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Validity and Reliability of an Adapted German Version of Scoliosis Research Society-22 Questionnaire

Niemeyer, Thomas MD, PhD*; Schubert, Christiane MD*; Halm, Henry F. MD; Herberts, Tina PhD; Leichtle, C MD*; Gesicki, Marco MD*

doi: 10.1097/BRS.0b013e31819b33be
Health Services Research

Study Design. Study to determine the internal consistency and validity of adapted German version of Scoliosis Research Society-22 (SRS-22) questionnaire.

Objective. To evaluate the validity and reliability of adapted German version of SRS-22 questionnaire.

Summary of Background Data. The SRS-22 questionnaire was developed to assess the health-related quality of life for English-speaking patients with idiopathic scoliosis. For scientific purpose and standardized comparison of outcome studies for the treatment of idiopathic scoliosis its adaptation into German is necessary to respect cultural and lingual differences.

Methods. Translation/retranslation of the English version of the SRS-22 was conducted, and all steps for cross-cultural adaptation process were performed. Thus, SRS-22 questionnaire and previously validated Roland-Morris score were mailed to 222 patients who had been treated surgically or conservatively for idiopathic scoliosis. Seventy-eight patients (35%) responded to the first set of questionnaires and 54 of the first time responder returned their second survey. The median age of all patients who joined the study was 19 years. Measures of reliability namely, selectivity, internal consistency, and reproducibility were determined by Cronbach’s α statistics and intraclass correlation coefficient, respectively. Concurrent validity was measured by comparing with an already validated questionnaire (Roland-Morris score). Measurement was made using the Spearman correlation coefficient.

Results. The study demonstrated satisfactory internal consistency with high Cronbach’s α values for 4 of the corresponding domains (pain, 0.75; self-image, 0.84; mental health, 0.88; and satisfaction, 0.61). However, the Cronbach’s α value for function/activity domain (0.67) was considerably lower than the original English questionnaire. For the same domains intraclass correlation coefficient demonstrating satisfactory test/retest reproducibility.

Conclusion. The adapted German version of the SRS-22 questionnaire can be used to assess the outcome of treatment for German-speaking patients with idiopathic scoliosis.

The study analyzed the validity and reliability of an adapted German version of Scoliosis Research Society-22 (SRS-22) Instrument. Translation/back-translation of the original English version of the SRS-22 was performed as a cross-cultural adaptation process. Translated scores were mailed to 202 patients with idiopathic scoliosis and from the returned results statistical analysis was performed determining concurrent and construct validity and reliability. The results demonstrated satisfactory concurrent validity and the calculated Cronbach’s α of internal consistency was very good for four domains (pain, self-image, mental health, satisfaction) and satisfactory for one domain (function/activity). The intraclass correlation for determine reliability demonstrated excellent test/retest reproducibility for two domains, and for three domains good test-retest reproducibility. This study confirmed that the adapted German version of SRS 22 can be used as outcome instrument for the treatment of German speaking patients with idiopathic scoliosis.

From the *Spine Service, Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany; †Centre for Spinal Surgery and Scoliosis, Klinikum Neustadt, Germany; and ‡Department of Medical Biometry, University of Tübingen, Tübingen, Germany.

Acknowledgment date: February 27, 2008. Acceptance date: June 20, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Thomas Niemeyer, MD, PhD, Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.