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Cognitive Testing of the Spinal Appearance Questionnaire (SAQ) with Typically Developing Youth and Youth with Idiopathic Scoliosis: Paper #20

Mulcahey, Mary Jane PhD; Santangelo, Anna Marie RN; Costello, Kim; Merenda, Lisa RN; Chafetz, Ross; Samdani, Amer F. MD; Betz, Randal R. MD

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United States

Summary: The spinal appearance questionnaire (SAQ), a patient‐reported outcome measure of appearance for youth with idiopathic scoliosis, underwent cognitive testing to evaluate reading, comprehension, and interpretation of the items. Not one item was read, answered, and interpreted without problem. Difficulties were encountered with medical words, vagueness of questions, and illustrations that were misidentified.This study does not support the use of the SAQ with youth and highlights the importance of field testing measures for readability and comprehension prior to use.

Introduction: This cross‐sectional study evaluates the readability, comprehension, and interpretation of items on the SAQ. Cognitive interview methodology of 57 youth (8‐16 yrs; average age 13) included 22 with scoliosis and 35 typically developing.

Methods: SAQ written and pictorially illustrated items and responses were read aloud. Subjects were required to think aloud to capture cognitive processes about the items and responses. For each item, subjects were asked “in your own words tell me how you would ask this question and what you think this question is asking.” Interviews were audio taped and transcribed verbatim. Percent of subjects with at least one problem per SAQ item was calculated. Problems were categorized and frequencies for each category were calculated.

Results: Not one SAQ item was read, answered, and interpreted without problem (Table 1). Subjects (12%) had least difficulty with item 16 (“I want to have more even shoulders”) and most difficulty (96%) with items 2 & 3 (rib prominence, flank prominence). Subjects did not understand the meaning of “prominence” and “flank;” these words were also problematic for subjects (84%) on items 7 & 8.65% of subjects reported item 12 (“I want to be more even”) as too vague, and 84% of subjects were unable to understand item 14 (“I want more even breasts”) either because they were not yet developed (40%) or the meaning was unclear (44%). The pictorial illustrations for items 2 and 3 were problematic for 58% and 49% of subjects, respectively. The illustrations of the lungs (item 4) and hips (items 4 & 5) were problematic for 42% and 27% of subjects, respectively. The lungs were misinterpreted as the heart, stomach, and breasts and the hips as the bladder, reproductive system, stomach, and digestive system. These results were consistent regardless of age or diagnoses.

Conclusion: This study does not support the use of the SAQ as currently used with youth due to use of complex medical words, vague questions, difficult illustrations, and various interpretations of the intent of many of the items. A modification of the SAQ is under development.

Significance: Acknowledgements: The study was funded in part by the Shriners Hospitals for Children‐Philadelphia and a grant from DePuy‐Spine, Inc.

© 2010 Lippincott Williams & Wilkins, Inc.

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