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Spinal (Scoliosis) Appearance Questionnaire

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Purpose

The SAQ was developed as a disease-specific measure of quality of life in patients with adolescent idiopathic scoliosis (AIS), specifically for younger patients, as it has more visual cues than verbal questions. The SAQ was designed to measure patients' and their parents' perception of their spinal deformity's appearance through the use of standardized drawings and questions

Link to Instrument

Acronym SAQ

Area of Assessment

Quality of Life
General Health

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Populations

Spinal Injuries
Pediatric Disorders

Key Descriptions

  • The SAQ is a 33-question assessment broken down into different sections. There are 11 pictorial questions the individual identifies what most looks like themselves. Questions 13 through 32 are rating questions where the individual rates each item out of 5 ratings these include: not true, a little true, somewhat true, Fairly true, or very true. Question 25 is to be answered only if the individual has had spinal correction surgery. Question 31 asks of items 13-30 of which is the most important to the individual. Question 32 asks about overall self-image using a scale of very bad, bad, fair, good, or very good. The final question is an open-ended question what the individual would like changed most about their body shape and why. SAQ has been translated into multiple languages including Danish Danish, French Canadian French Canadian, and Chinese Chinese.

Number of Items

33

Time to Administer

10-20 minutes minutes

Required Training

No Training

Age Ranges

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

+

years

Instrument Reviewers

Erik Brown, MS, LAT, ATC, CES, PES

Kellen Begeman, MA, ASCP MLS

Regan Saxton MS, OTR/L

Body Part

Back

ICF Domain

Body Structure

Measurement Domain

Emotion

Considerations

  • Due to the questions of the exam an individual taking this assessment needs to have the ability to understand how to read and write at a 6th grade level.
  • The individual needs to have an understanding of their scoliosis to report on the measurement.
  • The curve severity and how it is impacting their overall perspective should be taken into account when deciding to use this measure.
  • The relationship between mood and SAQ needs to be determined in order to assess the relationship between these variables

Spinal Injuries

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Normative Data

Idiopathic Scoliosis post-surgery: (Misterska et al., 2011; n = 40; mean age = 15.0(1.5) years; collected 2 years postoperatively; twice in 1 1-week interval)

 

Subscale

Median

95% CI from

95% CI to

Min Value

Max Value

Lower Quartile

Upper Quartile

General

7.23

2.06

2.76

1.00

4.67

4.00

10.00

Curve

1.78

1.56

1.99

1.00

3.00

1.00

2.00

Prominence

3.35

1.48

1.87

1.00

3.00

2.00

4.00

Trunk Shift

3.30

1.44

1.86

1.00

3.50

2.00

4.00

Waist

6.08

1.60

2.45

1.00

5.00

3.00

8.00

Shoulders

4.25

1.82

2.43

1.00

3.50

2.00

6.00

Kyphosis

1.70

1.49

1.91

1.00

3.00

3.00

2.00

Chest

4.55

1.79

2.76

1.00

5.00

2.00

7.50

Surgical scar

2.25

1.79

2.71

1.00

5.00

1.00

3.50

General result

34.48

1.78

2.27

1.00

3.65

25.00

42.50

 

*The table above presents the distribution of results from the SAQ in this particular study

 

Idiopathic scoliosis: (Misterska et al., 2014, n=41, mean age of patient = 13.60 (1.60) years; administered to both patients and parents, Polish version)

SAQ-pl subscales

Mean

95% CI

Min

Max

SD

Mean

95% CI

Min

Max

SD

P vlue

 

Completed by patient

Completed by parents

 

 

General

3.5

3.3-3.8

1.3

5.0

0.8

3.5

3.3-3.8

1.0

4.7

0.7

0.846

Curve

2.4

2.2-2.6

1.0

4.0

0.7

2.3

2.1-2.5

1.0

4.0

0.6

0.142

Prominence

1.7

1.6-1.9

1.0

2.5

0.4

1.9

1.7-2.0

1.0

3.0

0.5

0.059

Trunk shift

1.9

1.7-2.0

1.0

3.0

0.5

1.9

1.7-2.1

1.0

3.5

0.5

0.510

Waist

3.4

3.0-3.8

1.0

5.0

1.3

3.3

2.8-3.7

1.0

5.0

1.4

0.326

Shoulders

2.8

2.5-3.2

1.0

5.5

1.0

2.8

2.4-3.1

1.0

4.0

1.0

0.673

Kyphosis

1.9

1.6-2.1

1.0

3.0

0.7

1.9

1.6-2.1

1.0

3.0

0.7

1.000

Chest

2.6

2.2-3.1

1.0

5.0

1.5

2.9

2.2-3.3

1.0

5.0

1.7

0.581

Total Score

2.7

2.5-2.9

1.3

3.8

0.6

2.7

2.5-2.9

1.0

3.9

0.6

0.343

 

Idiopathic scoliosis: (Guo et al 2016, n= 112,  mean age 17.3 (3.1) years; traditional Chinese version)

Domain (no. of questions)

Domain mean (SD)

General (3)

3.7 (0.7)

Curve (1)

2.6 (0.9)

Prominence (2)

2.1 (0.8)

Trunk shift (2)

2.2 (0.9)

Waist (3)

3.9 (1.0)

Shoulders (2)

3.1 (0.8)

Kyphosis (1)

2.1 (0.8)

Chest (2)

3.9 (1.0)

Test/Retest Reliability

Idiopathic scoliosis: (Misterska et al 2014)

  • Excellent parent form test-retest reliability: (ICC = .99)

Idiopathic Scoliosis: (Thielsch et al., 2018; n=255; mean age = 30:0 (16.7) years; Cobb Angle 43.5 (20.9); 14.9%male)

  • Excellent SAQ Appearance test-retest reliability: (ICC = .84)
  • Adequate SAQ Expectations test-retest reliability (ICC = .67)
  • Excellent SAQ total score test-retest reliability (ICC = .80)

Idiopathic Scoliosis: (Lee, Shin, Goh, Son, & An, 2017; n = 112; age 12.2 (1.4); major curve magnitude 29.1 (13.2); 11.6%male)

  • Excellent test-retest reliability: (ICC = .922)

Idiopathic Scoliosis: (Xianzhao et al., 2012; n=215; mean age 14.58 (1.58); Major curve magnitude 36.84 (21.39) 14.4%male)

  • Excellent test-retest reliability: (ICC = .933)

Idiopathic Scoliosis: (Sanders et al., 2007 N =127 patients with idiopathic scoliosis or possible idiopathic scoliosis and to 112 parents of the patients; 93 patients (median interval, 4 days) and 77 parents (median interval, 5 days) completed the retest)

  • Adequate to Excellent test-retest reliability: (Spearman's rho, 0.57-0.99)

 

Idiopathic scoliosis: (Guo et al 2016, n= 112,  mean age 17.3 (3.1) years; traditional Chinese version)

 

Domain (no. of questions)

Intraclass correlation coefficient

General (3)

0.865

Curve (1)

0.805

Prominence (2)

0.828

Trunk shift (2)

0.854

Waist (3)

0.834

Shoulders (2)

0.799

Kyphosis (1)

0.842

Chest (2)

0.798

 

Internal Consistency

Idiopathic scoliosis: (Misterska et al 2014)

  • Excellent: Cronbach’s α was 0.81-0.83 for parent form

Idiopathic Scoliosis: (Thielsch et al., 2018)

  • Excellent: Cronbach’s α was 0.93 for the SAQ Appearance scale,
  • Excellent: Cronbach’s α 0.86 for SAQ Expectations
  • Excellent: Cronbach’s α 0.91 for SAQ total score

Idiopathic Scoliosis: (Lee et al., 2017)

  • Excellent: Cronbach's alpha range was 0.883

Idiopathic Scoliosis: (Xianzhao et al., 2012)

  • Excellent: Cronbach's alpha range from 0.903–0.956

*Scores higher than .9 may indicate redundancy in the scale questions.

