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Demographic Factors Affect Scoliosis Research Society-22 Performance in Healthy Adolescents: A Comparative Baseline for Adolescents With Idiopathic Scoliosis

Verma, Kushagra, MD, MS; Lonner, Baron, MD; Hoashi, Jane S., MD, MPH; Lafage, Virginie, PhD; Dean, Laura, BA; Engel, Itzhak, MD; Goldstein, Yael, PA-C

doi: 10.1097/BRS.0b013e3181cb474f

Study Design. Prospective analysis.

Objective. The purpose of this study was to: (1) evaluate the influence of variable demographic factors on the Scoliosis Research Society (SRS)-22 performance and (2) evaluate SRS-22 performance in normal adolescents without scoliosis to establish a comparative baseline for adolescent idiopathic scoliosis.

Summary of Background Data. The SRS-22 instrument has been used widely to evaluate patients with scoliosis but no study has characterized how variable patient demographics in normal, unaffected individuals may influence SRS-22 scores.

Methods. Healthy adolescents at a high school clinic and at referring pediatricians' private offices were asked to anonymously complete the SRS-22 instrument: 22 questions scaled 1–5 (highest). Additional questions assessed household income, race (white, Hispanic, African-American, other), gender, household status (single vs. dual parent), and body mass index. ANOVA and multivariate regression analyses were used to identify statistically significant factors (P < 0.05).

Results. Four hundred fifty unaffected adolescents completed the SRS-22 (62% female, 38% male; mean age 16 (range, 9.3–21.8), mean body mass index 22.8 (range, 13.5–47.5). Mean SRS-22 performance was 4.1 ± 0.5 (Activity: 4.0 ± 0.6; Pain: 4.3 ± 0.6; Image: 4.2 ± 0.6; Mental: 3.8 ± 0.8, Mean: 4.1 ± 0.5). Whites scored higher in the activity domain than Hispanic and other ethnicities, while African Americans scored higher in the pain domain than Hispanics (P < 0.05 for both). From the lowest income range to 125,000 dollars/yr, household income had a positive effect on the activity, image and mean SRS-22 score (P < 0.05 for all). Males scored higher than females in the mental health domain and mean SRS-22 (P < 0.0001). Dual parent versus single parent households had higher activity and mean SRS-22 scores (P < 0.005).

Conclusion. We report that male gender, dual parent household, white race and increased household income were predictive of higher SRS-22 scores in healthy adolescents without scoliosis. The impact of these factors represents a meaningful clinical difference in SRS-22 performance.

We evaluated the Scoliosis Research Society-22 performance in normal adolescents without scoliosis to determine the baseline effects of variable patient demographics on the Scoliosis Research Society-22 scores. Male gender, dual parent household, white race, and increased household income were predictive of higher the Scoliosis Research Society-22 scores in healthy adolescents without scoliosis, signifying a meaningful clinical difference in the Scoliosis Research Society-22 performance.

From the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.

Acknowledgment date: September 3, 2009. Revision date: October 19, 2009. Acceptance date: October 19, 2009.

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 Baron Lonner, MD, 820 2nd Ave, Suite 7A, New York, NY 10017; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.