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Pizones J, Moreno-Manzanaro L, Pupak A, Núñez-Pereira S, Larrieu D, Boissiere L, Richner-Wunderlin S, Loibl M, Zulemyan T, Yücekul A, Zgheib S, Charles YP, Chang DG, Kleinstueck F, Obeid I, Alanay A, Sánchez Pérez-Grueso FJ, Pellisé F. Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis. J Clin Med 2024; 13:2114. [PMID: 38610880 PMCID: PMC11012662 DOI: 10.3390/jcm13072114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student's t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3-1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test-retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Anika Pupak
- Spine Research Unit, Vall d’Hebron Institute of Research, 08035 Barcelona, Spain;
| | - Susana Núñez-Pereira
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
| | - Daniel Larrieu
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | | | - Markus Loibl
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Tais Zulemyan
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Altug Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Sara Zgheib
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Yann Philippe Charles
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 01757 Seoul, Republic of Korea;
| | - Frank Kleinstueck
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
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Ignasiak D, Behm P, Mannion AF, Galbusera F, Kleinstück F, Fekete TF, Haschtmann D, Jeszenszky D, Zimmermann L, Richner-Wunderlin S, Vila-Casademunt A, Pellisé F, Obeid I, Pizones J, Sánchez Pérez-Grueso FJ, Karaman MI, Alanay A, Yilgor Ç, Ferguson SJ, Loibl M. Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. Eur Spine J 2023; 32:571-583. [PMID: 36526952 DOI: 10.1007/s00586-022-07477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. METHODS A previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. RESULTS Weak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). CONCLUSIONS Spinal loads were estimated for patient-specific full spinal alignment profiles in a large cohort of patients with ASD pre-and postoperatively. Loads on the proximal segments were greater in association with sagittal malalignment and malorientation of proximal vertebra. Future work should explore whether they provide a causative mechanism explaining the associated risk of proximal junction complications.
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Affiliation(s)
- Dominika Ignasiak
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland.
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Frank Kleinstück
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Tamás F Fekete
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Dezsö Jeszenszky
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laura Zimmermann
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
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Mannion AF, Elfering A, Fekete TF, Pizones J, Pellise F, Pearson AM, Lurie JD, Porchet F, Aghayev E, Vila-Casademunt A, Mariaux F, Richner-Wunderlin S, Kleinstück FS, Loibl M, Pérez-Grueso FS, Obeid I, Alanay A, Vengust R, Jeszenszky D, Haschtmann D. Development of a mapping function ("crosswalk") for the conversion of scores between the Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI). Eur Spine J 2022; 31:3337-3346. [PMID: 36329252 DOI: 10.1007/s00586-022-07434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI) are two commonly used self-rating outcome instruments in patients with lumbar spinal disorders. No formal crosswalk between them exists that would otherwise allow the scores of one to be interpreted in terms of the other. We aimed to create such a mapping function. METHODS We performed a secondary analysis of ODI and COMI data previously collected from 3324 patients (57 ± 17y; 60.3% female) at baseline and 1y after surgical or conservative treatment. Correlations between scores and Cohen's kappa for agreement (κ) regarding achievement of the minimal clinically important change (MCIC) score on each instrument (ODI, 12.8 points; COMI, 2.2 points) were calculated, and regression models were built. The latter were tested for accuracy in an independent set of registry data from 634 patients (60 ± 15y; 56.8% female). RESULTS All pairs of measures were significantly positively correlated (baseline, 0.73; 1y follow-up (FU), 0.84; change-scores, 0.73). MCIC for COMI was achieved in 53.9% patients and for ODI, in 52.4%, with 78% agreement on an individual basis (κ = 0.56). Standard errors for the regression slopes and intercepts were low, indicating excellent prediction at the group level, but root mean square residuals (reflecting individual error) were relatively high. ODI was predicted as COMI × 7.13-4.20 (at baseline), COMI × 6.34 + 2.67 (at FU) and COMI × 5.18 + 1.92 (for change-score); COMI was predicted as ODI × 0.075 + 3.64 (baseline), ODI × 0.113 + 0.96 (FU), and ODI × 0.102 + 1.10 (change-score). ICCs were 0.63-0.87 for derived versus actual scores. CONCLUSION Predictions at the group level were very good and met standards justifying the pooling of data. However, we caution against using individual values for treatment decisions, e.g. attempting to monitor patients over time, first with one instrument and then with the other, due to the lower statistical precision at the individual level. The ability to convert scores via the developed mapping function should open up more centres/registries for collaboration and facilitate the combining of data in meta-analyses.
