Raso J

Discriminative and predictive validity of the scoliosis research society-22 questionnaire in management and curve-severity subgroups of adolescents with idiopathic scoliosis.

Study Design. Prospective cross-sectional measurement study. Objective. To determine the ability of the Scoliosis Research Society (SRS)-22 questionnaire to discriminate among management and scoliosis severity subgroups and to correlate with internal and external measures of curve severity. Summary of Background Data. In earlier studies of the SRS-22 discriminative ability, age was not a controlled factor. The ability of the SRS-22 to predict curve severity has not been thoroughly examined. Methods. The SRS-22 was completed by 227 females with adolescent idiopathic scoliosis. Using Analysis of covariance analyses controlling for age, the SRS-22 scores were compared among management subgroups (observation, brace, presurgery, and postsurgery) and curve-severity subgroups (in nonoperated subjects: Cobb angles of <30°, 30°–50°, and >50°). A stepwise discriminant analysis was used to identify the SRS-22 domains most discriminative for curve-severity categories. Correlation between SRS-22 scores and radiographic or surface topography measurements was used to determine the predictive ability of the questionnaire. Results. Pain was better for subjects treated with braces than for those planning surgery. Self-image was better for subjects under observation or postsurgery than for those planning surgery. Satisfaction was better for the brace and postsurgery subgroups than for the observation or presurgery subgroups. Statistically significant mean differences between subgroups were all larger than 0.5, which is within the range of minimal clinically important differences recommended for each of the 5-point SRS-22 domain scoring scales. Pain and mental health were worse for those with Cobb angles of >50° than with Cobb angles of 30° to 50°. Self-image and total scores were worse for those with Cobb angles of >50° than both other subgroups. Using discriminant analysis, self-image was the only SRS-22 domain score selected to classify subjects within curve severity subgroups. The percentage of patients accurately classified was 54% when trying to classify within 3 curve severity subgroups. The percentage of patients accurately classified was 73% when classifying simply as those with curves larger or smaller than 50°. Conclusion. Pain, self-image, and satisfaction scores could discriminate among management subgroups, but function, mental health and total scores could not. The total score and all domain scores except satisfaction discriminated among curve-severity subgroups. Using discriminant analysis, self-image was the only domain retained in a model predicting curve-severity categories.

Score distribution of the scoliosis research society-22 questionnaire in subgroups of patients of all ages with idiopathic scoliosis.

Study Design. Cross-sectional measurement study. Objective. To analyze the score distribution of the Scoliosis Research Society (SRS)-22 questionnaire domains and items for patients with idiopathic scoliosis (IS) of all ages. Summary of Background Data. Scoliosis-related quality-of-life questionnaires have demonstrated high ceiling effects in younger patients. However, the score distribution has not been examined thoroughly in other clinically relevant IS subgroups. Methods. The SRS-22 was completed by 173 females with IS. The proportions of ceiling effects, floor effects, of patients scoring greater than or equal to 4 out of 5 and the box plots of the score distribution for each domain and item were compared between subgroups. Subgroups were formed based on age (k = 4), management (k = 6), curve severity (k = 3), and curve type (k = 4). Results. Domain ceiling effects varied between 0% and 23.1%. Domain floor effects were observed only for Self-image (<7%) and Satisfaction (<12%). Only Pain and Satisfaction showed moderate (>20%) ceiling effects. Ceiling effects for Pain and Mental Health decreased with increasing age (P < 0.05). Pain ceiling effects decreased and Satisfaction ceiling effects increased from least to most invasive management (P < 0.05), but no differences were found among Cobb severity or curve types subgroups. Of the 22 items, 9 had major (≥50%) ceiling effects and 11 had moderate ceiling effects. Most subgroups (14/16) had 4 to 6 items with major ceiling effects. The following items had major ceiling effects in the majority of subgroups: Function, 9 and 15; Pain, 11 and 17; and Self-image, 14. Conclusion. Most SRS-22 domains had acceptable levels of ceiling effects (<20%) in the majority of the subgroups examined. However, more sensitive measurements may be needed to supplement the SRS-22 in assessing Pain in patients below 18 years or Satisfaction after surgery.

Correlation between quantity and quality of orthosis wear and treatment outcomes in adolescent idiopathic scoliosis.

Orthotic treatment is the most commonly used non-surgical treatment method for adolescent idiopathic scoliosis (AIS). This study determined whether treatment outcome correlates with how often and how well children with AIS wear their orthoses. Eighteen (18) subjects (3M, 15F) who were diagnosed with idiopathic scoliosis and had wom their orthoses from 6 months up to 1 year participated in this study. All subjects were prescribed Boston braces to be wom full time (23hrs/day). Twelve (12) subjects who completed their brace treatment were included in the data analysis. Three (3) treatment outcomes were classified as improvement, no change and deterioration. The quality of the brace wear was assessed by how often the brace was wom with zero force, below 80%, between 80 to 120%, and above 120% of the load level prescribed in the clinic. The quantity of brace wear was determined by how many hours per day they wore their brace. Subjects who wear their braces tighter and for more hours per day seem to have better outcomes.

The daily force pattern of spinal orthoses in subjects with adolescent idiopathic scoliosis

The efficacy of orthotic treatment for children with abnormal spinal curvature has been hampered by the lack of comprehensive information about wear characteristics. A battery-powered microcomputer system was developed to monitor loads exerted by orthoses used to treat children with spinal deformities during daily living. The system not only records how well the orthosis has been used, but also helps to ensure that the orthosis is being worn as prescribed. Data acquisition is controlled by a microcontroller and can be programmed to have sample intervals ranging from 1 second to 1 hour. Low power control circuitry is designed so that the system can be operated by a battery. In a preliminary study, 16 subjects (3M, 13F) used this system from 1 to 16 days (9.3±5.0) with the prescribed hours between 16 to 23 hours (22.3±1.3). This study demonstrated the feasibility of the approach, and that this device may increase the understanding of orthotic mechanics, and may help patients to wear their orthoses in a better way.

An objective measurement of brace usage for the treatment of adolescent idiopathic scoliosis.

Effectiveness of orthotic treatment for scoliosis depends on how much time and how well the orthosis is worn. Questionnaires and clinical judgment are subjective methods to wear compliance. Even though using a temperature sensor can objectively record how long the orthosis has been used, it may not be able to answer the orthosis effectiveness without knowing the wear tightness. Custom made thoracolumbosacral orthoses (TLSO) were instrumented with low power wireless data acquisition systems to measure the time and loads imposed by the pressure pad during daily activities. Force measurements were recorded at 1 sample/min and the system was able to record data up to 4 months without patient-involvement. Ten subjects (9F, 1M), age between 9 and 13.5 years, average 11.6±1.3 years, who prescribed a new TLSO and full-time brace wear were took part in this study over 4.4±1.0 months. Long-term logging of loads within a spinal orthosis is a reliable method to measure compliance objectively. The monthly quantity of brace wear ranged from 33% to 82%, average 60.0±4.3%. The monthly average loads imposed by the pressure pads varied from 39% to 78% relative to the reference level, average 64.3±4.6%. There was a statistically significant decrease in force, but increase in wear time over the period after the brace fitting session. This information may help to better understand the effectiveness of bracing and to predict the brace treatment outcomes.

Score distribution of the Scoliosis Quality of Life Index questionnaire in different subgroups of patients with adolescent idiopathic scoliosis.

Study Design. Prospective cross-sectional measurement study. Objective. To analyze the score distribution on the Scoliosis Quality of Life Index (SQLI) questionnaire domains and items for subjects with adolescent idiopathic scoliosis (AIS). Summary of Background Data. The SQLI was derived from the SRS-22 questionnaire so that it would be more applicable to persons with AIS between 10 and 18 years old. However, the score distribution of the SRS-22 is characterized by high ceiling effects within subgroups of persons with AIS. Methods. The SQLI questionnaire was completed by 95 females with AIS. Floor, ceiling effects, and score distribution were examined for subgroups based on age (n = 4), management (4), curve severity (3), and curve type (6). Results. Ceiling effect proportions (0%–40%) were higher than floor effects (n = 1). Back pain and satisfaction were the only domains with ceiling effects exceeding 20%. For some domains, ceiling effects were significantly most prevalent for younger subgroups, those with low or moderate curve severity and those treated less aggressively. High ceiling effects were also observed for the observation, postsurgical, main thoracic, and double major curves subgroups. More than half the participants scored over 4/5 for all SQLI domains in the overall sample and in the observation, surgery, <13.5 years, 13.5 to <15 years, <30°, 30° to 50°, main thoracic curves, double major curves, and thoracolumbar/lumbar curves subgroups, respectively. At least one item from each domain (except satisfaction) showed ceiling effects >50% in most subgroups (14 or more subgroups out of 15). Conclusion. Even though ceiling effects (>20%) were not common, scores clustered near the top of the SQLI scale. The SQLI score distribution may impair the questionnaires sensitivity to change and discriminative ability, particularly in younger subjects with lesser low or moderate curve severity, under observation or after surgery. The clinical utility of some SQLI items within each domain may be limited by high ceiling effects.

Instrumented rod rotator system for spinal surgery.

An electronically instrumented rod rotator has been developed to monitor forces and moments applied by surgeons during the derotation manoeuver to correct spinal curvature. This instrumented rod rotator consisted of an inclinometer and two pairs of strain gauges, with all the support circuitry. The strain gauge and the inclinometer data were sampled with a data-acquisition system, and the results were displayed in real time. The device was calibrated in the laboratory and used on seven subjects. The precision of the load measurement of this device was ±5 N in the range of 5–65 N. The distance between the middle of the rod rotator handle to the rod position was 0.21 m. The maximum loads applied by the surgeon during seven surgeries were from 22 to 57 N, with a torque (force x distance) from 4.6 to 12 Nm.

Bluetooth wireless database for scoliosis clinics

A database system with Bluetooth wireless connectivity has been developed so that scoliosis clinics can be run more efficiently and data can be mined for research studies without significant increases in equipment cost. The wireless database system consists of a Bluetooth-enabled laptop or PC and a Bluetooth-enabled handheld personal data assistant (PDA). Each patient has a profile in the database, which has all of his or her clinical history. Immediately prior to the examination, the orthopaedic surgeon selects a patients profile from the database and uploads that data to the PDA over a Bluetooth wireless connection. The surgeon can view the entire clinical history of the patient while in the examination room and, at the same time, enter in any new measurements and comments from the current examination. After seeing the patient, the surgeon synchronises the newly entered information with the database wirelessly and prints a record for the chart. This combination of the database and the PDA both improves efficiency and accuracy and can save significant time, as there is less duplication of work, and no dictation is required. The equipment required to implement this solution is a Bluetooth-enabled PDA and a Bluetooth wireless transceiver for the PC or laptop.

Prediction of curve progression for AIS patients treated with a TLSO Brace

Method Twenty subjects (17 females, 3 males), aged 13.4 ± 1.8 years, were prescribed a full-time TLSO (22 hr/day) and were monitored and followed for 3 years. All subjects met the SRS Brace Study inclusion criteria. The brace usage in terms of quantity (percent of wear time relative to the prescribed wear) and quality (percent of wear tightness relative to the prescribed tightness level) was logged with a compliance monitoring system. The Petersons risk of progression at the time when the brace was prescribed was calculated based on 4 variables: Risser sign, apex of the curve, age, and imbalance. In-brace curve correction (flexibility) was calculated using the following: (Initial Cobb in-brace Cobb)/Initial Cobb. A predictive model for curve progression using regression was developed based on the Petersons risk of progression, quantity, quality, and the percentage of in-brace correction. Data from six new subjects who used a monitoring system and were followed for 2 years after bracing was used to assess the validity of the model.

Research of Muscular Activity during Gait of Persons with Cerebral Palsy

Assessing muscular activity during gait in CP persons could provide valuable information in prescribing appropriate treatment to reduce the consequences of cerebral palsy as well as limiting further complication in cerebral palsy children. The main goal of this study was explored working regularities of muscle pairs in children population to show dependencies and variation on gait parameters. Functional evaluation was carried out on 20 cerebral palsy patients. The research have been done by using the system EMG. A surface electrode picked up on the main groups of muscles of lower limbs: the Rectus Femoris, the Vastus Lateralis, the Medial Hamstrings, the Lateral Gastrocnemius, and the Anterior Tibialis. There were several phases to the signal approach such as: data acquisition, data pre-processing, data modeling, data analysis and interpretation. From the results seen that for each task subjects have different strategies for keeping balance during walk depending on the basic level of muscle contraction or antagonistic and synergistic contraction required for that activity.