 

Idiopathic scoliosis: (Guo et al 2016, n= 112,  mean age 17.3 (3.1) years; traditional Chinese version)

 

 

Domain (no. of questions)

颁谤辞苍产补肠丑’蝉&苍产蝉辫;α

General (3)

0.665

Curve (1)

–

Prominence (2)

0.785

Trunk shift (2)

0.813

Waist (3)

0.896

Shoulders (2)

0.421

Kyphosis (1)

–

Chest (2)

0.940

 

Idiopathic scoliosis: (Matamalas et al 2014, n=80, ages 10-40 years old, Spanish version)

  • Excellent Cronbach’s α?=?0.89

 

 

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Idiopathic scoliosis: (Thielsch et al, 2018)

  • Poor  concurrent  validity convergent validity of the SAQ Total and PANAS (mood) (r = .30)
  • Poor  concurrent  validity convergent validity of the SAQ Total and PHQ-9 (depression) (r = .35)
  • Poor  concurrent  validity convergent validity of the SAQ Total and FKS (body dysmorphic disorder) (r = .33)
  • Poor  concurrent  validity convergent validity of the SAQ Total and WHO-5 (well-being) (r = -.38)
  • Poor  concurrent  validity convergent validity of the SAQ Total and PTQ (negative thinking) (r = .16)
  • Poor  concurrent  validity convergent validity of the SAQ Total and BFI-S (neuroticism) (r = .21)
  • Poor  concurrent  validity convergent validity of the SAQ Expectations and PANAS (mood) (r = .24)
  • Poor  concurrent  validity convergent validity of the SAQ Expectations and PHQ-9 (depression) (r = .30)
  • Adequate  concurrent  validity convergent validity of the SAQ Expectations and FKS (body dysmorphic disorder)(r = .32)
  • Poor  concurrent  validity convergent validity of the SAQ Expectations and WHO-5(well-being)(r = -.24)
  • Poor concurrent  validity convergent validity of the SAQ Expectations and PTQ (negative thinking(r = .21)
  • Poor  concurrent  validity convergent validity of the SAQ Expectations and BFI-S (neuroticism)(r = .20)
  • Poor  concurrent  validity convergent validity of the SAQ Appearance and PANAS (mood) (r = .27)
  • Adequate  concurrent  validity convergent validity of the SAQ Appearance and PHQ-9 (depression) (r = .31)
  • Poor  concurrent  validity convergent validity of the SAQ Appearance and FKS (body dysmorphic disorder)(r = .26)
  • Adequate  concurrent  validity convergent validity of the SAQ Appearance and WHO-5(well-being)(r = -.38)
  • Poor  concurrent  validity convergent validity of the SAQ Appearance and PTQ (negative thinking(r = .08)

Poor  concurrent  validity convergent validity of the SAQ Appearance and BFI-S (neuroticism)(r = .16)

Construct Validity

Convergent validity:

Idiopathic scoliosis: (Misterska et al 2014)

Correlation between SAQ-pl parent-patient differences and patient characteristics

