title: Re-evaluation of reliability and validity of simplified Chinese version of SRS-22 patient questionnaire: a multicenter study of 333 cases.
abstract: METHODS
  A multicenter cross-cultural study to re-evaluate the reliability and validity of the simplified Chinese version of Scoliosis Research Society-22 (SRS-22) Patient Questionnaire.
  
  
  OBJECTIVE
  To assess the concurrent validity and reliability of this instrument in mainland China.
  
  
  BACKGROUND
  The SRS-22 Questionnaire was developed to assess the health-related quality of life for patients with scoliosis in the United States. More recently, the reliability and validity analyses of traditional and simplified Chinese versions of this questionnaire were performed, respectively. However, with respect to the diversity of population and large proportion of rural patients in China, a multicenter study might be necessary to re-evaluate its adaptation.
  
  
  METHODS
  The original English version of the SRS-22 Questionnaire was translated into simplified Chinese. Considering the different health care systems in mainland China, the question 15 was modified; the respondent might be the parent if the patient was younger than 18 years. This multicenter study was performed by 13 scoliosis surgeons involving seven spine centers. The SRS-22 Questionnaire and a previously validated 36-Item Short-Form Health Survey Questionnaire were given to 391 patients with idiopathic scoliosis or congenital scoliosis without neurologic deficits. Of those, 136 patients were randomly selected for a second identical SRS-22 Questionnaire filled 1 week later and mailed back with a stamped return envelope.
  
  
  RESULTS
  A total of 333 patients fully completed both SRS-22 and 36-Item Short-Form Health Survey Questionnaires. Good consistency was observed for all the five domains of the SRS-22. Poorer internal consistency was found in questions 15 and 18. If question 15 was excluded, the α coefficient would increase to 0.68. The pain domain of SRS-22 had a high ceiling effect being 67.5%. The test-retest reproducibility was observed "good" in the pain domain and "excellent" for the remaining domains of SRS-22 Questionnaire. Good (10 domains) and moderate (23 domains) correlations were demonstrated while seven domains had poor correlation.
  
  
  CONCLUSIONS
  The simplified Chinese version of the SRS-22 Questionnaire was re-evaluated by a multicenter study to respect the diversity of population and cultural differences in mainland China, which showed good internal consistency and satisfactory test-retest reproducibility. It might be useful for clinical evaluation of Chinese adolescents and young adults with scoliosis treated with bracing or surgery, although it also encountered previously reported difficulties with some of the items related to different cultures and health care systems.
authors.affiliation: Department of Orthopaedics, Peking Union Medical College Hospital, Beijing, China. qiugx@medmail.com.cn
authors.forename: Guixing
authors.initials: G
authors.lastname: Qiu
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
authors.forename: Zezhang
authors.initials: Z
authors.lastname: Zhu
authors.forename: Zhen
authors.initials: Z
authors.lastname: Liu
authors.forename: Yuemin
authors.initials: Y
authors.lastname: Song
authors.forename: Yong
authors.initials: Y
authors.lastname: Hai
authors.forename: Zhuojing
authors.initials: Z
authors.lastname: Luo
authors.forename: Zude
authors.initials: Z
authors.lastname: Liu
authors.forename: Hongqi
authors.initials: H
authors.lastname: Zhang
authors.forename: Guohua
authors.initials: G
authors.lastname: Lv
authors.forename: Yipeng
authors.initials: Y
authors.lastname: Wang
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhang
authors.forename: Jianxiong
authors.initials: J
authors.lastname: Shen
authors.forename: Xu
authors.initials: X
authors.lastname: Sun
mesh_terms: D044466:Asian People; D002648:Child; D002681:China; D003431:Cross-Cultural Comparison; D006801:Humans; D007802:Language; D015203:Reproducibility of Results; D012600:Scoliosis / Q000175:diagnosis* / Q000628:therapy; D011795:Surveys and Questionnaires / Q000592:standards*; D014175:Translating; D055815:Young Adult