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STUDY DESIGN Retrospective study of the coronal curvature measurement on ultrasound (US) images with the aid of previous radiographs. OBJECTIVE To compare the reliability and accuracy of the coronal curvature measurements from US images on children who have adolescent idiopathic scoliosis (AIS) with and without the knowledge of previous radiographs. SUMMARY OF BACKGROUND DATA Using US imaging technique to measure coronal curvature on children with AIS has demonstrated high intra- and interrater reliabilities. However, the selection of end-vertebrae and the measurement difference between radiography and the US method were only moderately reliable. METHODS Two raters measured the coronal curvatures from 65 AIS standing US spine images, without (measured one time) and with the aid of previous standing radiographs (measured two times). The intra- and interrater reliability, the correlation and the difference between the radiographic and US measurements, and the error index of the end-vertebrae selection were assessed. RESULTS Overall, 109 curves were investigated. The intraclass correlation coefficients (ICC) of intra- and interrater reliability of the US coronal curvature measurement with the aid of previous radiographs (AOR) were 0.95 and 0.91, respectively. In comparison with the radiographic measurements, the correlation of AOR method (R) was 0.90 and the MAD was 2.8°; the corresponding results of the US measurement without the AOR (blinded US method) were 0.73° and 4.8°, respectively. The average error index on end-vertebral selection improved 43% with the AOR. CONCLUSION The AOR method significantly improved reliability and accuracy of the spinal curvature measurement on US images compared with the blinded US method (P

STUDY DESIGN A prospective randomized controlled trial. OBJECTIVE The aim of this study was to investigate the effectiveness of orthotic management versus exercise on spinal curvature, body symmetry, and quality of life. SUMMARY OF BACKGROUND DATA A number of well-designed studies comparing conservative treatment of adolescent idiopathic scoliosis (AIS) have been conducted and the evidence becomes stronger. However, there is a lack of the information on the effectiveness of orthotic management versus exercise. METHODS The inclusion criteria recommended by the Scoliosis Research Society (SRS) and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) were used during enrollment. Eligible patients were randomly assigned to either bracing group or exercise group. Patients in the bracing group were prescribed with a rigid thoracolumbosacral orthosis and requested to wear 23 h/day, while patients in the exercise group were treated with the protocol of the Scientific Exercise Approach to Scoliosis. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, and quality of life (QoL) were collected every 6 months. RESULTS Twenty-four patients in the bracing group and 29 patients in the exercise group participated in this study. For the intergroup comparison, the bracing group showed better results about the correction of spinal curvature (Cobb angle at the first 12 months of intervention, P = 0.039), scores concerning QoL, especially function (P

Study design Prospective cross-sectional measurement study. Objective To determine the ability of the Scoliosis Research Society (SRS)-22 questionnaire to discriminate among management and scoliosis severity subgroups and to correlate with internal and external measures of curve severity. Summary of background data In earlier studies of the SRS-22 discriminative ability, age was not a controlled factor. The ability of the SRS-22 to predict curve severity has not been thoroughly examined. Methods The SRS-22 was completed by 227 females with adolescent idiopathic scoliosis. Using Analysis of covariance analyses controlling for age, the SRS-22 scores were compared among management subgroups (observation, brace, presurgery, and postsurgery) and curve-severity subgroups (in nonoperated subjects: Cobb angles of 50 degrees). A stepwise discriminant analysis was used to identify the SRS-22 domains most discriminative for curve-severity categories. Correlation between SRS-22 scores and radiographic or surface topography measurements was used to determine the predictive ability of the questionnaire. Results Pain was better for subjects treated with braces than for those planning surgery. Self-image was better for subjects under observation or postsurgery than for those planning surgery. Satisfaction was better for the brace and postsurgery subgroups than for the observation or presurgery subgroups. Statistically significant mean differences between subgroups were all larger than 0.5, which is within the range of minimal clinically important differences recommended for each of the 5-point SRS-22 domain scoring scales. Pain and mental health were worse for those with Cobb angles of >50 degrees than with Cobb angles of 30 degrees to 50 degrees. Self-image and total scores were worse for those with Cobb angles of >50 degrees than both other subgroups. Using discriminant analysis, self-image was the only SRS-22 domain score selected to classify subjects within curve severity subgroups. The percentage of patients accurately classified was 54% when trying to classify within 3 curve severity subgroups. The percentage of patients accurately classified was 73% when classifying simply as those with curves larger or smaller than 50 degrees . Conclusion Pain, self-image, and satisfaction scores could discriminate among management subgroups, but function, mental health and total scores could not. The total score and all domain scores except satisfaction discriminated among curve-severity subgroups. Using discriminant analysis, self-image was the only domain retained in a model predicting curve-severity categories.

