An Analysis of Patient and Parent Assessment of Deformity in Idiopathic Scoliosis Using the Walter Reed Visual Assessment Scale

· (a – Medtronic Sofamor Danek)

Purpose: While patient’s perceptions of their deformity are a major aspect of idiopathic scoliosis, they are difficult to measure. The Walter Reed Visual Assessment Scale (WRVAS) demonstrates 7 visible aspects of spinal deformity in an analogue scale. Higher scores reflect worsening deformity. This study evaluates the scale compared to clinical parameters and written descriptions of the deformity from idiopathic scoliosis patients and their parents.

Methods: The WRVAS was administered to 182 idiopathic scoliosis patients at 4 centers in conjunction with categorized responses regarding demographics, curve characteristics, and open-ended questions about patients’ and their parents’ perceptions of their spinal deformity. The open-ended responses were categorized as either “deformity noted” or “no deformity noted”. Significance was selected at p=0.05.

Results: WRVAS scores strongly correlate with curve magnitude (p=.01) and clearly differentiates curves of >30° from lesser curves. Among treatment groups, patients without scoliosis, and patients observed, braced, or postoperative had significantly lower scores than those with surgery recommended. The instrument differentiated those noting no deformity from those noting a deformity. The correlation between patients’ and parents’ scores was high (Spearman’s rho=0.8). If neither the parent nor child noted a deformity, parents’ scores were not significantly different than the patients’. However, when a deformity was noted, parents gave higher scores than their children for rib prominence, shoulder level, scapular rotation, and the total score, but not for the other dimensions.

Conclusions: Increasing scores of the WRVAS are strongly correlated with curve magnitude lending construct validity to this type of assessment tool. Patients with “surgery recommended” report more visible deformity on the scale than observed, braced, and postoperative patients supporting the hypothesis that surgery improves the perceived appearance. Parents perceive more deformity of the ribs, and shoulders more than the patients, but other aspects of the deformity are identified equally.

· If noted, the author indicates something of value received. The codes are identified as: a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options.