title: Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific?
abstract: METHODS
  Prospective, observational study.
  
  
  OBJECTIVE
  To further validate the Scoliosis Research Society (SRS) instrument by comparing scores of adult deformity patients with no prior history of spine surgery to the scores of normal adult volunteers in age-gender matched groups.
  
  
  BACKGROUND
  Efforts have been made to validate the SRS questionnaire in adolescent and adult deformity patients. An important psychometric attribute of any quality of life tool is its ability to discriminate between subjects with and without the condition of interest. Discriminate validity of the SRS questionnaire has not been established in the primary (no prior surgical treatment) adult deformity population.
  
  
  METHODS
  The SRS questionnaire was issued prospectively to 935 primary adult deformity patients with a diagnosis of idiopathic or de novo scoliosis and minimum Cobb angle of 30 degrees (average Cobb angle: 54 degrees; range: 30 degrees-132 degrees). Five hundred forty-three patients were treated nonsurgically while 392 patients underwent surgical intervention. Baseline SRS scores of the deformity population were compared to 1222 volunteers with no history of spine disease randomly sampled from the US population. Analysis between the 2 populations was broken down into 6 age-gender groups: male/female; 20-40, 41-60, 61-80 years of age.
  
  
  RESULTS
  SRS domain scores of the deformity subgroups demonstrated significant statistical differences from their corresponding age-gender matched normative group. The only exceptions were the mental health domain in the older males, 61-80 years of age. The average SRS subscore for each age-gender subgroup was less than the tenth percentile in the corresponding normative population, indicating substantial limitations in these patients.
  
  
  CONCLUSIONS
  Our findings confirm the SRS instrument has excellent discriminate validity in the adult population. It appears to be disease-specific in the domains of pain, appearance and activity in adult spinal deformity patients who have not had prior surgery.
authors.affiliation: Department of Orthopedics, Washington University, St. Louis, MO 63110, USA. baldusc@wudosis.wustl.edu
authors.forename: Christine
authors.initials: C
authors.lastname: Baldus
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: John
authors.initials: J
authors.lastname: Harrast
authors.forename: Charles
authors.initials: C
authors.lastname: Edwards
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: William
authors.initials: W
authors.lastname: Horton
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Thomas
authors.initials: T
authors.lastname: Lowe
authors.forename: Steve
authors.initials: S
authors.lastname: Mardjetko
authors.forename: Stephen
authors.initials: S
authors.lastname: Ondra
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Christopher
authors.initials: C
authors.lastname: Shaffrey
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012600:Scoliosis / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D012720:Severity of Illness Index; D012737:Sex Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires