title: Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire--Scoliosis Version.
abstract: BACKGROUND
  Appearance concerns in individuals with adolescent idiopathic scoliosis can result in impairment in daily functioning, or body image disturbance. The Body Image Disturbance Questionnaire (BIDQ) is a self-reported, seven-question instrument that measures body image disturbance in general populations; no studies have specifically examined body image disturbance in those with adolescent idiopathic scoliosis. This study aimed to validate a modified version of the BIDQ in a population with adolescent idiopathic scoliosis and to establish discriminant validity by comparing responses of operatively and nonoperatively treated patients with those of normal controls.
  
  
  METHODS
  In the first phase, a multicenter study of forty-nine patients (mean age, fourteen years; thirty-seven female) with adolescent idiopathic scoliosis was performed to validate the BIDQ-Scoliosis version (BIDQ-S). Participants completed the BIDQ-S, Scoliosis Research Society (SRS)-22, Children's Depression Index (CDI), and Body Esteem Scale for Adolescents and Adults (BESAA) questionnaires. Descriptive statistics and Pearson correlation coefficients were calculated. In the second phase, ninety-eight patients with adolescent idiopathic scoliosis (mean age, 15.7 years; seventy-five female) matched by age and sex with ninety-eight healthy adolescents were enrolled into a single-center study to evaluate the discriminant validity of the BIDQ-S. Subjects completed the BIDQ-S and a demographic form before treatment. Independent-sample t tests and Pearson correlation coefficients were calculated.
  
  
  RESULTS
  The BIDQ-S was internally consistent (Cronbach alpha = 0.82), and corrected item total correlations ranged from 0.47 to 0.67. The BIDQ-S was significantly correlated with each domain of the SRS-22 and the total score (r = -0.50 to -0.72, p ≤ 0.001), with the CDI (r = 0.31, p = 0.03), and with the BESAA (r = 0.60, p < 0.001). BIDQ-S scores differed significantly between patients (1.50) and controls (1.06, p < 0.005), establishing discriminant validity.
  
