title: Postoperative Perfection: Ceiling Effects and Lack of Discrimination With Both SRS-22 and -24 Outcomes Instruments in Patients With Adolescent Idiopathic Scoliosis.
abstract: METHODS
  Review of a prospective database registry.
  
  
  OBJECTIVE
  To compare the Scoliosis Research Society (SRS)-22 and SRS-24 outcomes instruments in terms of scores, rate of ceiling effects, and discriminant ability in patients with pre- and postoperative adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  Despite improvements noted with the SRS-22, the SRS-24 is still occasionally used prospectively and for comparisons with previous studies reporting SRS-24 scores. Previous work has demonstrated that postoperative scores from the 2 versions are not interchangeable.
  
  
  METHODS
  A multicenter prospective registry of patients who underwent surgical correction of adolescent idiopathic scoliosis was queried for preoperative and 2-year postoperative SRS-22 and SRS-24 scores. Scores were compared between versions and ceiling effects were identified. Groups of deformity severity were created to evaluate discriminant ability.
  
  
  RESULTS
  829 patients were identified. The SRS-22 scores for pain and general function were significantly greater than SRS-24 scores (P < 0.001), whereas the SRS-22 scores were significantly lower than the SRS-24 for self-image (P < 0.001). Preoperative ceiling effect was only noted in 1 domain each. Both versions were able to discriminate between large (80°+) and small (<45°) preoperative curves in all domains and total scores (P < 0.05). Postoperatively, the SRS-22 scores for all shared domains and total score were significantly greater than SRS-24 scores (P < 0.001). Ceiling effects in 5 of 5 domain scores were noted postoperatively for SRS-22 and in 4 of 7 for SRS-24. With a smaller range of deformity postoperatively, only the SRS-22 self-image domain was able to discriminate between large (29°+) and small (≤11°) residual curves (P < 0.05).
  
  
  CONCLUSIONS
  Scores obtained by the SRS-22 and the SRS-24 are not translatable despite shared domains. Whereas both versions demonstrated preoperative discriminant ability, postoperative discrimination of residual deformity is lacking in both. Patient-reported outcomes of treatment are crucial in advancing treatment, and improvement in the ability to assess subjective outcomes is essential.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopedics, Rady Children's Hospital, San Diego, CA†Setting Scoliosis Straight Foundation, San Diego, CA.
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.forename: Carrie
authors.initials: C
authors.lastname: Bartley
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Marks
authors.forename: Burt
authors.initials: B
authors.lastname: Yaszay
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D012600:Scoliosis / Q000453:epidemiology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome