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An Insight Into the Health-Related Quality of Life of Adolescent Idiopathic Scoliosis Patients Who Are Braced, Observed, and Previously Braced

Cheung, Prudence Wing Hang, BDSc (Hons); Wong, Carlos King Ho, PhD; Cheung, Jason Pui Yin, MBBS, MMedSc, MS, PDipMDPath, FHKCOS, FHKAM, FRCSEd

doi: 10.1097/BRS.0000000000002918

Study Design. Prospective cross-sectional study.

Objective. To determine the health-related quality of life (HRQoL) of adolescent idiopathic scoliosis (AIS) patients undergoing bracing, previously braced and observation only.

Summary of Background Data. HRQoL is an important treatment outcome measure for AIS. A poor HRQoL may also negatively influence the success of bracing by reducing the likelihood of good brace compliance. Yet, the HRQoL thresholds for patients undergoing observation only, brace treatment or previous brace treatment is not well understood.

Methods. Chinese AIS patients with refined Scoliosis Research Society 22-item (SRS-22r) Questionnaire and 5-level EQ-5D (EQ-5D-5L) Questionnaire scores were consecutively recruited for this cross-sectional study. Patients were grouped based on their treatment modality (observation only, bracing, previously braced, and postoperatively). Coronal and sagittal Cobb angles, degree of apical vertebral rotation, and curve type were studied. Spearman correlation test, independent t test, and one-way analysis of variance (ANOVA) with Tukey Post-hoc test were performed for statistical analysis.

Results. A total of 652 AIS patients with mean age of 14.8 ± 1.9 years and mean Cobb angle of 18.6° ± 10.0° was studied. The respective mean SRS-22r total scores for bracing, observation, and previously braced groups were 4.20, 4.54, and 4.42, and mean EQ-5D-5L scores were 0.87, 0.95, and 0.92. The total and domain scores were correlated with coronal Cobb angles (P < 0.001) while only EQ-5D-5L correlated with sagittal Cobb angles (P < 0.001). Curves greater than 40° had worse HRQoL (P < 0.001). Currently braced patients had significantly worse HRQoL than those under observation, as indicated by lower EQ-5D-5L (0.08) and SRS-22r (0.35) scores (P < 0.001 to P < 0.05). Previously braced patients had better HRQoL than currently braced patients, with 0.05 higher EQ-5D-5L score (P < 0.001), and 0.23 higher SRS-22r score (P < 0.001). However, currently braced patients were more satisfied with treatment (1.94 difference; P < 0.001) than previously braced. There were no gross differences between patients previously braced and undergoing observation only.

Conclusion. The negative impact of bracing on HRQoL is only transient as previously braced patients have superior HRQoL. It appears as though the EQ-5D-5L scores are more sensitive to changes in the sagittal profile as compared with SRS-22r. Our study highlights the differences in HRQoL between patients only being observed, undergoing bracing or previous brace treatment and the importance of monitoring HRQoL throughout follow-up. Further longitudinal studies may help determine the timing and threshold of HRQoL changes during the entire duration of bracing as well as after brace weaning.

Level of Evidence: 2

Through SRS-22r and EQ-5D-5L, this study revealed currently braced had worse HRQoL than previously braced patients and those under observation, whereas previously braced patients' HRQoL was comparable to those under only observation. This suggests HRQoL can be restored post-weaning, any negative effect of bracing is transient. HRQoL variation found at different bracing duration may serve as potential marker for varying brace compliance.

Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China

Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China.

Address correspondence and reprint requests to Jason Pui Yin Cheung, MBBS, MMedSc, MS, PDipMDPath, FHKCOS, FHKAM, FRCSEd, Department of Orthopaedics and Traumatology, The University of Hong Kong 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China; E-mail:

Received 9 August, 2018

Revised 21 September, 2018

Accepted 3 October, 2018

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

General Research Fund (GRF) of the Research Grants Council (RGC) #17156416 funds were received in support of this work.

No relevant financial activities outside the submitted work.

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