SAQ-pl parent-patient differences

General

Curve

Prominence

Trunk shift

Waist

Shoulders

Kyphosis

Chest

Total score

Weight

rs = ?0.26

rs = 0.01

rs = 0.11

rs = ?0.13

rs = 0.04

rs = 0.06

rs = ?0.08

rs = ?0.06

rs = 0.02

Height

rs = ?0.51*

rs = 0.15

rs = 0.20

rs = 0.02

rs = 0.11

rs = 0.08

rs = ?0.08

rs = ?0.07

rs = 0.06

Body mass index

rs = ?0.04

rs = ?0.09

rs = 0.05

rs = ?0.21

rs = ?0.12

rs = ?0.04

rs = ?0.02

rs = ?0.09

rs = ?0.09

Age

rs = ?0.34*

rs = 0.22

rs = 0.13

rs = ?0.04

rs = 0.07

rs = 0.10

rs = 0.26

rs = ?0.10

rs = 0.09

Cobb angle

rs = ?0.02

rs = 0.07

rs = ?0.02

rs = 0.04

rs = 0.11

rs = 0.09

rs = 0.07

rs = 0.13

rs = 0.11

Angle of trunk rotation

rs = ?0.26

rs = ?0.37*

rs = ?0.06

rs = ?0.04

rs = ?0.15

rs = 0.09

rs = ?0.17

rs = 0.07

rs = ?0.19

Apical translation

rs = ?0.06

rs = 0.24

rs = 0.17

rs = ?0.12

rs = 0.10

rs = 0.11

rs = 0.09

rs = 0.09

rs = 0.18

Brace (hours/day)

rs = 0.36*

rs = ?0.01

rs = ?0.18

rs = 0.21

rs = 0.19

rs = ?0.12

rs = ?0.03

rs = 0.24

rs = 0.18

Brace (in months)

rs = 0.03

rs = ?0.07

rs = ?0.04

rs = ?0.22

rs = 0.13

rs = 0.02

rs = ?0.16

rs = 0.10

rs = 0.05

* p < 0.05; SAQ-pl-Polish version of the SAQ

 

Idiopathic scoliosis: (Thielsch et al, 2018)

  • Adequate convergent validity of the SAQ Total and Scoliosis Research Society (SRS) 22-r overall mean (r = -0.53)
  • Excellent convergent validity of the SAQ Total and SRS 22-r self image (r = -0.60)
  • Excellent convergent validity of the SAQ Total and overall stress (r = 0.60)
  • Adequate  convergent validity of the SAQ Appearance and SRS 22-r self image (r = -0.53)

Adequate convergent validity of the SAQ Appearance and overall stress (r = 0.51)

  • Adequate convergent validity of the SAQ Expectations and overall stress (r = 0.52)
  • Adequate convergent validity of the SAQ Appearance and Cobb angle (r = 0.55)

Idiopathic scoliosis: (Lee et al., 2017)

  • Adequate convergent validity of the K-SAQ scores and individual domain scores and K-SRS-22 appearance domain scores (r = - 451)

Idiopathic scoliosis: (Xianzhao et al., 2012)

  • Poor to Adequate convergent validity of the correlations between the SC-SAQ domains and the SC-SRS-22 appearance domain (ρ= ? 0.150 to ? 0.385)
  • Adequate convergent validity between the overall SC-SAQ and the SC-SRS-22 appearance domain (ρ= ? 0.401)

 

Idiopathic scoliosis: (Guo et al 2016, n= 112,  mean age 17.3 (3.1) years; traditional Chinese version)

Correlations between TC-SAQ domain scores and E-SAQ domain scores

Domain (no. of questions)

Pearson correlation coefficient

General (3)

0.954*

Curve (1)

0.892*

Prominence (2)

0.934*

Trunk shift (2)

0.918*

Waist (3)

0.932*

Shoulders (2)

0.820*

Kyphosis (1)

0.891*

Chest (2)

0.938*

Correlations between TC-SAQ domain scores and TC-SRS-22 self-image domain scores

 

TC-SRS-22 self-image

P

General (3)

0.412

<0.0001

Curve (1)

0.403

<0.0001

Prominence (2)

0.315

0.001

Trunk shift (2)

0.443

<0.0001

Waist (3)

0.155

0.121

Shoulders (2)

0.231

0.020

Kyphosis (1)

0.243

0.014

Chest (2)

0.178

0.075

 

 

Discriminant validity:

Idiopathic Scoliosis: (Lee et al., 2017)

  • Excellent discriminant validity of the K-SAQ total score was signi?cantly correlated with major curve magnitude (r=0.812)
  • Adequate discriminant validity with the K-SRS-22 appearance domain with a moderate correlation (r =?0.441)

Discriminant validity

Idiopathic Scoliosis: (Xianzhao et al., 2012)

  • Excellent discriminant validity of the SC-SAQ total score to the major curve magnitude(r = 0.827)
  • Adequate discriminant validity of the SC-SRS-22 appearance domain (r= ? 0.442)

