05) and every TAASQ-FV domain correlated with at least one SAQ domain (p < 0.05). Test-retest reliability for the total score and for each domain was good.

CONCLUSION

The translation and cross-cultural adaptation of the TAASQ questionnaire provides a French version that can measure the feeling about frontal appearance in girls with idiopathic scoliosis.

Experimental protocol to investigate cortical, muscular and body representation alterations in adolescents with idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. AIS is a three-dimensional morphological spinal deformity that affects approximately 1-3% of adolescents. Not all factors related to the etiology of AIS have yet been identified.

OBJECTIVE

The primary aim of this experimental protocol is to quantitatively investigate alterations in body representation in AIS, and to quantitatively and objectively track the changes in body sensorimotor representation due to treatment.

METHODS

Adolescent girls with a confirmed diagnosis of mild (Cobb angle: 10°-20°) or moderate (21°-35°) scoliosis as well as age and sex-matched controls will be recruited. Participants will be asked to perform a 6-min upright standing and two tasks-named target reaching and forearm bisection task. Eventually, subjects will fill in a self-report questionnaire and a computer-based test to assess body image. This evaluation will be repeated after 6 and 12 months of treatment (i.e., partial or full-time brace and physiotherapy corrective postural exercises).

RESULTS

We expect that theta brain rhythm in the central brain areas, alpha brain rhythm lateralization and body representation will change over time depending on treatment and scoliosis progression as a compensatory strategy to overcome a sensorimotor dysfunction. We also expect asymmetric activation of the trunk muscle during reaching tasks and decreased postural stability in AIS.

CONCLUSIONS

Quantitatively assess the body representation at different time points during AIS treatment may provide new insights on the pathophysiology and etiology of scoliosis.

Evaluating the Use of PROMs in Paediatric Orthopaedic Registries

Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.

A feasibility study of applying two-dimensional photogrammetry for screening and monitoring of patients with adolescent idiopathic scoliosis in clinical practice

Standing posteroanterior radiographs have been the golden standard to quantify the severity of scoliosis deformity. However, it exposes ionizing radiation to scoliosis patients, and cannot be used for routine screening and monitoring. This study aimed to develop a protocol of measuring postural indexes by using the noninvasive and radiation-free two-dimensional (2D) photogrammetry method and identify its clinical value in scoliosis screening and monitoring. The five postural indexes were measured from the posterior view of 110 participants. One-way ANOVA with post hoc Tukey HSD/Games-Howell analysis was used to compare the differences between the participants in the scoliosis group and the non-scoliosis group. Pearson coefficients of correlation were analyzed to identify the relationships between Cobb angles and each of the five quantitative postural indexes. Based on 2D photogrammetry, the postural indexes of C7 deviation (p = 0.02), shoulder alignment (p < 0.001), scapula alignment (p < 0.001), waist angle discrepancy (p < 0.001), and PSIS alignment (p < 0.001) could significantly differentiate scoliosis and non-scoliosis patients during screening. The waist angle discrepancy (r = 0.4, p = 0.01; r = 0.8, p = 0.03; r = 0.7, p = 0.01) and shoulder alignment (r = 0.6, p = 0.03) had moderate to strong positive correlations with the Cobb angles, which supported their clinical values in monitoring scoliotic curvature changes of adolescent idiopathic scoliosis (AIS) patients.

SRS-22r Self-Image After Surgery for Adolescent Idiopathic Scoliosis at 10-year Follow-up

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

To examine SRS-Self Image scores at up to 10 years after surgery for adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

Self-image is complex with implications for surgical and patient-reported outcomes after AIS surgery. Surgically modifiable factors that impact self-image are inconsistently reported in the literature with few longer-term reports. We examined the rate and durability of self-image improvement.

MATERIALS AND METHODS

An AIS registry was queried for patients with up to 10 years of follow-up after AIS surgery. A mixed effects model estimated change in SRS-22 Self Image from baseline to 6 weeks, 1 year, 2 years, 5 years, and 10 years. All enrolled patients contributed data to the mixed effects models. A sub-analysis of patients with 1-year and 10-year follow-up evaluated worsening/static/improved SRS-22 Self Image scores examined stability of scores over that timeline. Baseline demographic data and 1-year deformity magnitude data were compared between groups using parametric and nonparametric tests as appropriate.

RESULTS

Data from 4608 patients contributed data to the longitudinal model; 162 had 1-year and 10-year data. Mean SRS-Self Image improvement at 10-year follow-up was 1.0 (95% CI: 0.9-1.1) point. No significant changes in Self-Image domain scores were estimated from 1-year to 10-year (all P >0.05) postoperative. Forty (25%) patients had SRS-Self Image worsening from 1 year to 10 years, 36 (22%) improved, and 86 (53%) were unchanged. Patients who worsened over 10 years had lower SRS-Self Image at baseline than those unchanged at enrollment (3.3 vs. 3.7, P =0.007). Neither radiographic parameters nor SRS-Mental Health were different at baseline for the enrolled patients.

CONCLUSION

Ten years after surgery, 75% of patients reported similar or better SRS-Self Image scores than one year after surgery. Nearly 25% of patients reported worsening self-image at 10 years. Patients who worsened had lower baseline SRS-Self Image scores, without radiographic or mental health differences at baseline or follow-up.

Internalization of the Western Standard of Beauty and Body Satisfaction: Evaluation Utilizing COPS and SATAQ-3 Questionnaires among Girls with Scoliosis

Background and Objectives: Patients with adolescent idiopathic scoliosis (AIS) more frequently present significant back-related body image disturbances compared with healthy controls. The study aimed to adapt two screening questionnaires: Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) and Cosmetic Procedure Screening Questionnaire (COPS), that could identify AIS patients, especially those threatened with body image disorders and might predict dissatisfaction with a desired-by-patients cosmetic result of treatment. Materials and Methods: In total, 34 AIS patients who undergo Cheneau brace treatment were asked to complete SATAQ-3 and COPS. Results: AIS patients presented a high level of internalization. Clinical and radiological factors that play a crucial role in the evaluation and decision process during brace treatment were not significantly associated with COPS and SATAQ-3 total scores. The SATAQ-3 total score and COPS results were also not related to sociodemographic parameters of the analyzed group. Conclusions: The presented study confirms the usefulness of the questionnaires, which aimed to isolate sociocultural risk factors of body image disorders in scoliosis patients as predictors of treatment dissatisfaction and worse compliance.

Why Don't Adolescents Wear Their Brace? A Prospective Study Investigating Psychosocial Characteristics That Predict Scoliosis Brace Wear

BACKGROUND

Although bracing for adolescent idiopathic scoliosis can prevent curve progression and reduce the risk for future surgery, children frequently do not wear their braces as prescribed. The purpose of this study is to investigate how a broad array of psychosocial characteristics predict future compliance with scoliosis brace wear.

METHODS

This was a single institution, prospective cohort study. All adolescents prescribed a first-time brace for adolescent idiopathic scoliosis were eligible. Patients and their parents completed a separate series of questionnaires that assessed baseline psychosocial characteristics across 6 domains: (1) brace-specific attitudes; (2) body image and self-esteem; (3) school performance and social relationships; (4) psychological health; (5) family functioning; and (6) demographics and scoliosis-specific details (242 total questions across 12 validated questionnaires). Objective brace compliance was collected using temperature-sensitive monitors. Defining compliance as percentage of brace prescription completed, comparative analyses were performed to identify baseline psychosocial characteristics that were associated with future wear. A composite measure (Bracing Fidelity Follow-Up Scale [BFFS]) of the 12 most predictive individual questions across all domains (both parent and adolescent) was constructed to help assess which adolescents were at highest risk of failure to wear their brace. Total BFFS score for each parent-adolescent dyad who completed all the included surveys was then determined by awarding one point for each factor that positively influenced future brace wear (maximum 12 points), and a correlation was calculated between total score and percent adherence to prescribed brace wear.

RESULTS

A total of 41 patients were included. On average, patients with high self-esteem, above average peer relationships and poor brace-specific attitudes had lower brace compliance, although patients with increased loneliness and parental religiousness had higher compliance. Body image, socioeconomic status, family dynamics, and school performance had no significant relationship with brace use. Total score on the Bracing Fidelity Follow-Up Scale (BFFS) was significantly associated with improved brace wear (r=0.687, P <0.001). Those with a score of 6 or above (n=15/33 [45%], median compliance 96%) were more reliable users (15/15 with compliance >75%), and those with a score of 5 or less (n=18/33 [55%], median compliance 50%) had less consistent brace wear (9/18 with compliance <50%).

CONCLUSION

This prospective study identifies numerous baseline psychosocial factors that are associated with future compliance with scoliosis brace wear. Although in need of further validation before widespread clinical application, the novel BFF scale offers a potential opportunity to partially discriminate between compliant and noncompliant scoliosis brace users such that supportive resources (eg, supportive counseling, peer-support groups, additional provider-based education, etc.) can be targeted to those patients most likely to benefit.

LEVEL OF EVIDENCE

II.

Disordered Eating and Body Image Concerns in Young Adult Women With Scoliosis

Background

Researchers have called for more investigation into disordered eating behaviors in females with scoliosis.

Objective

The objective of the current study was to assess the associations between body image concerns, disease-specific indicators of scoliosis (ie, age of diagnosis, having undergone bracing treatment, being told by a physician your scoliosis required surgery, having a spinal fusion), quality of life, and disordered eating in a sample of young adult women diagnosed with idiopathic scoliosis during adolescence.

Design

This study was cross-sectional in design.

Methods

Participants were 177 young adult women ages 18 to 30 years diagnosed with idiopathic scoliosis by a physician who completed questionnaires online.

Results

Undergoing bracing treatment (r = -.440; P < .001), greater age at scoliosis diagnosis (r = .563; P < .001), being told scoliosis required surgery (r = -.196; P < .050), annual income (r = .306; P < .001), level of education (r = .228; P < .010), and race/ethnicity (r = -.213; P < .050) were associated with the EDE-Q Global Score. The Body Shape Questionnaire Total Score and EDE-Q Global Score (r = .848; P < .001) and EDE-Q Weight Concern Score (r = .813; P < .001) were associated. The strongest correlations between the EDE-Q and the SRS-22-Revised Subscales were generally evidenced on the SRS-22-Revised Mental Health Subscale (rs ranged from -.200 to -.371; P < .001). After controlling for annual income, highest level of education, undergoing bracing treatment, and age of scoliosis diagnosis, the Body Shape Questionnaire Total Score was significantly correlated with the EDE-Q Eating Concern Score (standardized beta coefficient = .618; P < .001).

Conclusions

These findings underscore the importance of assessing body image concerns in young adult women with scoliosis experiencing disordered eating as this information may provide valuable information relevant to treatment planning.

Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients

BACKGROUND

To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment.

OBJECTIVE

The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals.

METHODS

Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength.

RESULTS

Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081).

CONCLUSIONS

The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.

Outcomes of Definitive Spine Fusion Using All-pedicle-Screw Constructs in Skeletally Immature Patients Aged 8 to 10 Years With Severe Idiopathic Early-Onset Scoliosis

BACKGROUND

The choice between growth-sparing techniques or definitive spine fusion for severe idiopathic early-onset scoliosis (IEOS) in skeletally immature patients aged 8 to 10 years represents a challenging dilemma. Although growth-sparing techniques show high complication rates in severe IEOS, the outcomes of definitive fusion in borderline skeletally immature patients with severe IEOS have not been investigated. We aimed to investigate the outcomes of early definitive fusion using all-pedicle-screw constructs in skeletally immature patients aged 8 to 10 years with severe IEOS.

METHODS

The inclusion criteria were as follows: IEOS, age 8 years or above, major coronal curve ≥90 degrees, thoracic height >18 cm, no history of previous spine surgery, no intraspinal anomalies and at least 3 years of postoperative follow-up. Patients underwent instrumented spinal fusion with all-pedicle-screw constructs and multiple Ponte osteotomies. All patients completed the Scoliosis Research Society 22 revision (Arabic version) questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) preoperatively and at the last follow-up.

RESULTS

Fifty-five patients (24 males, 31 females; mean age: 8.96 y; range: 8 to 10 y) with severe IEOS met the inclusion criteria (mean follow-up period: 4.1±0.6 y; range: 3 to 5 y). The mean major coronal Cobb angle improved significantly (P<0.001) from 107±12.5 degrees to 26.8±6.8 degrees. Mean thoracic kyphosis improved significantly (P<0.001) from 57.2±15.8 degrees to 31.2±4.4 degrees. The loss of correction at the latest follow-up was nonsignificant. The total Scoliosis Research Society 22 revision (SRS-22r) score improved significantly from 2.5±1 to 4.3±0.7. The mean BIDQ-S score improved significantly from 4.1±0.3 to 1.6±0.3. The immediate postoperative gains in the mean thoracic height (T1-T12) and spinal height (T1-S1) were 14.9% and 19.6%, respectively, and the overall height increase at the latest follow-up was 17.8% and 23.8%, respectively. One patient underwent revision for implant failure (rod breakage).

