James T Bennett1, Amer F Samdani2, Tracey P Bastrom3, Robert J Ames1, Firoz Miyanji4, Joshua M Pahys1, Michelle C Marks5, Baron S Lonner6, Peter O Newton3, Harry L Shufflebarger7, Burt Yaszay3, John M Flynn8, Randal R Betz9, Patrick J Cahill8. 1. Shriners Hospitals for Children, 3551 N Broad Street, Philadelphia, 19140, PA, USA. 2. Shriners Hospitals for Children, 3551 N Broad Street, Philadelphia, 19140, PA, USA. asamdani@shrinenet.org. 3. Rady Children's Hospital, San Diego, CA, USA. 4. British Columbia Children's Hospital, Vancouver, BC, Canada. 5. Setting Scoliosis Straight Foundation, San Diego, CA, USA. 6. NYU Hospital for Joint Diseases, New York, NY, USA. 7. Nicklaus Children's Hospital, Miami, FL, USA. 8. Children's Hospital of Philadelphia, Philadelphia, PA, USA. 9. Institute for Spine and Scoliosis, Lawrenceville, NJ, USA.
Abstract
PURPOSE: The minimal clinically important difference (MCID) of the Appearance domain of the SRS-22 questionnaire is an increase ≥1.0 in surgically treated patients with adolescent idiopathic scoliosis (AIS). However, no study has sought to identify the factors associated with an SRS-22 Appearance score increase greater than the MCID at 2 years. METHODS: A retrospective analysis was performed on a prospectively collected multicenter database of 1020 surgically treated AIS patients with a minimum 2-year follow-up. Patients were divided into two cohorts: "I" = Improved after surgery (Δ Appearance ≥1.0) and "NI" = Not improved after surgery (Δ Appearance <1.0). Univariate regression was used to find a significant difference between the cohorts for individual measures. Multivariate logistic regression was used to find continuous predictors. RESULTS: 663 (65%) patients were improved greater than the MCID, and 357 were not improved (35%). The improved cohort trended toward a greater percentage of underweight patients (p = 0.074) with lower preoperative SRS Appearance scores (p < 0.001) and larger preoperative trunk shifts (p = 0.033). Postoperatively, those patients with greater percent correction of thoracic (p = 0.021) and lumbar (p = 0.003) Cobb angles, smaller apical lumbar translation (p = 0.006), and a greater correction in trunk shift (p = 0.003) were most likely to attain the MCID. CONCLUSION: Several factors influence which patients are most likely to attain the MCID following surgery for AIS. Factors such as preoperative appearance scores and body weight are patient specific; other factors such as percent correction of the thoracic and lumbar Cobb angles, trunk shift, and lumbar apical translation may be influenced by the surgeon. LEVEL OF EVIDENCE: II.
PURPOSE: The minimal clinically important difference (MCID) of the Appearance domain of the SRS-22 questionnaire is an increase ≥1.0 in surgically treated patients with adolescent idiopathic scoliosis (AIS). However, no study has sought to identify the factors associated with an SRS-22 Appearance score increase greater than the MCID at 2 years. METHODS: A retrospective analysis was performed on a prospectively collected multicenter database of 1020 surgically treated AIS patients with a minimum 2-year follow-up. Patients were divided into two cohorts: "I" = Improved after surgery (Δ Appearance ≥1.0) and "NI" = Not improved after surgery (Δ Appearance <1.0). Univariate regression was used to find a significant difference between the cohorts for individual measures. Multivariate logistic regression was used to find continuous predictors. RESULTS: 663 (65%) patients were improved greater than the MCID, and 357 were not improved (35%). The improved cohort trended toward a greater percentage of underweight patients (p = 0.074) with lower preoperative SRS Appearance scores (p < 0.001) and larger preoperative trunk shifts (p = 0.033). Postoperatively, those patients with greater percent correction of thoracic (p = 0.021) and lumbar (p = 0.003) Cobb angles, smaller apical lumbar translation (p = 0.006), and a greater correction in trunk shift (p = 0.003) were most likely to attain the MCID. CONCLUSION: Several factors influence which patients are most likely to attain the MCID following surgery for AIS. Factors such as preoperative appearance scores and body weight are patient specific; other factors such as percent correction of the thoracic and lumbar Cobb angles, trunk shift, and lumbar apical translation may be influenced by the surgeon. LEVEL OF EVIDENCE: II.
Entities:
Keywords:
MCID; Minimal clinically important difference; Outcome; SRS questionnaire; Scoliosis
Authors: K H Bridwell; H L Shufflebarger; L G Lenke; T G Lowe; R R Betz; G S Bassett Journal: Spine (Phila Pa 1976) Date: 2000-09-15 Impact factor: 3.468
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Authors: R Christopher Glattes; Douglas C Burton; Sue Min Lai; Elizabeth Frasier; Marc A Asher Journal: Spine (Phila Pa 1976) Date: 2007-07-15 Impact factor: 3.468