Study Design. Cross-sectional measurement study. Objective. To analyze the score distribution of the Scotiosis Research Society (SRS)-22 questionnaire domains and items for patients with idiopathic scoliosis (IS) of all ages. Summary of Background Data. Scoliosis-related quality-of-life questionnaires have demonstrated high ceiling effects in younger patients. However, the score distribution has not been examined thoroughly in other clinically relevant IS subgroups. Methods. The SRS-22 was completed by 173 females with IS. The proportions of ceiling effects, floor effects, of patients scoring greater than or equal to 4 out of 5 and the box plots of the score distribution for each domain and item were compared between subgroups. Subgroups were formed based on age (k = 4), management (k = 6), curve severity (k = 3), and curve type (k = 4). Results. Domain ceiling effects varied between 0% and 23.1%. Domain floor effects were observed only for Self-image ( 20%) ceiling effects. Ceiling effects for Pain and Mental Health decreased with increasing age (P < 0.05). Pain ceiling effects decreased and Satisfaction ceiling effects increased from least to most invasive management (P < 0.05), but no differences were found among Cobb severity or curve types subgroups. Of the 22 items, 9 had major (≥50%) ceiling effects and 11 had moderate ceiling effects. Most subgroups (14/16) had 4 to 6 items with major ceiling effects. The following items had major ceiling effects in the majority of subgroups: Function, 9 and 15; Pain, 11 and 17; and Self-image, 14. Conclusion. Most SRS-22 domains had acceptable levels of ceiling effects (

STUDY DESIGN Cross-sectional correlation study. OBJECTIVE To determine the threshold in spinal deformity severity measurements beyond which there is a progressive decline in health-related quality-of-life (HRQOL). SUMMARY OF BACKGROUND DATA The associations between HRQOL and scoliosis deformity measures are at best moderate when assessed using linear regressions. This may be because HRQOL is not affected until a severity threshold is reached. Identifying the thresholds in deformity beyond which HRQOL deteriorates could assist in treatment recommendations. METHODS The Scoliosis Research Society-22 (SRS-22) questionnaire was completed by 101 females with adolescent idiopathic scoliosis (age, 15.0 +/- 1.8; largest Cobb angle, 36.9 degrees +/- 14.6 degrees). Radiographs and surface topography were used to quantify the severity of the internal (largest Cobb angle) and external deformity (cosmetic score, decompensation, trunk twist), respectively. Segmented linear regression models were estimated to determine the association between SRS-22 domains and spinal deformity measures. This analysis also identifies deformity thresholds beyond which HRQOL is more affected. The percentage of variance explained (R2) by linear and segmented models were compared (alpha = 0.05) to identify the best models. RESULTS Cobb angle predicted significantly more variance in all SRS-22 domains except mental health using segmented models (R2: 0.09-0.30) than linear models (R2: 0.02-0.21). Segmented models with a single threshold estimated at a Cobb angle between 43 degrees and 48 degrees predicted between 3% and 11% more variance compared to corresponding linear model using the same variables. Surface topography parameters were not strongly associated with SRS-22 variables with linear and segmented models explaining less than 10% of the variance. CONCLUSION Deterioration in SRS-22 scores is mildly associated with increases in the severity of the internal deformity. HRQOL is stable until the curve reaches a maximal Cobb angle threshold at approximately 45 degrees where HRQOL declines linearly with increasing internal deformity. The association between HRQOL and scoliosis severity is low, but is better explained by segmented rather than linear models.

Prospective cross-sectional measurement study.To analyze the score distribution on the Scoliosis Quality of Life Index (SQLI) questionnaire domains and items for subjects with adolescent idiopathic scoliosis (AIS).The SQLI was derived from the SRS-22 questionnaire so that it would be more applicable to persons with AIS between 10 and 18 years old. However, the score distribution of the SRS-22 is characterized by high ceiling effects within subgroups of persons with AIS.The SQLI questionnaire was completed by 95 females with AIS. Floor, ceiling effects, and score distribution were examined for subgroups based on age (n = 4), management (4), curve severity (3), and curve type (6).Ceiling effect proportions (0%-40%) were higher than floor effects (n = 1). Back pain and satisfaction were the only domains with ceiling effects exceeding 20%. For some domains, ceiling effects were significantly most prevalent for younger subgroups, those with low or moderate curve severity and those treated less aggressively. High ceiling effects were also observed for the observation, postsurgical, main thoracic, and double major curves subgroups. More than half the participants scored over 4/5 for all SQLI domains in the overall sample and in the observation, surgery,13.5 years, 13.5 to15 years,30 degrees, 30 degrees to 50 degrees, main thoracic curves, double major curves, and thoracolumbar/lumbar curves subgroups, respectively. At least one item from each domain (except satisfaction) showed ceiling effects50% in most subgroups (14 or more subgroups out of 15).Even though ceiling effects (20%) were not common, scores clustered near the top of the SQLI scale. The SQLI score distribution may impair the questionnaire's sensitivity to change and discriminative ability, particularly in younger subjects with lesser low or moderate curve severity, under observation or after surgery. The clinical utility of some SQLI items within each domain may be limited by high ceiling effects.