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Exhibit from the SRS 2002 Annual Meeting
INTRODUCTION: While available data suggest that bracing may improve
the natural history of patients with adolescent
idiopathic scoliosis with moderate curves, little attention has
been paid to the potential impact of brace treatment on the
psychosocial health and quality of life of adolescent patients.
As such, the purpose of this study was to assess quality of life
issues, including self-image, role function, and psychosocial
health, in a cohort of patients under evaluation for adolescent
idiopathic scoliosis and to examine differences between patients
treated with a brace versus patients treated with observation
alone.
METHODS: Quality of life data was collected from all patients
with a diagnosis of adolescent idiopathic scoliosis and a spinal
curvature greater than 10 degrees at the Children’s Hospital
of New York between September 1997 to June 2001. Two new
quality of life instruments were used to capture physical and
psychosocial aspects of quality of life – the Child Health
Questionnaire (CHQ) and the American Academy of Orthopaedic Surgeons
Pediatric Outcomes Data Collection Instrument
(PODCI). Parent responses to both questionnaires were used as
proxies for their children. Regression and multivariate
analyses were conducted to compare the two groups and to determine
the effect of age, gender, and Cobb angle on quality
of life.
RESULTS: Our patient cohort consisted of 130 patients, who were
predominantly female (76%), with an average curve of 28
degrees and an average age of 13.6 years. Ninety patients were
treated with observation alone (average curve 24 degrees),
while 40 patients were treated with bracing (average curve 36).
The quality of life in this group of adolescents with
idiopathic scoliosis significantly differed from age-adjusted
norms for three CHQ domains, all of which were higher in our
patient group – behavior scale (p=0.001), self esteem (p=0.01),
and parental-impact time scale (p=0.0003). Furthermore,
regression analysis showed differences in several quality of life
domains within this group of adolescents. Overall, girls tended
to have higher quality of life scores, especially with respect
to general health (p=0.0497), parent-impact time scale
(p=0.03), expectations (p=0.042), and upper extremity & physical
function (p=0.01). Furthermore, age was found to have
a negative impact on bodily pain (p=0.0253), while older children
scored higher on the parental-impact emotional scale
(p=0.03). In addition, as the Cobb angle increased, quality of
life tended to be lower, particularly on the parental-impact
emotion scale (p=0.003) and the physical summary score (p=0.02).
There were few differences in health-related quality of
life between patients undergoing brace treatment versus those
undergoing observation. Multivariable analysis with Bonferroni
adjustment showed that braced adolescents had statistically higher
quality of life scores in only one CHQ domain (parental
impact-time scale, p=0.0498) and one PODCI domain (happiness,
p=0.027). The remaining domains were not statistically
significantly different between the two treatment groups.
CONCLUSIONS: While adolescent idiopathic scoliosis may effect
quality of life in this patient group, patients treated with spinal
bracing did not seem to have significantly different health-related
quality of life, as compared with patients in the observation
group.
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