Abstract
Background:
Idiopathic scoliosis has historically been considered a benign condition without significant functional limitations for the patient. However, as curves progress, patients may experience worsening pain, deformity, and quality of life. Patient reported outcome measures (PROMs) help assess functional limitations that may indicate treatment.
Purpose:
The objective of this study was to compare physical activity related PROM scores in three groups of patients with different severities of spinal curvature.
Methods:
Pediatric patients diagnosed with adolescent and juvenile idiopathic scoliosis, kyphoscoliosis, or spinal asymmetry completed the SRS-22R, HSS Pedi-FABS activity scale, and Patient-Reported Outcomes Management Information System (PROMIS) Pediatric Computer Adaptive Tests for Mobility and Physical Activity (PA) at a single institution from July 2018 to February 2019. Radiographic images were reviewed, and patients were grouped as Spinal Asymmetry (SA), Mild Deformity (MD), and Severe Deformity (SD) by major Cobb angle measuring less than 10°, between 10° and 40°, and greater than 40° respectively. One-way ANOVA with a Tukey post-hoc correction was used to determine differences between groups.
Results:
206 pediatric patients (65% female) with a mean age 13.5 ± 2.2 years were included. The mean Cobb angles by group were 7.1° ± 2.1° in SA (n=51), 19.4° ± 7.8° in MD (n=130), and 50.2° ± 9.1° in SD (n=25). Compared to both SA and MD patients, SD patients scored lower on PROMIS Mobility (p<0.005). Compared to SA patients only, SD patients had lower scores on the HSS Pedi-FABS (p<0.01) and SRS-22R Function (p<0.05). PROMIS PA scores decreased with increasing spinal deformity, but these differences were not statistically significant. There was no significant difference between SA and MD for all PROMs administered.
Conclusion:
These findings suggest that mobility, function, and physical activity are affected by increasing severity of spinal curvature. Patients with severe spinal deformity reported lower PROMs compared to patients without clinical spinal deformity. Finally, patients with spinal asymmetry and mild deformity do not report significantly different PROMs.
Tables:
Mean PROM scores by group. NS, nonsignificant.
| SA | MD | SD | P value | |
|---|---|---|---|---|
| PROMIS Mobility | 56.7 ± 5.4 | 54.6 ± 7.4 | 49.6 ± 9.0 | <0.005 between SA & SD, MD & SD |
| PROMIS PA | 47.1 ± 7.4 | 45.2 ± 8.8 | 43.4 ± 10.5 | NS |
| SRS-22R Function | 4.9 ± 0.3 | 4.7 ± 0.4 | 4.6 ± 0.4 | <0.05 between SA & SD |
| HSS Pedi-FABS | 17.8 ± 7.5 | 15.0 ± 8.6 | 11.8 ± 6.3 | <0.01 between SA & SD |