CONCLUSION

Early definitive fusion for skeletally immature patients with severe IEOS yielded excellent correction with major improvements in patient quality of life. Severe IEOS poses a significant risk, but definitive fusion can potentially mitigate that risk in patients aged 8 to 10 years.

Prevalence and Predictors of Scoliosis and Back Pain in 591 Adolescents: A Randomized, Stratified, Cross-Sectional Study in Riyadh, Saudi Arabia

Purpose

Owing to the difficulty of establishing a screening program for scoliosis and back pain, along with their disabling consequences and the lack of local prevalence rates, we sought to study the prevalence of scoliosis and back pain in adolescents in Saudi Arabia and the burden reported by the affected age group on the health system.

Materials and methods

A school-based, cross-sectional pilot study covering all school districts in Riyadh, Saudi Arabia, was conducted. Students between 12 and 18 years of age were included. Students with any spinal or neurological disorders were excluded. Physical examinations to screen for scoliosis and student-filled questionnaires to assess back pain and health-related quality of life were performed.

Results

Of the 700 students, 591 met the inclusion criteria. High suspicion of adolescent idiopathic scoliosis (AIS) was considered in 174 students (29.44%). In addition, 45.42% of the students had a history of back pain. The Oswestry Disability Index showed that 87 students had disabilities. The average Scoliosis Research Society-22 score was 3 out of 5. A significant difference was found in the self-image and mental health domains for AIS (p = 0.04, p = 0.02, respectively). Age showed a significant increase in the odds ratio of a positive physical exam for every increase of one year in age (p < 0.01).

Conclusion

Identifying the prevalence rates and early associated factors during adolescence would help lower the burden on the health system and benefit public health in general. A nationwide study is required to identify the relationship between scoliosis and back pain.

Exploration of Contributory Factors to an Unpleasant Bracing Experience of Adolescent Idiopathic Scoliosis Patients a Quantitative and Qualitative Research

BACKGROUND

To obtain a better understanding of the wearing habits and preferences of Adolescent Idiopathic Scoliosis (AIS) patients undergoing rigid brace treatment, we examine what factors contribute to patients' perceived discomfort during the treatment.

METHODS

Seventeen AIS patients treated with a rigid brace were recruited. We asked them to complete a questionnaire and participate in an interview study. Finally, we measure the interface corrective force and perceived discomfort with the participants for different positions and assess the correlation.

RESULTS

Our survey reveals that participants scored the lowest in the domains of environmental factors, psycho-spiritual factors, satisfaction, and self-image. Appearance anxiety, physical and psychological discomfort and inconvenience were the three most frequently mentioned problems in the interviews on participants' daily bracing experiences. A significant, moderately positive relationship between corrective force and discomfort level was found only when participants were lying on their left side, but not in any of the other positions. No significant correlation between treatment length and perceived discomfort was found.

CONCLUSIONS

Future work should focus on reducing the psychological burden and the inconvenience of wearing a brace, rather than on reducing physical discomfort resulting from the corrective force.

Evaluation of Self-Perceived Body Image in Adolescents with Mild Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is the most prevalent types of scoliosis, affecting up to 3% of children around the world. The progression of AIS can cause alteration in psychological components such as self-perceived body image and self-identity, which negatively affect the teenager quality of life (QoL). The mainly aim of this cross-sectional study is to investigate how mild AIS impacts self-perceived body image in young people. Fifteen participants (mean age = 14.47 ± 2.825) of both sexes (male = 5; female = 10) with a curve magnitude from 10° up to 25° completed the Scoliosis Research Society Patient Questionnaire (SRS-22), the Trunk Appearance Perception Scale (TAPS) and were subject to spinal analysis and photogrammetry. Results display statistical differences between self-perceived body image and other SRS-22 domains (Hotelling t2= 70.29; F(3,12) = 20.08; p < 0.001). Additionally, the regression model, which better explained the self-perceived variability, was fit by function/activity, pain, and mental health domains (F(4,10) = 4.39; p = 0.029; R2 = 0.545). Although AIS was not severe, it negatively affected participants self-perceived body image. More attention in AIS qualify of life is needed, and early treatments could be necessary to prevent psychological impairments self-perception related.

Family Functioning Affected by Adolescent Idiopathic Scoliosis in China: A Cross-Sectional Study

Adolescent idiopathic scoliosis (AIS) is a common chronic disease in youths, presenting with spinal deformity. Previous studies reported that the family functioning of family members would be affected after a child is diagnosed with a chronic health condition. However, no previous study focused on the relationship between AIS and family function. This study is a cross-sectional study that enrolled 54 AIS families and 92 ordinary families and evaluated their family function in 7 domains using the McMaster family assessment device (FAD). The results showed that the AIS family got a lower score than a healthy family in all 7 subscales except for the problem-solving subscale. There was no significant difference between the patients with AIS (1.90 ± 0.42∼2.23 ± 0.32) and their parents (1.92 ± 0.35∼2.21 ± 0.29) in all seven subscales (p ≥ 0.05). The scores of the parents were moderately/strongly correlated with those of the patients with AIS in all seven subscales (γ = 0.456∼0.696, p < 0.05). Approximately, 20.4-87% of the families experienced unhealthy family functioning, with affective involvement (57.4%), and behavior control (87%) representing the unhealthiest subscales with the mean scores above the cutoff. It can be concluded that the AIS family performed better than a healthy family in family functions.

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.

Early operative morbidity in 184 cases of anterior vertebral body tethering

Fusion is the current standard of care for AIS. Anterior vertebral body tethering (AVBT) is a motion-sparing alternative gaining interest. As a novel procedure, there is a paucity of literature on safety. Here, we report 90-day complication rates in 184 patients who underwent AVBT by a single surgeon. Patients were retrospectively reviewed. Approaches included 71 thoracic, 45 thoracolumbar, 68 double. Major complications were those requiring readmittance or reoperation, prolonged use of invasive materials such as chest tubes, or resulted in spinal cord or nerve root injury. Minor complications resolved without invasive intervention. Mean operative time and blood loss were 186.5 ± 60.3 min and 167.2 ± 105.0 ml, respectively. No patient required allogenic blood transfusion. 6 patients experienced major (3.3%), and 6 had minor complications (3.3%). Major complications included 3 chylothoracies, 2 hemothoracies, and 1 lumbar radiculopathy secondary to screw placement requiring re-operation. Minor complications included 1 patient with respiratory distress requiring supplementary oxygen, 1 superficial wound infection, 2 cases of prolonged nausea, and 1 Raynaud phenomenon. In 184 patients who underwent AVBT for AIS, major and minor complication rates were both 3.3%.

