BackgroundFour patient-reported outcome (PRO) instruments are commonly used to assess body image in idiopathic scoliosis (IS): the Quality of Life Profile for Spinal Deformities (QLPSD), SRS-22 Self-Image scale, Spinal Appearance Questionnaire (SAQ), and Trunk Appearance Perception Scale (TAPS). The aim of this study is to compare the psychometric properties of these instruments in patients with IS and report the translational/cultural adaptation of the SAQ to Spanish.MethodsThe four instruments in a Spanish version were administered to 80 patients with IS aged 10 to 40 years old. The sample was stratified according to scoliosis magnitude (less and more than 45º). Analysis was also conducted for age groups. The psychometric properties studied included convergent and divergent construct validity, as well as internal consistency. Convergent validity was evaluated by correlation analysis between the self-image instruments and Cobb angle. Divergent validity was assessed with correlation analysis between PRO scores and SRS-22 dimensions scores such as Function, Pain and Mental Health.ResultsIn the overall sample, each of the PRO instruments demonstrated high internal consistency (QLPSD Body Image, α = 0.80; SRS-22 Self Image, α = 0.78; SAQ, α = 0.89; TAPS, α = 0.87), also both for younger and adult patients subgroups. Correlation with curve magnitude was significant for each of the four scales. However, the correlation was higher for the pictorial scales (SAQ Appearance r = 0.61, TAPS r = - 0.62) than for the textual scales (QLPSD-bi r = 0.36, SRS-22 Self-Image scale r = - 0.41). In the younger group, correlation between Cobb angle and textual scales (QLPSD-bi and SRS-22 Self-Image Scale) was not significant. Body Image scales showed significant correlations with SRS-22 Pain, Function and Mental Health dimensions.ConclusionsAll four instruments tested have good psychometric properties. Pictorial scales (SAQ Appearance and TAPS) correlated better with the radiological magnitude of the curve and this correlation is independent of age. Unexpectedly, all four scales demonstrated significant correlations with non-body image dimensions and the divergent hypothesis was not confirmed. Globally, pictorial scales showed slightly better construct validity to test body image perception than textual scales.

ObjectiveTo determine the validity of digital photography as an evaluation method for shoulder balance (ShB) in patients with idiopathic scoliosis.Material and methodsA total of 80 patients were included (mean age 20.3 years; 85% women). We obtained a full x-ray of the vertebral column and front and back clinical photography for all patients. For antero-posterior x-rays we measured the proximal thoracic curve angles (CPT). To evaluate radiological shoulder balance we calculated the clavicle-rib intersection angle (CRIA) and T1-tilt. For clinical photography we measured shoulder height angle (SHA), axilla height angle (AHA) and the left right trapezium angle (LRTA). We analyzed the reliability of the different photographic measurements and the correlation between these and the radiological parameters.ResultsThe mean magnitude of PTC, CRIA and T1-tilt were 19°, −0.6° and 1.4° respectively. Mean SHA from the front was −1.7°. All photographic measurements revealed an excellent-near perfect intra and inter-observer reliability in both photographic projections. No correlation was found between the ShB and the magnitude of the PTC. A statistically significant correlation was found between clinical balance of the shoulders and radiological balance (r between 0.37 and 0.51).ConclusionsDigital clinical photography appears to be a reliable method for objective clinical measurement of ShB. The correlation between clinical and radiological balance is statistically significant although moderate/weak.

BackgroundAs a result of scientific and medical professionals gaining interest in Stress and Health Related Quality of Life (HRQL), the aim of our research is, thus, to validate into Spanish the German questionnaire Bad Sobernheim Stress Questionnaire (BSSQ) (mit Korsett), for adolescents wearing braces.MethodsThe methodology used adheres to literature on trans-cultural adaptation by doing a translation and a back translation; it involved 35 adolescents, ages ranging between 10 and 16, with Adolescent Idiopathic Scoliosis (AIS) and wearing the same kind of brace (Rigo System Chêneau Brace). The materials used were a socio-demographics data questionnaire, the SRS-22 and the Spanish version of BSSQ(brace).es. The statistical analysis calculated the reliability (test-retest reliability and internal consistency) and the validity (convergent and construct validity) of the BSSQ (brace).es.ResultsBSSQ(brace).es is reliable because of its satisfactory internal consistency (Cronbach's alpha coefficient was 0.809, p < 0.001) and temporal stability (test-retest method with a Pearson correlation coefficient of 0.902 (p < 0.01)).It demonstrated convergent validity with SRS-22 since the Pearson correlation coefficient was 0.656 (p < 0.01). By undertaking an Exploratory Principal Components Analysis, a latent structure was found based on two Components which explicate the variance at 60.8%.ConclusionsBSSQ (brace).es is reliable and valid and can be used with Spanish adolescents to assess the stress level caused by the brace.

We have not found a significant correlation between clinical/radiological ShB and perceived ShB in non-operated IS patients. It seems that ShB is not a key factor in patient trunk deformity perception. In addition, patient expectations regarding improvement with treatment are not directly related to actual clinical imbalance.

BackgroundInvestigating Health Related Quality of Life (HRQL) is considered determinant in patients with Adolescent Idiopathic Scoliosis (AIS) in clinical as in research field. The aim of the present study is to explore the most relevant aspects of personality of the patients with AIS and its relationship with HRQL.Method50 patients (mean age = 16 years) were given a socio-demographic data questionnaire, the Human Figure Drawing (HFD) and SRS (Scoliosis Research Society) -22.ResultsIn Subtotal SRS-22, patients presented a mean value of 3.9. In HFD, half of these patients presented physical and/or emotional tensions with reference to the shoulders and almost all of them did not show any expression of aggressiveness. No relationship between personality and HRQL was confirmed. The older the patients were, the more body tension was discovered as well as the more concerns about their bodies they showed to have. There was also a correlation between growing old and a decreasing in Mental Health. Previous conservative treatment did not show any impact on personality or on HRQL.ConclusionsPatients with AIS suffer stress and general concern more frequently with the increase of age. We suggest an appropriate supportive treatment for this type of patients.