Patient Satisfaction After Surgical Correction of Adolescent Idiopathic Scoliosis
Norton Leatherman Spine Center, Louisville, KY, USA. Spine
(Impact Factor: 2.3).
05/2011; 36(12):965-8. DOI: 10.1097/BRS.0b013e3181e92b1d
The purpose of this study is to evaluate the relationship between change in SRS-22 domain scores and satisfaction with management in patients who underwent surgical correction for adolescent idiopathic scoliosis (AIS).
The Scoliosis Research Society-22 (SRS-22) is a widely used instrument to measure clinical outcomes in patients with scoliosis. The relationship between patient satisfaction and changes in domain scores in the SRS-22 has not been previously reported.
This is a longitudinal cohort of 745 patients with AIS who underwent surgical correction and had completed SRS-22 preoperative and 2 years postoperative. Patients who had a previous spine surgery were excluded. Wilcoxon tests were used to compare preop and 2-year postop scores. Spearman correlations were used to evaluate associations between change in SRS-22 domain scores from preoperative to 2 years postoperative and the 2-year SRS Satisfaction score.
There were 622 females and 123 males with a mean age of 14.2 years and a mean Cobb angle of 54°. There was a statistically significant difference between paired preoperative and 2-year postoperative SRS domain scores. Spearman correlations between the change in SRS domain scores and the SRS Satisfaction score at 2 years postoperative were statistically significant but were low to moderate: Appearance = 0.284, Activity = 0.172, Pain = 0.260, Mental = 0.202, and Total = 0.398.
Although there is a statistically significant change in all the SRS domain scores from preoperative to 2 years postsurgical correction of AIS, there was low to moderate associations between the change in any of the domain scores and patient satisfaction with treatment. This may be attributable to the prominent ceiling effect in the Satisfaction domain, or the lack of responsiveness of the SRS-22 to measure clinically relevant changes in activity, pain and mental health 2 years after correction of scoliosis in the adolescent population.
Available from: Anna-Clara Rullander
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ABSTRACT: Scoliosis surgery is one of the most extensive elective surgical processes performed on young people. Although there is a great store of knowledge of surgical techniques, patients' experiences of going through surgery have not been extensively studied.
The aim of this study is to describe how a cohort of young people and their parents retrospectively rate postoperative pain and nausea and describe their experiences of scoliosis surgery.
In a retrospective cohort study, 87 young people aged 8-25 years with scoliosis who underwent corrective surgery from 2004 to 2007 were invited to complete a questionnaire, as were their parents. The semistructured questionnaire dealt with experiences of pain, nausea, and global satisfaction pre- and posthospitalization, assessed by visual analogue scales. The free text commentaries were analyzed using qualitative content analysis.
A total of 51 patients (59%) and 65 parents (75%) answered the questionnaires. Out of the completed questionnaires, 41 had idiopathic, 23 neuromuscular, and 6 other types of scoliosis. Postoperative patient-rated pain was severe 7.3 (median, interquartile range 5-8.4, visual analogue scale 0-10 cm), and the severe pain lasted for 5 (median, 2.7-7.0) days. Nausea was rated to a median of 5 (1.1-7.3) and lasted for a median of 3 (1-5.2) days. Global satisfaction was rated to a median of 3.2 (1.5-5.2). Postoperative pain was the most prominent issue, and present pain was found in 51% of respondents. Nausea and loss of appetite were common during the entire hospital stay. Waiting for the nurses' assistance, lack of control, and technical failures with the analgesia equipment caused discomfort. Parents experienced a lack of confidence in the nurses and felt helpless to support their child or relieve the child's suffering.
Young people who underwent scoliosis surgery reported severe postoperative pain and nausea during the hospitalization period and persistent and recent onset pain after discharge, although they did not indicate global dissatisfaction with the hospital stay.
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ABSTRACT: STUDY DESIGN:: Prospective cohort study. OBJECTIVE:: Prospectively compare patient reported as well as clinical and radiological outcomes following anterior or posterior surgery for right thoracic AIS in a single centre by the same surgeons. SUMMARY OF BACKGROUND DATA:: Anterior and posterior spinal instrumentation and arthrodesis are both well established treatments of thoracic AIS. The majority of studies comparing the two approaches have focused on radiographic outcomes. There remains a paucity of prospectively gathered patient reported outcomes comparing surgical approaches. METHODS:: 42 consecutive patients with right thoracic AIS were treated in a single centre by one of two surgeons with either anterior (n=18) or posterior (n=24) approaches and followed up for over 2 years. Radiographic, clinical and patient reported outcomes of the Modified Scoliosis Research Society Outcome Instrument (MSRSI) were gathered and analysed by an independent surgeon. RESULTS:: Patients reported significant improvements in all areas of MSRSI, especially pain and self image domains. There were no significant differences in the degree of improvement in any domains between the groups. Posterior and anterior surgery corrected rib hump by 53% and 61% respectively (P=0.4). Main thoracic curve Cobb angle was corrected from 69° to 26° (62%) by posterior surgery and 61° to 23° (64%) by anterior surgery (P=0.6). Posterior surgery significantly reduced kyphosis and lumbosacral lordosis. Anterior surgery had no overall affect of sagittal alignment but seemed able to correct those hypokyphotic preoperatively. Complications differed and were largely approach related; intrathoracic in anterior and wound related in posterior surgery. CONCLUSIONS:: Patients with right thoracic AIS of differing curve types but otherwise similar preoperatively demonstrated that anterior and posterior surgery are largely equivalent. Patient reported outcomes are improved similarly by either approach. Both offer excellent radiographic and trunk deformity correction. Differences in the effect of sagittal alignment, operative time and complications should be considered when selecting approach.
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ABSTRACT: Study Design. Review and statistical analysis of studies evaluating health-related quality of life (HRQOL) in adolescents with untreated adolescent idiopathic scoliosis (AIS) using Scoliosis Research Society (SRS) outcomes.Objective. Apply normative values and minimum clinical important differences (MCID) for the SRS22r to the literature. Identify whether the HRQOL of adolescents with untreated AIS differs from unaffected peers and if any differences are clinically relevant.Summary of Background Data. The effect of untreated AIS on adolescent HRQOL is uncertain. The lack of published normative values and MCID for the SRS22r has so far hindered our interpretation of previous studies. The publication of this background data allows these studies to be re-examined.Methods. Using suitable inclusion criteria a literature search identified studies examining HRQOL in untreated adolescents with AIS. Each cohort was analysed individually. 95% confidence intervals for the difference in SRS22r domain mean scores between the cohorts with AIS and the published data for unaffected adolescents were used to identify statistically significant differences. If the lower bound of the confidence interval was greater than the MCID the difference was considered clinically significant.Results. Of 21 included patient cohorts 81% reported statistically worse pain than those unaffected. Yet in only 5% of cohorts was this difference clinically important. Of the 11 cohorts included examining patient self image 91% reported statistically worse scores than those unaffected. In 73% of cohorts this difference was clinically significant. Affected cohorts tended to score well in function/activity and mental health domains and differences from those unaffected rarely reached clinically significant values.Conclusions. Pain and self image tend to be statistically lower amongst cohorts with AIS than those unaffected. The literature to date suggests it is only self image which consistently differs clinically. This should be considered when assessing the possible benefits of surgery.
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