The body image disturbance questionnaire-scoliosis better correlates to quality of life measurements than the spinal assessment questionnaire in pediatric idiopathic scoliosis

PURPOSE

Idiopathic scoliosis (IS) patients can have body dissatisfaction which can affect their perception of health. Two body image measures, the Spinal Appearance Questionnaire (SAQ) and the Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S), have been used in pediatric IS with variable correlation to the SRS-22r and radiographs, but have not been compared to each other. As patient reported outcomes (PROs) continue to be highlighted in large database studies and national hospital ranking system scoring, we should narrow use to the best and most efficient. We aim to determine which of two better correlates to pediatric IS patients' radiographs and quality of life (QoL) scores.

METHODS

Consecutive IS patients aged 10-19 years old without surgery prospectively completed BIDQ-S, SAQ, SRS-22r, and PedsQL self-reported outcome measures. BIDQ-S and SAQ were compared in correlation to the two QoL surveys, as well as to radiographic major curve, shoulder asymmetry, lateral upright ribcage offset at apex, and coronal/sagittal balance. Spearman's r was used for correlations.

RESULTS

104 surveys with mean age 14.4 years and mean major curve 42° (14°-74°) were included. BIDQ-S and SAQ scores strongly correlated to each other (r = 0.76), but BIDQ-S had a stronger correlation to total SRS-22r (- 0.75 vs - 0.61 SAQ), PedsQL total (- 0.76 vs - 0.55) and better or no difference in each SRS-22r and PedsQL domain. Both poorly correlated to radiographs (main curve: r = 0.32 BIDQ-S, 0.31 SAQ).

CONCLUSION

The BIDQ-S correlates better to SRS-22r and PedsQL for pediatric IS patients than the SAQ. Neither correlate well to radiographs.

LEVEL OF EVIDENCE

III.

Adolescents' Experiences of Idiopathic Scoliosis in the Presurgical Period: A Qualitative Study

OBJECTIVE

Adolescent idiopathic scoliosis (AIS) is a sideways curvature of the spine that can progress severely during adolescent development and require surgical intervention. This qualitative study was conducted to explore the psychosocial experiences of adolescents with idiopathic scoliosis during the presurgical stage of treatment.

METHODS

Fourteen adolescents with moderate-to-severe AIS aged 12-17 years participated in semistructured interviews and data were analyzed using inductive reflexive thematic analysis.

RESULTS

Four key themes were generated from the analysis. "Proceeding with Caution" described adolescents' adaptation to the physical impact of their AIS, while "Am I Different?" encompassed adolescents' perceptions of their changing appearance and visibility of their condition. "An Emotional Journey" captured the rollercoaster of emotions from shock at diagnosis to the daunting realization of the severity of their condition, while knowing others with AIS could ease the emotional burden. Finally, adolescents' concerns and expectations about their prospective surgery were captured by the theme "No Pain, No Gain", whereby they were often keen to put surgery behind them.

CONCLUSIONS

Understanding and addressing adolescents' psychosocial support needs as they manage the challenges associated with idiopathic scoliosis is a key component of promoting better outcomes among this patient group. Clinical implications and opportunities for support provision are discussed.

The patient generated index and decision regret in adolescent idiopathic scoliosis

HYPOTHESIS

AIS patients and their parents will have distinct perspectives regarding the impact of AIS on patients' lives.

INTRODUCTION

Current outcome assessment tools for AIS do not fully assess patient-specific disease impact and fail to distinguish between patient and parent perspectives. Patient Generated Index (PGI) has been used in other disease states to assess individual experiences. This study assesses PGI in operative AIS patients and their parents.

DESIGN

Level 1, prospective multi-center study.

METHODS

44 AIS patient and parent pairs completed the PGI questionnaire comprised of three stages (S1, S2, S3) and decision regret (DR). S1 asks for five areas of the patient's life most affected by AIS and a 6th encompassing all other areas of their lives affected, S2 focuses on the magnitude of effect, S3 identifies desire to improve affected areas and DR if the surgery did not improve the specific area. S1 free responses were organized into 14 domains. Descriptive statistics were reported for stage scores; free-response format of PGI and DR limited ability for paired sample t test analysis.

RESULTS

Mean age at surgery was 14.3 years, 84% female, and mean major curve magnitude was 61°. The three most common patient-reported concerns prior to surgery were (in descending order): sports, general function, and general fitness. However, the three most common parent-reported concerns were (in descending order): general function, sports, and appearance. Patients reported self-esteem and parents reported physical appearance as the most affected domain (S2). Patients reported pain and self-esteem and parents reported sleep and self-esteem as main operative aspirations (S3). Decision regret was the highest for uncertainty of future health in patients and sleep in parents.

CONCLUSION

AIS patients and their parents reported different concerns and DR regarding surgical treatment. PGI provides insight into patient and parent views toward the disease as well as treatment aspirations.

Reliability and Validity of the Turkish Version of the Body Image Disturbance Questionnaire-Scoliosis

STUDY DESIGN

It is cross-cultural adaptation and validation of the Body Image Disturbances Questionnaire.

OBJECTIVE

The purpose of the study was to adopt the English version of the Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) into Turkish language.

SUMMARY OF BACKGROUND DATA

BIDQ-S is originally adopted from BIDQ scale which is designed to be used for healthy subjects in order to assess concerns and distress about physical appearance, and impairment on daily functioning. However, there is no culturally adopted and validated BIDQ-S for the Turkish population.

METHOD

Translation and back translation method was used to guide the translation process of the BIDQ-S from English to Turkish. In order to determine and confirm the factor structure of the Turkish BIDQ-S exploratory and confirmatory factor analysis were performed. Convergent validity of the Turkish BIDQ-S- was determined by calculating the correlations of BIDQ-S, and the factors emerged, with the indicators of subjective well-being which consists of three components: positive affect (PA), negative affect (NA), and satisfaction with life (SWL) and of health related quality of life measured by Scoliosis Research Society Questionnaire (SRS-22).

RESULTS

The data from the present study demonstrated that different from the original, German and Chinese versions two factor solutions were found. The Turkish BIDQ-S also showed satisfactory internal consistency value with Cronbach α equals to 0.88 construct validity.

CONCLUSION

In conclusion, current study shows that Turkish BIDQ-S is a valid and reliable questionnaire for assessing the body image concerns in patients with scoliosis in Turkish population.

LEVEL OF EVIDENCE

4.

Body Awareness and its Relation to Quality of Life in Individuals with Idiopathic Scoliosis

An individual's body awareness depends on the integration of bodily signals from both inside and outside the body. The etiology of idiopathic scoliosis includes a variety of somatosensorial and biomechanical alterations that may affect an individual's body awareness. In this study, we investigated body awareness and its relation to quality of life among individuals with idiopathic scoliosis. We studied 96 participants with scoliosis and 71 healthy control participants. We evaluated both participant groups' body awareness using the Awareness-Body-Chart, and we assessed the quality of life of those with scoliosis using the Scoliosis Research Society-22 (SRS-22) questionnaire. The overall body awareness score and the body awareness values for the face, cervical/lumbar region, back, shoulder, upper arm, lower arm/elbow, hand, genital area, thigh/hip, lower leg, and foot were all found to be significantly lower among the participants with scoliosis than among healthy participants. Among participants with scoliosis, the body awareness value for the back region was positively correlated with pain, body image, mental health, and overall quality of life scores on the SRS-22, whereas the pain score on the Awareness-Body-Chart was negatively correlated with the function/activity, pain, mental health, and overall scores for the SRS-22. This study showed that participants with idiopathic scoliosis have poorer body awareness than control participants without scoliosis, and body awareness among participants with scoliosis was correlated with their self-reports of pain, body image, function, and mental health. These findings highlight the particular importance of body awareness to quality of life for individuals with scoliosis.

Validation of the Korean Version of the Body Image Disturbance Questionnaire-Scoliosis

STUDY DESIGN

Cross-cultural adaptation and validation of the Body Image Disturbance Questionnaire-Scoliosis OBJECTIVE.: The purpose of this study was to evaluate the reliability and validity of an adapted Korean version of the Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S).

SUMMARY OF BACKGROUND DATA

A modified version of the BIDQ instrument has been validated in adolescent idiopathic scoliosis (AIS) to assess the perception of spinal appearance and psychological disturbance. However, there is no culturally adapted, reliable, and validated BIDQ-S for the Korean population.

METHODS

Translation/retranslation of the English version of the BIDQ-S was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the BIDQ-S (K-BIDQ-S) and the previously validated appearance domain of the Korean version of the Scoliosis Research Society-22 Outcomes questionnaire (K-SRS-22) and Spinal Appearance Questionnaire (K-SAQ) were mailed to 152 patients with AIS. Reliability assessments were conducted using κ statistics to assess item agreements, and intraclass correlation coefficients (ICCs) and Cronbach α values were calculated. Convergent validity was evaluated by comparing the scores of the K-BIDQ-S, K-SAQ, and K-SRS-22 appearance domain and discriminant validity by analyzing relationships between K-BIDQ-S score and patient characteristics.

RESULTS

All items of the K-BIDQ-S had κ values of agreement >0.6. The K-BIDQ-S showed excellent test/retest reliability with an ICC of 0.912. Internal consistency of the K-BIDQ-S was found to be very good (α = 0.880). Convergent validity testing demonstrated good correlations between the K-BIDQ-S and K-SAQ (r = 0.617), and between the K-BIDQ-S and K-SRS-22 (r = -651). The correlation between the K-BIDQ-S and major curve magnitude was significant (r = 0.688). Discriminant validity was confirmed by significant differences in K-BIDQ-S scores among patients requiring observation, bracing, or surgery.

CONCLUSION

The K-BIDQ-S showed satisfactory reliability and validity, and thus, is considered suitable for the evaluation of spinal deformity appearance in Korean-speaking patients with AIS.

LEVEL OF EVIDENCE

3.

Surface topography assessment of body shape after surgical correction in adolescent idiopathic scoliosis

HYPOTHESIS

Body surface topography (ST) improvements are associated with surgical correction in adolescent idiopathic scoliosis (AIS) and correlate with radiographic imaging.

DESIGN

Prospective observational study.

INTRODUCTION

Patients undergoing correction of AIS are most affected by body image. Radiographs have been the standard assessment tool but do not assess body shape features. ST, a validated, radiation-free assessment tool, directly represents the patient's deformity. We set out to assess ST improvements associated with surgical correction in AIS.

METHODS

Twenty-three consecutive operative AIS patients were enrolled and had radiographs and posterior ST obtained pre- and postoperatively (PO). ST changes were compared using paired t test, and correlations of ST with radiograph measurements were evaluated by linear regression.

RESULTS

Mean age at surgery was 15.0 ± 2 years, 82.6% female with mean follow-up of 1.0 year. Major Cobb angle improved from 56.91° ± 15.57° to 13.70° ± 4.89°. ST scoliosis angle corrected from 41.43° ± 11.52° to 11.78° ± 7.84° (p < .0001). Trunk length increased from 401.22 ± 32.43 to 422.30 ± 25.77 mm (Δ21.08 mm; p = .0004). Pelvic obliquity (waist asymmetry) trended toward improvement (6.0 ± 4.3 vs. 5.3 ± 7.1 mm; p = .06). Surface rotation was corrected from 17.35 ± 6.73 to 11.8 ± 4.12 mm (p < .0001), highly correlated with clinical trunk rotation (T p = .002 and TL p = .02). ST highly correlated with radiographic parameters. Sagittal balance correlated with improved function (p = .02).

CONCLUSION

ST, a radiation-free body shape assessment tool, improved with surgical correction of AIS and was highly correlated with radiographic outcomes.

Trends and Characteristics of Spine Research From 2006 to 2015: A Review of Spine Articles in a High Impact General Orthopedic Journal

STUDY DESIGN

Literature review.

OBJECTIVE

To determine characteristics and trends in published spine research over a recent decade in a high impact, general orthopedic surgery journal.

SUMMARY OF BACKGROUND DATA

Recent trends in published spine research in a high-impact orthopedic surgery journal are unknown. Such knowledge could guide future research in the field.

METHODS

A comprehensive literature review of clinical and basic science spine articles published in The Journal of Bone & Joint Surgery from 2006 to 2015 was conducted. Articles were assessed for: title, year of publication, authorship, academic degrees of the authors, number of citations, institution of origin, and spine topic. Clinical articles were evaluated for: sex and race/ethnicity of the human subjects, level of evidence, and inclusion of patient-reported outcome measures (PROMs). Basic science articles were evaluated for: type of study (animal, cadaver, cell-based), sex of the animals, cadavers or cells studied (male, female, or male and female), and presence of sex-based reporting (defined as reporting of results by sex).

RESULTS

A total of 203 spine articles were evaluated from the 10-year study period. At least 35 validated or nonvalidated patient-reported outcome measures were utilized in clinical spine research. The most commonly reported PROMs were the Oswestry Disability Index (24.4%), Short Form-36 Health Survey (23.7%), and Visual Analog Scale for Pain (19.3%). The average level of evidence improved from 3.25 in 2006 to 2.60 in 2015. Only 13.2% of clinical spine articles reported the race/ethnicity of the subjects.

CONCLUSION

A consensus regarding validated PROMs in spine research would be valuable. From 2006 to 2015, the level of evidence of spine articles in The Journal of Bone & Joint Surgery improved. Accurate and complete reporting of patient demographics is an area for improvement in spine research in light of studies demonstrating sex and race/ethnicity-related differences in clinical outcome after spine surgery.

LEVEL OF EVIDENCE

5.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

OBJECTIVE

In the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.

METHODS

A retrospective study of the Kids' Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10-17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.

RESULTS

There were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).

CONCLUSIONS

This study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

Development of a new 360-degree surface topography application

BACKGROUND

Surface-topography has been used for almost two decades in the radiation-free clinical evaluation of spinal posture. So far, it was limited to the analysis of back surface and spine. In order to better understand, diagnose and treat complex spinal pathologies, it is important to measure the whole torso.

RESEARCH QUESTION

Purpose of this study was to introduce and test an application that allows 360° reconstruction and analysis of the patient's torso.

METHODS

The application uses the information gathered from eight distinct scans and angles. For validation we used an Alderson phantom as an anthropomorphic body. Defined areas and volumes were measured by CT and surface-topography. Inter- and intra-rater reliability was tested in 35 healthy subjects by two observers.

RESULTS

The results revealed good correspondence between systems in the imaging and evaluation of the Alderson model (5.3-0.5%). Inter- (0.9-0.98) and intra-rater reliability (0.8-0.95) testing revealed good and excellent results in the detection of almost all body surface structures and measurement of areas and volumes. Only area and volume measurements using jugular notch as a reference showed partly moderate results in reliability (0.62-0.93) testing.

SIGNIFICANCE

We were able to introduce a novel 360° torso scan application using surface topography to reconstruct torso measurements. The results of our study showed its high validity and reliability. In the future, this application needs to be tested in patients with spinal pathologies. In summary, this new application may help to better understand, diagnose and treat patients with pathologies of torso and spine.

Body Image Disturbance Improvement After Operative Correction of Adolescent Idiopathic Scoliosis

HYPOTHESIS

Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) is a sensitive outcomes instrument to evaluate improvements in body image-related psychosocial effects with surgical correction.

DESIGN

Prospective observational study.

INTRODUCTION

The BIDQ-S was previously validated (convergent validity, internal consistency) as a tool to assess body image-related distress and psychosocial impairment in adolescent idiopathic scoliosis (AIS). This study was conducted to evaluate responsiveness to change in the BIDQ-S associated with surgical treatment of AIS two years postoperatively to complete the validation of this questionnaire.

METHODS

Seventy-five consecutive operative AIS patients were enrolled and completed BIDQ-S and Scoliosis Research Society-22 (SRS-22) at preoperative and two-year postoperative visits. Demographic and radiographic data were collected. Preoperative and two-year postoperative BIDQ-S (1 = best, 5 = worst) and SRS-22 scores (1 = worst, 5 = best) were compared using paired t test. Correlations between BIDQ-S and SRS-22 scores were evaluated by linear regression.

RESULTS

Eighty-four percent of the subjects were females, with average age at surgery of 14.4 ± 1.6 years. The mean follow-up was 2.26 years (range 2.0-4.5). The major Cobb was corrected from 50.0° ± 7.2° to 14.2° ± 5.8° (Δ = 71.3% ± 12.1%; p < .0001). There was a significant improvement in BIDQ-S scores after surgery (1.64 ± 0.51 to 1.21 ± 0.38, p < .0001). BIDQ-S improvements were correlated with change in SRS self-image (p = .0055), activity (p = .0057), mental (p = .0018), and overall mean (p = .0007) domains. Preoperative, two-year postoperative, and Δ BIDQ-S score were not associated with major Cobb magnitude, truncal rotation, or Lenke curve type. Patients who reached SRS-22r minimal clinically important difference (MCID) in activity and self-image domains had worse preoperative BIDQ scores than those who did not reach MCID (activity 1.91 vs. 1.54 [1 = best, 5 = worst], p = .0099; self-image 2.08 vs. 1.51, p < .0001). Greater improvement in BIDQ-S was noted in patients who reached MCID in SRS-22 self-image than those who did not (Δ = 0.77 vs. 0.38, p = .0052).

CONCLUSION

BIDQ-S is responsive to surgical correction of AIS. The BIDQ-S is a valuable clinical outcome tool to assess the psychosocial effects of scoliosis in adolescents augmenting existing outcome instruments.

Noncontact sports participation in adolescent idiopathic scoliosis: effects on parent-reported and patient-reported outcomes