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Affiliation(s)
- A F Mannion
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - A Elfering
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - T F Fekete
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - J Pizones
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - F Pellise
- Spine Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - A M Pearson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - J D Lurie
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - F Porchet
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - E Aghayev
- Spine Tango Task Force, EUROSPINE, Uster, Switzerland
| | | | - F Mariaux
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - S Richner-Wunderlin
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - F S Kleinstück
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - M Loibl
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - F S Pérez-Grueso
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - I Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - R Vengust
- Department of Orthopedic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - D Jeszenszky
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - D Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
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Mannion AF, Elfering A, Fekete TF, Harding IJ, Monticone M, Obid P, Niemeyer T, Liljenqvist U, Boss A, Zimmermann L, Vila-Casademunt A, Sánchez Pérez-Grueso FJ, Pizones J, Pellisé F, Richner-Wunderlin S, Kleinstück FS, Obeid I, Boissiere L, Alanay A, Bagó J. Shorter and sweeter: the 16-item version of the SRS questionnaire shows better structural validity than the 20-item version in young patients with spinal deformity. Spine Deform 2022; 10:1055-1062. [PMID: 35476321 DOI: 10.1007/s43390-022-00509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger (< 20y) patients, for whom the questionnaire was originally designed, is not currently known. METHODS Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit. RESULTS Compared with the 20-item version, the 16-item solution significantly increased the fit (p < 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French. CONCLUSION In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.
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Affiliation(s)
- A F Mannion
- Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland.
| | - A Elfering
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - T F Fekete
- Spine Centre, Schulthess Klinik, Zürich, Switzerland
| | | | - M Monticone
- Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P Obid
- Dept. of Orthopaedics and Orthopaedic Surgery, Greifswald, University Hospital, Ferdinand-Sauerbruch-Strasse, Greifswald, 17475, Germany
| | - T Niemeyer
- Spine and Scoliosis Center, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany
| | - U Liljenqvist
- Department Spine Surgery, St Franziskus Hospital, Münster, Germany
| | - A Boss
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - L Zimmermann
- Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | - A Vila-Casademunt
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | - J Pizones
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - F Pellisé
- Spine Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - S Richner-Wunderlin
- Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | | | - I Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - L Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - A Alanay
- Dept. Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - J Bagó
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
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Mannion AF, Loibl M, Bago J, Vila-Casademunt A, Richner-Wunderlin S, Fekete TF, Haschtmann D, Jeszenszky D, Pellisé F, Alanay A, Obeid I, Pérez-Grueso FS, Kleinstück FS. What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients. Eur Spine J 2020; 29:1340-1352. [DOI: 10.1007/s00586-020-06365-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/31/2019] [Accepted: 03/03/2020] [Indexed: 01/12/2023]
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Richner-Wunderlin S, Mannion AF, Vila-Casademunt A, Pellise F, Serra-Burriel M, Seifert B, Aghayev E, Acaroglu E, Alanay A, Pérez-Grueso FJS, Obeid I, Kleinstück F. Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study. Eur Spine J 2018; 28:127-137. [PMID: 30218168 DOI: 10.1007/s00586-018-5754-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/20/2018] [Accepted: 09/01/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate factors that distinguish between patients with adult spinal deformity (ASD) with and without an indication for surgery, irrespective of their final treatment. METHODS Baseline variables (demographics, medical history, outcome measures, coronal, sagittal and neurologic parameters) were evaluated in a multicentre, prospective cohort of patients with ASD. Multivariable analyses were carried out for idiopathic and degenerative patients separately with the dependent variable being "indication for surgery" and baseline parameters as independent variables. RESULTS In total, 342 patients with degenerative ASD and 624 patients with idiopathic ASD were included in the multivariable models. In patients with degenerative ASD, the parameters associated with having an indication for surgery were greater self-rated disability on the Oswestry Disability Index [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.07] and a lower thoracic kyphosis (OR 0.97 95% CI 0.95-0.99), whereas in patients with idiopathic ASD, it was lower (worse) SRS self-image scores (OR 0.45 95% CI 0.32-0.64), a higher value for the major Cobb angle (OR 1.03 95% CI 1.01-1.05), lower age (OR 0.96 95% CI 0.95-0.98), prior decompression (OR 3.76 95% CI 1.00-14.08), prior infiltration (OR 2.23 95% CI 1.12-4.43), and the presence of rotatory subluxation (OR 1.98 95% CI 1.11-3.54) and sagittal subluxation (OR 4.38 95% CI 1.61-11.95). CONCLUSION Specific sets of variables were found to be associated with an indication for surgery in patients with ASD. These should be investigated in relation to patient outcomes for their potential to guide the future development of decision aids in the treatment of ASD. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | | | | | - F Pellise
- Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | - B Seifert
- Department of Biostatistics and Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - E Aghayev
- Schulthess Klinik, Zurich, Switzerland
| | | | - A Alanay
- Acibadem University, Istanbul, Turkey
| | | | - I Obeid
- Pellegrin University Hospital, Bordeaux, France
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Mannion AF, Elfering A, Bago J, Pellise F, Vila-Casademunt A, Richner-Wunderlin S, Domingo-Sàbat M, Obeid I, Acaroglu E, Alanay A, Pérez-Grueso FS, Baldus CR, Carreon LY, Bridwell KH, Glassman SD, Kleinstück F. Factor analysis of the SRS-22 outcome assessment instrument in patients with adult spinal deformity. Eur Spine J 2017; 27:685-699. [PMID: 28866740 DOI: 10.1007/s00586-017-5279-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/03/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Designed for patients with adolescent idiopathic scoliosis, the SRS-22 is now widely used as an outcome instrument in patients with adult spinal deformity (ASD). No studies have confirmed the four-factor structure (pain, function, self-image, mental health) of the SRS-22 in ASD and under different contexts. Factorial invariance of an instrument over time and in different languages is essential to allow for precise interpretations of treatment success and comparisons across studies. This study sought to evaluate the invariance of the SRS-22 structure across different languages and sub-groups of ASD patients. METHODS Confirmatory factor analysis was performed on the 20 non-management items of the SRS-22 with data from 245 American English-, 428 Spanish-, 229 Turkish-, 95 French-, and 195 German-speaking patients. Item loading invariance was compared across languages, age groups, etiologies, treatment groups, and assessment times. A separate sample of SRS-22 data from 772 American surgical patients with ASD was used for cross-validation. RESULTS The factor structure fitted significantly better to the proposed four-factor solution than to a unifactorial solution. However, items 14 (personal relationships), 15 (financial difficulties), and 17 (days off work) consistently showed weak item loading within their factors across all language versions and in both baseline and follow-up datasets. A trimmed SRS (16 non-management items) that used the four least problematic items in each of the four domains yielded better-fitting models across all languages, but equivalence was still not reached. With this shorter version there was equivalence of item loading with respect to treatment (surgery vs conservative), time of assessment (baseline vs 12 months follow-up), and etiology (degenerative vs idiopathic), but not age (< vs ≥50 years). All findings were confirmed in the cross-validation sample. CONCLUSION We recommend removal of the worst-fitting items from each of the four domains of the SRS-instrument (items 3, 14, 15, 17), together with adaptation and standardization of other items across language versions, to provide an improved version of the instrument with just 16 non-management items.
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Affiliation(s)
- A F Mannion
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - A Elfering
- Institute for Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
| | - J Bago
- Spine Unit, Hospital Universitari Vall Hebron, Passeig Vall Hebron 119-129, Traumatology Building 2nd Floor, 08035, Barcelona, Spain
| | - F Pellise
- Spine Unit, Hospital Universitari Vall Hebron, Passeig Vall Hebron 119-129, Traumatology Building 2nd Floor, 08035, Barcelona, Spain
| | - A Vila-Casademunt
- Spine Research Unit, Vall Hebron Institute of Research (VHIR), Passeig Vall Hebron 119-129, Traumatology Building 2nd Floor, 08035, Barcelona, Spain
| | - S Richner-Wunderlin
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - M Domingo-Sàbat
- Spine Research Unit, Vall Hebron Institute of Research (VHIR), Passeig Vall Hebron 119-129, Traumatology Building 2nd Floor, 08035, Barcelona, Spain
| | - I Obeid
- Pellegrin Bordeaux University Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - E Acaroglu
- Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, 06700, Ankara, Turkey
| | - A Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Büyükdere cad, 40 Maslak, 344457, Istanbul, Turkey
| | - F S Pérez-Grueso
- Hospital Universitario La, Paz Paseo de la Castellana 261, 28046, Madrid, Spain
| | - C R Baldus
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - L Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40205, USA
| | - K H Bridwell
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - S D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40205, USA
| | - F Kleinstück
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
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