Comparison of untreated adolescent idiopathic scoliosis with normal controls: a review and statistical analysis of the literature.

STUDY
DESIGN: Review and statistical analysis of studies evaluating health-related quality of life (HRQOL) in adolescents with untreated adolescent idiopathic scoliosis (AIS) using Scoliosis Research Society (SRS) outcomes.
OBJECTIVE: To apply normative values and minimum clinical important differences for the SRS-22r to the literature. Identify whether the HRQOL of adolescents with untreated AIS differs from unaffected peers and whether any differences are clinically relevant. SUMMARY OF BACKGROUND DATA: The effect of untreated AIS on adolescent HRQOL is uncertain. The lack of published normative values and minimum clinical important difference for the SRS-22r has so far hindered our interpretation of previous studies. The publication of this background data allows these studies to be re-examined.
METHODS: Using suitable inclusion criteria, a literature search identified studies examining HRQOL in untreated adolescents with AIS. Each cohort was analyzed individually. Statistically significant differences were identified by using 95% confidence intervals for the difference in SRS-22r domain mean scores between the cohorts with AIS and the published data for unaffected adolescents. If the lower bound of the confidence interval was greater than the minimum clinical important difference, the difference was considered clinically significant.
RESULTS: Of the 21 included patient cohorts, 81% reported statistically worse pain than those unaffected. Yet in only 5% of cohorts was this difference clinically important. Of the 11 cohorts included examining patient self-image, 91% reported statistically worse scores than those unaffected. In 73% of cohorts this difference was clinically significant. Affected cohorts tended to score well in function/activity and mental health domains and differences from those unaffected rarely reached clinically significant values.
CONCLUSION: Pain and self-image tend to be statistically lower among cohorts with AIS than those unaffected. The literature to date suggests that it is only self-image which consistently differs clinically. This should be considered when assessing the possible benefits of surgery.