International Utilization of the SRS-22 Instrument to Assess Outcomes in Adolescent Idiopathic Scoliosis: What Can We Learn From a Medical Outreach Group in Ghana?

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Cross-cultural studies on adolescent idiopathic scoliosis (AIS) populations are limited. This study evaluated the discriminate validity of the Scoliosis Research Society Questionnaire (SRS-22) in Ghana between adolescents with and without AIS. SRS-22 outcomes from AIS and normal adolescents in Ghana were also compared with scores from AIS and normal adolescents in America.


A retrospective review of preoperative SRS-22 questionnaires from Ghana and New York City was completed. In Ghana, 84 adolescents without scoliosis (healthy-G) (32 female adolescents; mean age, 13.3 y) and 61 patients with AIS (AIS-G) (76 female adolescents; mean age, 15.4 y) were administered with the SRS-22 questionnaire. From the New York City, 450 healthy adolescents (healthy-US) (279 female adolescents; mean age, 16 y) and 302 patients with AIS (AIS-US) (227 female adolescents; mean age, 14.9 y) also completed the SRS-22 questionnaire. Patients with curve magnitudes <40 (nonoperative) were then excluded. All 4 groups were matched based on age and sex, resulting in 4 groups of 40 subjects (25 female adolescents; mean age, 14.5 y for all groups). Differences in SRS-22 scores across the groups were analyzed using analysis of variance and analysis of covariance, with the Bonferroni post hoc tests, to control for differences in curve magnitude.


Mean curve magnitude for the matched groups was larger for the AIS-G group [67.2 degrees (range, 42 to 130 degrees)] as compared with the AIS-US group [52 degrees (range, 40 to 76 degrees)] (P<0.01). When controlling for the curve magnitude, a significant difference between all 4 study groups was found within all domains and total score (P<0.01). AIS-G displayed significantly lower scores in the activity, image, pain, and mental health domains (P<0.01); this reached the minimal clinically importance difference for these domains. Healthy-US and healthy-G had better overall and domain-specific scores than AIS-US and AIS-G, respectively (P<0.05).


These findings illustrate the affect of AIS within a culture as well as across cultures. Healthy adolescents had significantly better scores than scoliotic adolescents. Ghanaian adolescents had significantly worse Health-Related Quality-of-Life scores than American adolescents, especially those suffering from AIS. These differences should be kept in mind by those treating this already emotionally vulnerable adolescent population.

Level of Evidence:

Level II Prognostic.

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