Metrology of Health-Related Quality of Life Measurements in Adults and Adolescents with Scoliosis

  • Author / Creator
    Alanazi, Malik
  • Background: Scoliosis impacts Quality of Life (QOL). Stabilization exercises have been shown to be effective for improving patient reported outcomes (PROMS.); however, our literature review examining the effects of such exercises on QOL showed that such studies in adults with scoliosis are lacking. PROMs with adequate measurements are prerequisites for conducting such studies. However, there has been no head to head comparisons to identify the best tools for measuring changes in QOL in the same samples of adults and adolescents with scoliosis. Widely used QOL PROMs have limitations such as ceiling effects, and insufficient reliability and validity evidence. Recently developed quality of life PROMs including the Italian Spine Youth Quality of Life (ISYQOL), Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ), and Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) aim to address these limitations but a thorough metrological comparison is needed.
    Objectives: This thesis aimed to: Systematically review the effects of stabilization exercises on pain, disability, and quality of life in adults with scoliosis, compare the test-retest reliability and convergent validity of the two versions of the Spinal Appearance Questionnaire (SAQ) in Adolescents with Idiopathic Scoliosis, and determine the test-retest reliability and convergent validity of the BIDQ-S, TAASQ, and ISYQOL scores in adolescents and adults with scoliosis against radiographic measurements and established quality of life questionnaires (Scoliosis Research Society 22r [SRS-22r] and SAQ v1.1).
    Methods: First, a systematic review on stabilization exercises for adult scoliosis was conducted on March 9, 2017 of Medline, CINAHL, Embase, SportDiscus and the Cochrane Register of Controlled Trials. Data extracted included information about participants, treatments, and results on pain, function and quality of life. Each study was appraised for quality using the Cochrane Risk of Bias tool.
    For the 3 metrological studies, two established questionnaires (the Scoliosis Research Society-22 refined (SRS-22r) and the Spinal Appearance Questionnaire (SAQv.1.1)) and three new questionnaires (ISYQOL, TAASQ, and BIDQ-S) were collected along with radiographic measurements (Maximum Cobb angle, coronal balance, and thoracic and lumbar vertebral rotations). Questionnaires were administered electronically twice with a one-week interval between.
    Results: The systematic review found limited evidence from only one study with high risk of bias that stabilization exercises significantly improve pain, disability and quality of life.
    The test-retest reliability of the SAQ domains (ICC3,1 = 0.72 to 0.94) in adolescents with scoliosis was similar or slightly lower than for the SAQ v1.1 Total, Appearance, and Expectations domain scores (ICC3,1 =0.86 to 0.94). Significant correlation was observed between the SAQ scores and both the SRS-22r Total score (r= -0.35 to -0.59) and the Cobb angle (r= 0.38 to 0.59). The SAQ v1.1 Total score correlated with the SRS-22r Total score (r=-0.50) and with Cobb angle r = 0.35 to 0.63. The ceiling and floor effect analysis favored the newer SAQ v.1.1.
    Test-retest reliability estimate (ICC3,1) for new questionnaires in adolescents with idiopathic scoliosis ranged from 0.77 to 0.95 compared to 0.70 to 0.93 in adults with scoliosis. Correlations that met our threshold and supported convergent validity between the new and established questionnaires numbered in adolescents with scoliosis and ranged from r = 0.35 to 0.70 compared to r = 0.38 to 0.72 in adults with scoliosis. Correlation between radiographic measurements and new questionnaires that met our threshold and supported convergent validity ranged from r = -0.35 to -0.47 in adolescents with scoliosis compared to r = -0.35 to -0.60 in adults with scoliosis.
    In adolescents with scoliosis, only the ISYQOL did not present notable ceiling or floor effects (≥15%). Both, the ISYQOL and the BIDQ-S did not present notable ceiling or floor effects (≥15%) in adults with scoliosis.
    Conclusion: This thesis highlighted the need for studies evaluating the effects of exercise on QOL in adults with scoliosis. In addition, it suggested that clinicians and researchers should use the SAQ v1.1 instead of the old version of the SAQ. In general, all new questionnaires demonstrated convergent validity, adequate reliability and acceptable ceiling and floor effects levels for research use in both adults and adolescents with scoliosis.

  • Subjects / Keywords
  • Graduation date
    Fall 2020
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.