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Validation of the Scoliosis Appearance Questionnaire: Paper #19

Carreon, Leah Y. MD, MSc; Sanders, James O. MD; Polly, David W. MD; Sucato, Daniel J. MD, MS; Parent, Stefan MD, PhD; Diamond, Beverly E. PhD

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Summary: The SAQ is a valid measure of self‐image in patients with adolescent idiopathic scoliosis. It has higher correlation coefficient to curve magnitude than the SRS Appearance domain and total score. It also discriminates between patients who require surgery from those who do not.

Introduction: The Scoliosis Appearance Questionnaire (SAQ) was originally developed from the Walter Reed Visual Assessment Scale. Although the SAQ has been administered to a large sample of patients with adolescent idiopathic scoliosis (AIS) treated surgically, its psychometric properties have only been studied in a small sample of patients. The purpose of this study is to evaluate the validity of the SAQ.

Methods: The SAQ was administered to patients seen in the clinic for evaluation of AIS. This included patients who were being observed, braced or scheduled for surgical treatment of their curves. The SAQ was administered concurrently with the Scoliosis Research Society‐22 (SRS‐22) questionnaire. Standard demographic data was collected. Radiographic measures including Lenke type and curve magnitude were also collected.

Results: Of the 1802 patients that participated, 83% were female; with a mean age of 14.8 ± 2.1 years and mean Cobb angle of 55.8±13.7 degrees. From the original 32 items of the SAQ, 14 items were found to have significant correlations across all Lenke types, producing 2 factors: an Appearance factor (Items 1 to 10) and an Expectations factor (Items 12 to 15). The responses to the items are summed giving a range of 10 to 50 for the Appearance domain and 4 to 20 for the Expectations domain. Higher scores represent worse measures. Baseline data comparing patients who were observed, braced and had surgery are summarized in Table 1. In patients who had surgery, domain scores were statistically significantly different from the one‐year scores for Appearance (24.9 vs 14.8, p<0.0001), Expectations (15.7 vs 8.3, p<0.0001) and Total (40.5 vs 23.0, p<0.0001). Correlations with the major curve magnitude were higher for the SAQ Appearance (0.361) and SAQ Total (0.324) scores compared to correlations between the SRS Appearance (0.033) and SRS Total (0.160) scores.

Conclusion: The SAQ is a valid measure of self‐image in patients with adolescent idiopathic scoliosis. It has higher correlation coefficient to curve magnitude than the SRS Appearance domain and total score. It also discriminates between patients who require surgery from those who do not.

© 2010 Lippincott Williams & Wilkins, Inc.

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