  
  CONCLUSIONS
  The BIDQ-S is an internally consistent outcomes instrument that correlated with the SRS-22, CDI, and BESAA outcomes instruments in a scoliosis population. The scores of the patients with scoliosis indicated greater back-related body image disturbance compared with healthy controls. To our knowledge, this user-friendly instrument is the first to examine body image disturbance in adolescent idiopathic scoliosis, and it provides a comprehensive evaluation of how scoliosis-related appearance concerns impact psychosocial and daily functioning.
authors.affiliation: Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Auerbach
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, 16th Street and First Avenue, New York, NY 10003.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Divisions of Plastic and Reconstructive Surgery (C.E.C.) and Orthopaedic Surgery (J.M.F.), The Children's Hospital of Philadelphia, Wood Ambulatory Care Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104.
authors.forename: Canice E
authors.initials: CE
authors.lastname: Crerand
authors.affiliation: Nemours Children's Clinic-Wilmington, Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803.
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Divisions of Plastic and Reconstructive Surgery (C.E.C.) and Orthopaedic Surgery (J.M.F.), The Children's Hospital of Philadelphia, Wood Ambulatory Care Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104.
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.affiliation: Pediatric Orthopedic & Scoliosis Center, Department of Orthopaedic Surgery, Rady Children's Hospital, 3030 Children's Way #410, San Diego, CA 92123.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bastrom
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, 16th Street and First Avenue, New York, NY 10003.
authors.forename: Phedra
authors.initials: P
authors.lastname: Penn
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, 16th Street and First Avenue, New York, NY 10003.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, 16th Street and First Avenue, New York, NY 10003.
authors.forename: Courtney
authors.initials: C
authors.lastname: Toombs
authors.affiliation: UCSF School of Medicine, 500 Parnassus Avenue, San Francisco, CA 94143.
authors.forename: Neil
authors.initials: N
authors.lastname: Bharucha
authors.affiliation: SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203.
authors.forename: Whitney P
authors.initials: WP
authors.lastname: Bowe
authors.affiliation: Pediatric Orthopedic & Scoliosis Center, Department of Orthopaedic Surgery, Rady Children's Hospital, 3030 Children's Way #410, San Diego, CA 92123.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D001828:Body Image / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012600:Scoliosis / Q000523:psychology*; D011795:Surveys and Questionnaires
references.citation: J Am Acad Dermatol. 2007 Aug;57(2):222-30
references.pmid: 17498840
references.citation: Spine (Phila Pa 1976). 2010 Nov 15;35(24):2134-9
references.pmid: 20508549
references.citation: Eat Weight Disord. 2006 Sep;11(3):118-25
references.pmid: 17075238
references.citation: Stud Health Technol Inform. 2002;88:24-9
references.pmid: 15456000
references.citation: J Pediatr Orthop B. 2002 Apr;11(2):96-9
references.pmid: 11943980
references.citation: Zhonghua Wai Ke Za Zhi. 2008 Apr 15;46(8):588-91
references.pmid: 18844053
references.citation: J Pers Assess. 2001 Feb;76(1):90-106
references.pmid: 11206302
references.citation: Spine (Phila Pa 1976). 2003 Jan 1;28(1):74-8
references.pmid: 12544960
references.citation: Spine J. 2013 Feb;13(2):127-33
references.pmid: 23218828
references.citation: Diabet Med. 2009 Oct;26(10):1063-7
references.pmid: 19900240
references.citation: Spine (Phila Pa 1976). 1986 Sep;11(7):756-8
references.pmid: 3787349
references.citation: Spine (Phila Pa 1976). 1999 Aug 15;24(16):1693-9; discussion 1699-700
references.pmid: 10472104
references.citation: Ortop Traumatol Rehabil. 2009 Nov-Dec;11(6):530-41
references.pmid: 20032529
references.citation: Stud Health Technol Inform. 2002;91:462-4
references.pmid: 15457777
references.citation: Clin Orthop Relat Res. 1976 May;(116):99-102
references.pmid: 1277659
references.citation: J Adolesc Health. 2008 Jan;42(1):58-63
references.pmid: 18155031
references.citation: J Am Acad Child Adolesc Psychiatry. 1995 Dec;34(12):1637-47
references.pmid: 8543535
references.citation: J Affect Disord. 2003 Mar;74(1):33-48
references.pmid: 12646297
references.citation: Spine (Phila Pa 1976). 1997 Jun 15;22(12):1380-4
references.pmid: 9201842
references.citation: Spine (Phila Pa 1976). 2007 Sep 1;32(19 Suppl):S101-8
references.pmid: 17728675
references.citation: Obes Surg. 2007 Jun;17(6):792-9
references.pmid: 17879580
references.citation: J Bone Joint Surg Br. 2002 Apr;84(3):392-4
references.pmid: 12002499
references.citation: Spine (Phila Pa 1976). 2003 Sep 15;28(18):2158-63
references.pmid: 14501929
references.citation: Ann Plast Surg. 1998 Apr;40(4):403-7
references.pmid: 9555996
references.citation: Head Neck. 2010 Mar;32(3):301-9
references.pmid: 19626634
references.citation: World J Surg Oncol. 2009 Aug 13;7:66
references.pmid: 19678927
references.citation: J Burn Care Rehabil. 1992 Jan-Feb;13(1):33-8
references.pmid: 1572853
references.citation: Body Image. 2005 Jun;2(2):151-9
references.pmid: 18089183
references.citation: Spine (Phila Pa 1976). 2005 Mar 1;30(5):547-50
references.pmid: 15738788
references.citation: Spine (Phila Pa 1976). 2006 Dec 15;31(26):3027-38
references.pmid: 17173000
references.citation: Spine (Phila Pa 1976). 1994 Jul 15;19(14):1562-72
references.pmid: 7939992
references.citation: J Pediatr Orthop. 1997 Nov-Dec;17(6):712-7
references.pmid: 9591971
references.citation: Spine J. 2007 Sep-Oct;7(5):541-6
references.pmid: 17448732
references.citation: Int J Epidemiol. 1996 Aug;25(4):829-34
references.pmid: 8921463
references.citation: Spine (Phila Pa 1976). 2002 Feb 15;27(4):E87-91
references.pmid: 11840115
references.citation: J Adv Nurs. 2001 Sep;35(5):683-90
references.pmid: 11529970
references.citation: Body Image. 2004 Jan;1(1):71-81
references.pmid: 18089142
references.citation: J Burn Care Rehabil. 1989 Sep-Oct;10(5):454-61
references.pmid: 2793926
references.citation: J Pediatr Orthop. 1989 May-Jun;9(3):257-61
references.pmid: 2786006
references.citation: Eur Spine J. 2001 Aug;10(4):278-88
references.pmid: 11563612
references.citation: J Dev Behav Pediatr. 1991 Jun;12(3):171-6
references.pmid: 1831205
references.citation: Spine (Phila Pa 1976). 1987 Dec;12(10):983-6
references.pmid: 3441826
references.citation: Soc Sci Med Med Anthropol. 1981 Jan;15B(1):31-44
references.pmid: 7209604
references.citation: J Bone Joint Surg Am. 1984 Dec;66(9):1381-7
references.pmid: 6501335
references.citation: Psychosom Med. 2000 Jul-Aug;62(4):576-82
references.pmid: 10949104
references.citation: J Pediatr Psychol. 1997 Feb;22(1):29-43
references.pmid: 9019046
references.citation: J Child Psychol Psychiatry. 2001 Jul;42(5):669-78
references.pmid: 11464971
references.citation: Spine (Phila Pa 1976). 2007 Nov 15;32(24):2719-22
references.pmid: 18007251
references.citation: Psychol Sch. 2009 Sep 1;46(8):767-775
references.pmid: 20336184