Comparing risks against benefits of adolescent idiopathic scoliosis (AIS) patients participating in sports represents a controversial topic in the literature. Previous studies have reported sports participation as a possible risk factor for AIS development, while others describe its functional benefits for AIS athletes. The objective of this study was to determine if sports participation had an impact on pain, function, mental status, and self-perception of deformity in patients and their parents. Patients had full spine radiographs and completed baseline surveys of demographics, socioeconomics, and patient-reported outcomes (PRO): Scoliosis Research Society (SRS)-30, Body Image Disturbance Questionnaire, and Spinal Appearance Questionnaire (SAQ: Children and Parent). Patients were grouped by their participation (sports) or nonparticipation (no-sports) in noncontact sports. Demographics, radiographic parameters, and PRO were compared using parametric/nonparametric tests with means/medians reported. Linear regression models identified significant predictors of PRO. Forty-nine patients were included (sports: n=29, no-sports: n=20). Both groups had comparable age, sex, BMI, bracing status, and history of physical therapy (all P>0.05). Sports and no-sports also had similar coronal deformity (major Cobb: 31.1° vs. 31.5°). Sagittal alignment profiles (pelvic incidence, pelvic incidence minus lumbar lordosis, thoracic kyphosis, and sagittal vertical axis) were similar between groups (all P>0.05). Sports had better SRS-30 (Function, Self-image, and Total) scores, SAQ-Child Expectations, and SAQ-Parent Total Scores (P<0.05). Regression models revealed major Cobb angle (β coefficient: -0.312) and sports participation (β coefficient: 0.422) as significant predictors of SRS-30 Function score (R=0.434, P<0.05). Our data show that for AIS patients with statistically similar bracing status and coronal and sagittal deformities, patients who participated in sports were more likely to have improved functionality, self-image, expectations, and parental perception of deformity. Further investigation is warranted to acquire a comprehensive understanding of the relationship between AIS and patient participation in sports. Maintaining moderate levels of physical activity and participating in safe sports may benefit treatment outcomes. Level of Evidence III - Retrospective Comparative Study.

Der Body Image Disturbance Questionnaire

Zusammenfassung. Eine Körperbildstörung ist ein Symptom unterschiedlicher psychischer Störungen. Im deutschen Sprachraum fehlt ein Instrument, das die Körperbildstörung transdiagnostisch, global und unter Einbezug des Ausmaßes des Leidens und der Beeinträchtigung erfasst. Der aus dem Englischen übersetzte Body Image Disturbance Questionnaire (BIDQ) wurde in mehreren Teilstudien zusammen mit inhaltlich verwandten Instrumenten bei erwachsenen Männern und Frauen eingesetzt ( N = 997). In einer Studie wurde der BIDQ erneut nach 4 Wochen von einem Anteil der Teilnehmenden ( n = 68) ausgefüllt. Die bestätigte einfaktorielle Struktur des BIDQ zeigte eine exzellente interne Konsistenz (α = .92) und kurzfristige Stabilität ( r = .89, p < .001). Er korrelierte signifikant mit spezifischen Körperbildkomponenten, körperbildassoziierter Psychopathologie und psychosozialem Wohlbefinden (BMI: .16 ≤  r ≤ .70; Essstörungspsychopathologie: alle p < .001). Der deutsche BIDQ erfasst erfolgreich transdiagnostisch die Schwere einer Körperbildstörung. Nach erwiesener Veränderungssensitivität kann er auch im Rahmen der Verlaufsdiagnostik bei der Behandlung unterschiedlicher psychischer Störungen eingesetzt werden.

APSS-ASJ Best Clinical Research Award: Is There a Difference between Patients' and Parents' Perception of Physical Appearance in Adolescent Idiopathic Scoliosis?

Study Design

Prospective study.

Purpose

To compare patients’ and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores.

Overview of Literature

Few studies have looked into the differences between patients’ and parents’ perceptions of their appearance.

Methods

AIS patient–parent pairs (n=170) were recruited. The patients’ and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire.

Results

Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score.

Conclusions

There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients’ perception of the six PAs had weak correlation with SRS-22r scores.

Health-related Quality of Life and Body Image Disturbance of Adolescents With Severe Untreated Idiopathic Early-onset Scoliosis in a Developing Country

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

This study aimed to investigate the health-related quality of life (HRQOL) and body image disturbance of adolescents with untreated severe idiopathic early-onset scoliosis (IEOS) in a developing country.

SUMMARY OF BACKGROUND DATA

IEOS has the potential to progress rapidly and may lead to significant disability if left untreated. Moreover, it can lead to significant body image changes that may lead to social and psychological stresses on developing adolescents. In developing countries, untreated severe IEOS among adolescents is common.

METHODS

The Scoliosis Research Society 22 revision (SRS-22r) Arabic version questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) were used to investigate the HRQOL and body image disturbance of these patients.

RESULTS

A total of 137 patients with untreated severe IEOS (mean age, 15.5 years; range, 12-21 years) were included: group 1 (76 patients) with major curve angles of 90° to 120°, group 2 (61 patients) with major curve angles above 120°, and group 3 comprising 50 healthy controls were used for comparison. No significant differences were found regarding age, sex, and body mass index among the groups. Group 1 had significantly lower scores than group 3 in all SRS-22r domains (P < 0.001). Group 2 had significantly lower scores than group 1 in all SRS-22r domains, except for satisfaction (P < 0.005); the satisfaction domain had 100% worst answers in groups 1 and 2. Group 2 had worse scores than group 1 in all BIDQ-S questions (P < 0.001). No significant differences were found between males and females in all SRS-22r domains and BIDQ-S questions (P > 0.05). Further, 13% to 100% and 25% to 71% of the patients provided the worst answers to the SRS-22r and BIDQ-S questions, respectively.

CONCLUSION

The HRQOL and body image of the adolescents with untreated severe IEOS in a developing country were severely impaired.

LEVEL OF EVIDENCE

3.

Reliability and validity of the Spinal Appearance Questionnaire (SAQ) and the Trunk Appearance Perception Scale (TAPS)

Background

The Spinal Appearance Questionnaire (SAQ) and the Trunk Appearance Perception Scale (TAPS) are questionnaires that mostly rely on drawings to assess scoliosis patients’ subjective viewpoints on their trunk deformity. Our aim was to perform an in-depth assessment of the psychometric quality of both measures, the SAQ (version 1.1) and TAPS, and compare them to provide practical recommendations.

Methods

Web-based survey study with 255 patients suffering from idiopathic scoliosis (age 30.0 ± 16.7 years, Cobb angle 43.5 ± 20.9°) and 189 matched healthy control individuals. Participants answered a broad set of validated questionnaires including SRS 22-r, PHQ-9, PANAS, FKS, WHO-5, BFI-S, and PTQ. We calculated reliability (Cronbach’s α, test–retest correlations) as well as factorial, convergent, divergent, concurrent, and discriminant validity.

Results

Reliability was high (Cronbach’s α ≥ .86; test–retest r ≥ .80), except for test–retest correlation of the SAQ Expectations scale (r = 0.67). Both the SAQ and TAPS measures showed clear factor solutions, indicating factorial validity. High correlations with theoretically related measures (e.g., SRS 22-r, overall stress, Cobb angle) indicated convergent validity. Moderate correlations occurred with concurrent criteria such as mood, depression, body dysmorphic disorder, and well-being. The matched-pair analysis revealed strong evidence for discriminant validity (Cohen’s d > 2 for SAQ total score and TAPS). Subgroup analyses showed that patients with more severe Cobb angles (≥ 40°) and those ≥ 46 years of age had significantly worse SAQ and TAPS scores.

Conclusion

We recommend using the TAPS for future clinical workups and research, as it is much shorter and revealed slightly higher psychometric quality in comparison to the SAQ.

Electronic supplementary material

The online version of this article (10.1186/s13018-018-0980-1) contains supplementary material, which is available to authorized users.

Persian adaptation of the Bad Sobernheim stress questionnaire for adolescent with idiopathic scoliosis

Purpose: To examine the validity and reliability of the Persian versions of the Bad Sobernheim Stress Questionnaire-Deformity/Brace in adolescent idiopathic scoliosis.Materials/methods: Persian forward/backward translation of the Bad Sobernheim Stress Questionnaire-Deformity/Brace was produced, and all stages for a cross-cultural adaptation process were carried out based on the International Quality of Life Assessment guidelines. The measurements of internal consistency and test-retest reliability were assessed by Cronbach's α and intraclass correlation coefficient (ICC), respectively. The Spearman correlation coefficient was used to analyse the concurrent validity by comparison with the Scoliosis Research Society-22r questionnaire.Results: A total of 53 scoliosis patients (age 13.47 ± 1.78 years, Cobb angle 27.66 ± 11.77°) was included. The Bad Sobernheim Stress Questionnaire-Deformity/Brace presented acceptable internal consistency (Cronbach's α for both: 0.72) and ICCs (0.97 and 0.88, respectively). The Bad Sobernheim Stress Questionnaire-Deformity showed no significant correlation with the Scoliosis Research Society-22r, while the Bad Sobernheim Stress Questionnaire-Brace showed a significant correlation with the Scoliosis Research Society-22r total score, function/activity, self-image, and mental health dimensions (p < 0.01).Conclusions: The Persian Bad Sobernheim Stress Questionnaire-Brace validly and reliably measures brace-related stress in AIS patients undergoing brace treatment.Implications for rehabilitationThe cross-cultural adaptation of the Persian version of the Bad Sobernheim Stress Questionnaire was performed.The Persian-Bad Sobernheim Stress Questionnaire has satisfactory internal consistency, test-retest reliability, and concurrent validity in adolescents with idiopathic scoliosis.The Persian version of the Bad Sobernheim Stress Questionnaire is suitable for clinical investigations.

Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity: Do Dementia Patients Have More Complications?

STUDY DESIGN

Retrospective analysis of a prospectively collected, national inpatient hospital database.

OBJECTIVE

We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes.

SUMMARY OF BACKGROUND DATA

Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity-related self-image.

METHODS

The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications.

RESULTS

A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer.

CONCLUSION

Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks.

LEVEL OF EVIDENCE

2.

Comparison of Surgical Outcome of Adolescent Idiopathic Scoliosis and Young Adult Idiopathic Scoliosis: A Match-Pair Analysis of 160 Patients

STUDY DESIGN

Retrospective study.

OBJECTIVE

To investigate if the surgical outcome of young adults was equivalent to adolescents for surgical correction of thoracic adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

Despite numerous reports on the satisfactory surgical correction, some AIS patients or families still have the assumption that delay of surgery into young adulthood may be more beneficial. Hence, the strict paired analysis of clinical outcome between AIS and adult idiopathic scoliosis (AdIS) is required, which lacks report in the current literature.

METHODS

This is a retrospective 1:1 matched cohort. A total of 80 pairs were recruited with the following inclusion criteria: (A) female Lenke Type 1A or 1B idiopathic scoliosis; (B) selective fusion; (C) adolescents aged 10 to 18 years and young adults aged 19 to 29 years; (D) one-stage posterior approach; (E) all-pedicle-screws instrumentations; (F) major Cobb angle 45° to 80°. AIS patients and AdIS patients were matched for apex, major thoracic curve magnitude (±5°), lumbar curve magnitude (±5°), time of surgery (±6 month), and follow-up (±6 month).

RESULTS

The age at the time of surgery in AdIS patients averaged 22.21years, significantly larger than that of AIS patients (22.21 vs. 14.47 yr). AdIS patients had significant lower curve flexibility. Accordingly, lower correction rate and larger postoperative main Cobb angle were found in AdIS patients. Regarding quality of life, no significant difference was observed between the two groups during follow-up.

CONCLUSION

The results may provide evidence for spine surgeons to communicate with AIS patients and their families regarding pros and cons of the delay of surgery into young adulthood. AIS patients would gain better radiographic curve correction compared with matched AdIS patients due to more flexibility. When considering potential curve progression, the radiographic outcome of AdIS may be even worse. Whereas delaying to adulthood may have similar health-related quality of life and reduce the risk of adding-on phenomenon.

LEVEL OF EVIDENCE

3.

Body Image and Quality of Life in Adolescents With Craniofacial Conditions

OBJECTIVE

To evaluate body image in adolescents with and without craniofacial conditions and to examine relationships between body image and quality of life.

DESIGN

Case-control design.

SETTING

A pediatric hospital's craniofacial center and primary care practices.

PARTICIPANTS

Seventy adolescents with visible craniofacial conditions and a demographically matched sample of 42 adolescents without craniofacial conditions.

MAIN OUTCOME MEASURE

Adolescents completed measures of quality of life and body image including satisfaction with weight, facial and overall appearance, investment in appearance (importance of appearance to self-worth), and body image disturbance (appearance-related distress and impairment in functioning).

RESULTS

Adolescents with craniofacial conditions reported lower appearance investment (P < .001) and were more likely to report concerns about facial features (P < .02) compared with nonaffected youth. Females in both groups reported greater investment in appearance, greater body image disturbance, and lower weight satisfaction compared with males (P < .01). Within both groups, greater body image disturbance was associated with lower quality of life (P < .01). The two groups did not differ significantly on measures of quality of life, body image disturbance, or satisfaction with appearance.

CONCLUSIONS

Body image and quality of life in adolescents with craniofacial conditions are similar to nonaffected youth. Relationships between body image and quality of life emphasize that appearance perceptions are important to adolescents' well-being regardless of whether they have a facial disfigurement. Investment in one's appearance may explain variations in body image satisfaction and serve as an intervention target, particularly for females.