Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery

Abstract

No results on long-term outcome in terms of health-related quality of life (HRQL) have previously been presented for patients treated for adolescent idiopathic scoliosis. A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before the age of 21, either with distraction and fusion using Harrington rods [surgical treatment group (ST), n=156; 145 females and 11 males] or with a brace [brace treatment group (BT), n=127; 122 females and 5 males] were followed at least 20 years after completion of the treatment. Ninety-four percent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM'S questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination including radiography and clinical examination. An age-and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. The results showed no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly, reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine percent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back [P<0.001 ST vs controls, P=0.0010 BT vs controls, and n.s. (P=0.024) ST vs BT], mostly due to difficulties with physical participation in activities or selfconsciousness about appearance. Pain was a minor reason for limitation. No correlation was found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment. Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being, and a few (1.5%) were severely physically disabled due to the back.

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment

“…In line with our results, other studies also found no major impact of gender [7,15,20], Cobb angle [7,9] and curve type [2,7,9] on HRQoL after treatment.…”

“…Climent et al [7] also found that patients treated with a brace were less satisfied with management than patients treated surgically. A similar trend was seen in a study by Danielsson et al [9] on HRQoL after follow-up of at least 20 years in patients treated with a brace and patients treated surgically; they reported a more negative effect of the treatment period on patients treated with a brace than on patients treated surgically, but in that study different measures were used than in our study. Furthermore, in the present study, patients treated only surgically had highest scores on the self-image/ appearance domain and on the single-item general health; although significant, these differences were rather small (respectively, 0.2 points on a 5-point scale and 7 points on a 100-point scale).…”

“…Ascani et al [1] on the other hand, found no increased incidence of pain, but found real psychological disturbances in 19% of untreated AIS patients. With respect to long-term follow-up on HRQoL in conservatively treated patients, Danielsson et al concluded that minimal pain occurred compared with normal controls [8] and that psychosocial well-being is quite good 20 years after brace or surgical treatment and is equal to the general population [9]. However, at the start of the 21st century with changing adolescent culture and experience, it is important to keep evaluating HRQoL in new AIS patient groups.…”

Epidemiology of adolescent idiopathic scoliosis

“…Another bias mentioned in nearly all epidemiologic studies is that they do not consider the psychological impact of scoliosis on children, although it has been described extensively in current literature [47][48][49]. Young girls particularly, but also boys, that have deformities might feel embarrassed when being examined in school.…”

Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically?

“…Cosmesis for the adolescent patient is an important factor for self-confidence, as studies have shown evidence of psychological distress in this population due to cosmetic concerns [1][2][3][4].…”