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Analysis of Patient and Parent Assessment of Deformity in Idiopathic Scoliosis Using the Walter Reed Visual Assessment Scale

Sanders, James O. MD*; W. Polly, David Jr, MD; Cats-Baril, William PhD‡§; Jones, JoAnn BS; Lenke, Larry G. MD; O’Brien, Michael F. MD**; Stephens Richards, B. MD††; Sucato, Daniel J. MD††Members of the AIS Section of the Spinal Deformity Study Group

doi: 10.1097/01.BRS.0000084629.97042.0B
Health Services Research

Objectives. This study evaluates the Walter Reed Visual Assessment Scale (WRVAS) compared with clinical parameters and written descriptions of the deformity from idiopathic scoliosis patients and their parents.

Summary of Background Data. The WRVAS demonstrates seven visible aspects of spinal deformity in an analogue scale. Higher scores reflect worsening deformity.

Materials and Methods. The WRVAS was administered to 182 idiopathic scoliosis patients at four centers in conjunction with open-ended questions about patients’ and their parents’ perceptions of their spinal deformity. The open-ended responses were categorized as either “deformity noted” or “no deformity noted.”

Results. WRVAS scores strongly correlate with curve magnitude (P = 0.01) and clearly differentiates curves of 30° or more from lesser curves. Among treatment groups, patients with surgery recommended had significantly higher scores than that of other patients. The instrument differentiated those noting no deformity from those noting a deformity. The correlation between patients’ and parents’ scores was high (Spearman’s rho = 0.8). When a deformity was noted, parents gave higher scores than did their children for rib prominence, shoulder level, scapular rotation, and the total score, but not for the other dimensions.

Conclusions. Increasing scores of the WRVAS are strongly correlated with curve magnitude lending construct validity to this type of assessment tool. Patients with “surgery recommended” report more visible deformity on the scale than observed, braced, and postoperative patients, supporting the hypothesis that surgery improves the perceived appearance. Parents perceive more deformity of the ribs and shoulders more than did the patients, but other aspects of the deformity are identified equally. WRVAS scores correlate significantly with curve magnitude and treatment. Parents and patients have similar scores, but with parents perceiving more deformity of the ribs and shoulders than patients.

From the *Shriners Hospitals for Children, Erie, Pennsylvania;

†Walter Reed Army Medical Center, Washington, DC;

‡University of Vermont, Burlington, Vermont;

§Data Harbor, Chicago, Illinois;

¶Medtronic Sofamor Danek, Memphis, Tennessee;

∥Washington University, St. Louis, Missouri;

††Denver Orthopedics, Wheat Ridge, Colorado; and

††Texas Scottish Rite Hospital, Dallas, Texas.

Acknowledgment date: October 18, 2002.

First revision date: March 31, 2003.

Acceptance date: April 7, 2003.

This study was supported through a grant from Medtronic-Sofamor Danek with technical assistance from Data-Harbor.

The manuscript submitted does not contain information about medical device(s)/drug(s). Corporate/Industry funds were received in support of this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

One of the authors (DWP) is an employee of the United States Government. The views and opinions expressed herein are his personal views and are not to be construed as official.

© 2003 Lippincott Williams & Wilkins, Inc.