title: A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument.
abstract: METHODS
  A multicenter study examining the association between radiographic and outcomes measures in adolescent idiopathic scoliosis.
  
  
  OBJECTIVE
  To evaluate the association between an objective radiographic scoring system and patient quality of life measures as determined by the Scoliosis Research Society outcomes instrument.
  
  
  BACKGROUND
  Although surgical correction of scoliosis has been reported to be positively correlated with patient outcomes, studies to date have been unable to demonstrate an association between radiographic measures of deformity and outcomes measures in patients with adolescent idiopathic scoliosis.
  
  
  METHODS
  A standardized radiographic deformity scoring system and the Scoliosis Research Society outcome tool were used prospectively in seven scoliosis centers to collect data on patients with adolescent idiopathic scoliosis. A total of 354 data points for 265 patients consisting of those with nonoperative or preoperative curves >or=10 degrees, as well as those with surgically treated curves, were analyzed. Correlation analysis was performed to identify significant relationships between any of the radiographic measures, the Harms Study Group radiographic deformity scores (total, sagittal, coronal), and the seven Scoliosis Research Society outcome domains (Total Pain, General Self-Image, General Function, Activity, Postoperative Self-Image, Postoperative Function, and Satisfaction) as well as Scoliosis Research Society outcomes instrument total scores. Radiographic measures that were identified as significantly correlated with Scoliosis Research Society outcome scores were then entered into a stepwise regression analysis.
  
  
  RESULTS
  The coronal measures of thoracic curve and lumbar curve magnitude were found to be significantly correlated with the Total Pain, General Self-Image, and total Scoliosis Research Society scores (P < 0.0001). The thoracic and upper thoracic curve magnitudes were also correlated with General Function (P < 0.002). The "coronal" subscore as well as the "total" score of the Harms Study Group radiographic scoring system were also significantly correlated with these Scoliosis Research Society domain and total scores. No radiographic measures taken after surgery were significantly correlated with the postoperative domains of the Scoliosis Research Society outcomes instrument. Stepwise regression analysis of these radiographic measures as predictors of Scoliosis Research Society scores resulted in adjusted R2 values of 0.03-0.07 (P < 0.0001). Although these results show that a significant association exists between the radiographic Cobb angle measure of the scoliosis and the Scoliosis Research Society outcomes scores, the low R2 values indicate that variables other than the radiographic appearance of the deformity (e.g., psychosocial, functional) must also be affecting these scores.
  
  
  CONCLUSIONS
  The Cobb angle measure of the major deformity has a small, but statistically significant, correlation with the reported Total Pain, General Self-Image, and General Function as measured by the Scoliosis Research Society outcomes instrument. None of the radiographic measures in this population correlated with postoperative domain scores of the Scoliosis Research Society outcomes tool.
authors.affiliation: Children's Hospital and Health Center, San Diego, California, USA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Wilson
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Wenger
authors.forename: Thomas
authors.initials: T
authors.lastname: Haher
authors.forename: Andrew
authors.initials: A
authors.lastname: Merola
authors.forename: Larry
authors.initials: L
authors.lastname: Lenke
authors.forename: Thomas
authors.initials: T
authors.lastname: Lowe
authors.forename: David
authors.initials: D
authors.lastname: Clements
authors.forename: Randy
authors.initials: R
authors.lastname: Betz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012044:Regression Analysis; D015203:Reproducibility of Results; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery; D012737:Sex Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000601:surgery; D014481:United States