Survey And Analysis Of Influencing Factors Of Health-related Quality Of Life In Adolescents With Idiopathic Scoliosis

【Objectives】1. To evaluate the validity and reliability ofadapted simplified Chinese Version of the SRS-22 questionnaire.2. To investigate the correlation between the postoperative radiographic parameters of adolescent idiopathic scoliosis patients and the scores for the SRS-22 domains.3. To investigate the urban-rural differences of patient outcome in postoperative AIS patients using the SRS-22 questionnaire.4. To determine the influence of the preoperative brace treatment on corrective surgery and quality of life (QoL) of adolescents with idiopathic scoliosis.【Method】1. Translation and crosscultural adaptation of the English version of the SRS-22 was done,the final form of the simplified Chinese translation of the SRS-22 questionnaire was a consensus reached by an expert committee. Later, the SRS-22 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were mailed to 87 patients who had been surgically treated for adolescent idiopathic scoliosis. All patients had a minimum of 1.5 years follow-up. 63 patients (72.4%) responded to the first set of questionnaires. The average age of these patients (6 male, 57 female) was 17.7 years (range, 14.3-23.8 years). 56 patients of the first time respondents returned their second survey. The two measures of reliability as internal consistency and reproducibility were determined by Cronbachαstatistics and intraclass correlation coefficient(ICC), respectively. Concurrent validity was measured by comparing with the SF-36 questionnaire. Measurement was made using the Pearson correlation coefficient (r).2. Ninety-five AIS patients(13 males, 82 females)who were treated with surgery were separated into two groups(Thoracic Scoliosis,Thoracolumbar/lumbar Scoliosis).Their average fellow-up was 2.8 years. The patients of thoracic scoliosis were 64,and the patients of thoracolumbar/lumbar scoliosis were 31.All patients received radiographic examination and completed the SRS-22 Questionnaire. Radiographic parameters were evaluated in X-rays. Correlations between the scores of the four domains using the SRS-22 and radiographic parameters were calculated using Spearman's correlation coefficient by rank (rs).3. 117 AIS patients(16 males, 101 females)who were treated with surgery were separated into two groups(Urban group,rural group).There were 62 patients in urban group and 55 patients in rural group.All patients'average fellow-up was 3.1 years.There were no statistically significant differences between the groups for gender,age,main curve location,preoperative and postoperative main curve Cobb angle (P>0.05). But there was significant difference for economic status(P<0.05). All patients were evaluated using the SRS-22 questionnaire. SRS-22 scores were statistical compared in individual domains and items using the t test.4. Ninety-four AIS patients who underwent simple posterior corrective surgery and pedicle screw fixation were studied. The patients were divided into 2 groups: those who had preoperative brace treament prior to surgery (group BS) and those who had not (group S). The groups were matched for gender, Lenke type and major curve Cobb angle. Radiological parameters were assessed before, immediately after and at least 2 years after surgery. Postoperative quality of life was determined using the SRS-22 questionnaire.【Results】1. The Cronbachαvalues for the four domains (function/activity,pain, self-image/appearace, mental health) were >0.7, The Cronbachαvalue for satisfaction of management domain wasacceptable. The intraclass correlation coefficient for the 5 domains was 0.74,0.78,0.86,0.81 and 0.84, respectively, demonstrating a satisfactory reproducibility. Considering concurrent validity, 3 domains had excellent correlation, while 10 had good correlation, and 21 had moderate correlation.2. C7 translation,thoracic kyphosis, lumbar lordosis and the residual Cobb angle of major thoracic curve did not reveal any correlations with the scores of the four SRS-22 domains. The residual Cobb angle of major thoracic curve was inversely correlated with self-image(rs=-0.411,P=0.001).3. Urban patients had significantly higher scores in satisfaction of management domain compared with rural patients.And urban patients had significantly lower scores in the self-image/appearace domain. There were no significant differences in function/activity,pain and mental health domains(P>0.05).With regard to individual items,there were significant differences in the scores between the 2 groups for 7 items(P<0.05).. 4. The preoperative minor curve Cobb angle was significantly greater in the BS group (34.9o vs. 29.4o, P=0.037). Postoperative radiological parameters in the coronal and sagittal planes were similar. There was a significantly higher number of fused vertebrae in BS compared to S patients (10.3 vs. 9.6, P=0.044). There were no significant between group postoperative differences with regards to function/activity, pain, mental health or Satisfaction of management as determined by the SRS-22. Self-image/appearance scores were significantly higher in BS compared to S patients (4.0 vs. 3.8, P=0.010).【Conclusions】1. The tests being performed in this study demonstrated that adapted simplified Chinese Version of the SRS-22 questionnaire showed high levels of the reliability and concurrent validity.It may be useful for clinical evaluation of Chinese adolescent patients with scoliosis.2. Patients with a greater Cobb angle of major thoracic curve had a negative self-image. Thoracic scoliotic deformity with prominence should be substantially reduced by the surgical treatment to improve self-image regarding back appearance.3. SRS-22 scores in the postoperative urban AIS population differed from that of the rural population.The urban-rural differences differences affect SRS-22 scores and patient's perceptions.4. Preoperative brace treatment may be a risk factor for minor curve progression, but does not appear to significantly influence surgical outcome. Postoperative self perceived quality of life is not negatively affected by preoperative brace treatment.