title: Cognitive testing of the spinal appearance questionnaire with typically developing youth and youth with idiopathic scoliosis.
abstract: BACKGROUND
  The Spinal Appearance Questionnaire (SAQ) underwent initial psychometric studies, which suggested good reliability and discriminative ability. Although the SAQ is used as a self report of appearance, our center was concerned about its use with youth owing to complex words and vague questions. We conducted this cross-sectional study to evaluate the readability, comprehension, and interpretation of items on the SAQ.
  
  
  METHODS
  Cognitive interview methodology of 76 youths (8 to 16 y; average age 13) included 31 with scoliosis and 45 typically developing. Subjects were required to read each SAQ item and think aloud to capture cognitive processes about the items and responses. Interviews were audiotaped and transcribed verbatim. Problems were categorized and frequencies for each category were calculated.
  
  
  RESULTS
  There were reading and comprehension problems and problems understanding the illustration with every written and pictorial SAQ item, respectively. The percent of subjects who encountered at least one problem ranged from 16% to 96%. Subjects had difficulty with understanding the intent of every SAQ item and with understanding the meaning of specific words such as "prominence" and "flank." The pictorial illustrations for items 2 and 3 were problematic for 58% and 49% of subjects, respectively. The illustrations of the lungs (item 4) and hips (items 4 and 5) were problematic for 42% and 27% of subjects, respectively. These results were consistent regardless of age or diagnoses.
  
  
  CONCLUSIONS
  This study does not support the use of the SAQ as currently used with youth owing to use of complex medical words, vague questions, difficult illustrations, and various interpretations of the intent of many of the items.
  
  
  METHODS
  Not applicable (not an intervention study).
authors.affiliation: Shriners Hospitals for Children-Philadelphia, Philadelphia, PA 19140, USA. mmulcahey@shrinenet.org
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Mulcahey
authors.forename: Ross S
authors.initials: RS
authors.lastname: Chafetz
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Santangelo
authors.forename: Kimberly
authors.initials: K
authors.lastname: Costello
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Merenda
authors.forename: Christina
authors.initials: C
authors.lastname: Calhoun
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
mesh_terms: D000293:Adolescent; D001828:Body Image; D002648:Child; D003071:Cognition; D032882:Comprehension; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D011594:Psychometrics; D015203:Reproducibility of Results; D012600:Scoliosis / Q000523:psychology*; D012649:Self Concept; D011795:Surveys and Questionnaires / Q000592:standards*