Idiopathic scoliosis: (Matamalas et al 2014, n=80, ages 10-40 years old, Spanish version)

 

< 18 years old

≥ 18 years old

Overall sample

n

42

38

80

Mean age (years) (SD)

13.9 (1.9)

27.3 (7.4)

20.3 (8.6)

MLC (SD) (largest Cobb angle)

42.8° (13.0)

49° * (11.7)

21.2° (13)

Gender (% female)

85.7%

84.2%

85%

Appearance SAQ

Relation with Cobb angle (Pearson’s r)

.6

.55

.61

Expectation SAQ

Relation with Cobb angle (Pearson’s r)

.26**

.23**

.24

*Indicates significant between-groups mean differences in t-Student test.

**Indicates no significant correlation coefficient.

 

TAPS

QLPSDbi

Self-image SRS-22

SAQ expect

Function SRS22

Pain SRS22

Mental health SRS22

SAQ.App

-.80**

.60**

-.67**

.42**

-.6**

-.49**

-.43**

SAQ.expect

-.36**

 .61**

 -.55**

  

-.29**

-.24*

-.20

 

Floor/Ceiling Effects

Idiopathic scoliosis: (Misterska et al 2014)

  • Moderate floor effect was observed in 5 domains: Trunk shift (9.80 %), Waist (9.80 %), Shoulders (14.60 %), Kyphosis (29.30 %) and Chest (31.70 %) of SAQ-pl parent form.
  • Moderate ceiling effect was observed in the following two domains of the SAQ-pl parent form: Waist (19.50 %) and Chest (29.30 %).

Idiopathic Scoliosis: (Lee et al., 2017)

  • Significant ceiling effect of waist (17.9%) and chest (18.8%) domains found and significant floor effects of the kyphosis domain (15.2%).

Idiopathic Scoliosis:

(Xianzhao et al., 2012)

  • Significant ceiling effect on waist (19.5%) and chest (20.5%) domains and significant floor effects of curve (15.3%) and kyphosis (16.7%).

Idiopathic scoliosis: (Guo et al 2016, n= 112,  mean age 17.3 (3.1) years; traditional Chinese version)

No significant floor effect was found except for the prominence (15.2 %) and kyphosis (22.3 %) domains. Meanwhile, a significant ceiling effect was found in the waist (26.8 %) and chest (33.0 %) domains.

Responsiveness

Large effect sizes were noted and reported among the groups to result in the SAQ being statistically significant to rate an individual’s perception of their scoliosis

The SAQ demonstrates excellent responsiveness to surgical curve correction. Large effect size and standardized response mean were determined for all domains except for patient chest domain (>0.8) (Sanders et al., 2007).

Pediatric Disorders

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Normative Data

Adolescent idiopathic Scoliosis

(Carreon et al 2017, n=1802; mean age 14.8+/-2.1; mean initial Cobb angle of 55.8?+/- 13.7?; 83% female)

*Lenke Type

N

SAQ Appearance

SAQ Expectations

SAQ Total

Lenke 1

785

25.01±6.46

15.62±4.68

40.47±9.26

Lenke 2

343

25.50±6.83

15.91±4.88

41.22±10.01

Lenke 3

134

25.94±6.31

15.59±4.73

43.32±8.67

Lenke 4

68

28.16±7.24

15.16±7.24

43.32±8.67

Lenke 5

238

22.25±5.82

15.95±4.74

38.07±8.73

Lenke 6

107

24.64±5.96

15.81±4.57

40.30±9.15

*Lenke type refers to the different categories to classify spinal curvature

 

Adolescent idiopathic Scoliosis

(Misterska et al 2014, n=41 females, minimum duration of Cheneau brace application of at least 12 h a day, a Cobb angle of 20–40°, 10–17 years of age, patients and parents used assessment)

Distribution of results of SAQ-pl parents form and SAQ-pl patients form

SAQ-pl subscales

Mean

95 % CI

Min.

Max.

SD

Mean

95 % CI

Min.

Max.

SD

p value

From

To

From

To

Patients

Parents

General

3.5

3.3

3.8

1.3

5.0

0.8

3.5

3.3

3.8

1.0

4.7

0.7

0.846

Curve

2.4

2.2

2.6

1.0

4.0

0.7

2.3

2.1

2.5

1.0

4.0

0.6

0.142

Prominence

1.7

1.6

1.9

1.0

2.5

0.4

1.9

1.7

2.0

1.0

3.0

0.5

0.059

Trunk shift

1.9

1.7

2.0

1.0

3.0

0.5

1.9

1.7

2.1

1.0

3.5

0.5

0.510

Waist

3.4

3.0

3.8

1.0

5.0

1.3

3.3

2.8

3.7

1.0

5.0

1.4

0.326

Shoulders

2.8

2.5

3.2

1.0

5.5

1.0

2.8

2.4

3.1

1.0

4.0

1.0

0.673

Kyphosis

1.9

1.6

2.1

1.0

3.0

0.7

1.9

1.6

2.1

1.0

3.0

0.7

1.000

Chest

2.6

2.2

3.1

1.0

5.0

1.5

2.9

2.2

3.3

1.0

5.0

1.7

0.581

Total score

2.7

2.5

2.9

1.3

3.8

0.6

2.7

2.5

2.9

1.0

3.9

0.6

0.343

 

 

Adolescent idiopathic Scoliosis

(Roy-Beaudry et al 2011, n=182, mean age=15 years old, mean maximum Cobb angle =27 degree, French-Canadian version)

 

Questionnaire/Domain (No. Questions)

Domain Means (SD)

% With Floor Effect

% With Ceiling Effect

SAQ-fv patient (1=best; n=182)

General (3)

2.5 (1.1)

1.1

10.4

Curve (1)

2.0 (0.9)

1.7

19.8

Prominence (2)

1.8 (0.7)

0.0

30.2

Trunk Shift (2)

1.8 (0.8)

0.6

24.7

Waist (3)

2.5 (1.5)

14.8

29.1

Shoulders (2)

2.3 (1.1)

0.6

26.4

Kyphosis (1)

1.8 (0.9)

0.6

47.8

Chest (2)

2.3 (1.5)

15.4

42.9

SAQ-fv parent (1=best; n=170)

General (3)

2.7 (1.0)

0.6

10.6

Curve (1)

2.2 (0.9)

2.9

18.2

Prominence (2)

1.8 (0.7)

0.0

28.8

Trunk Shift (2)

2.0 (0.9)

1.2

24.1

Waist (3)

2.9 (1.4)

14.1

24.7

Shoulders (2)

2.5 (1.0)

0.6

20

Kyphosis (1)

1.8 (0.8)

0.6

41.2

Chest (2)

2.5 (1.5)

14.7

36.5

SD indicates standard deviation; SAQ-fv, Spinal Appearance Questionnaire French Version

 

Adolescent idiopathic Scoliosis

(Simony et al 2016, n=51, mean age=16±2 years old, 40.8±28.8 days between baseline and follow-up, Dutch Translation)

 

Descriptive statistics on individual domain scores and total scores.

SAQ domains

Baseline

Follow-up

p-value

Appearance

Mean scores (SD)

20.21 (7.67)

20.26 (7.29)

.557

% Floor

0

0

  

% Ceiling

0

0

  

Expectations

Mean scores (SD)

13.97 (5.06)

13.25 (5.39)

.388

% Floor

5.88

7.84

  

% Ceiling

19.61

17.65

  

Total

Mean scores (SD)

34.18 (10.26)

33.52 (10.55)

.564

% Floor

0

0

  

% Ceiling

0

0


 

Test/Retest Reliability

Adolescent idiopathic Scoliosis

(Carreon et al 2017)

  • Excellent SAQ Appearance test-retest reliability: (ICC = .81)
  • Adequate SAQ Expectations test-retest reliability (ICC = .91)
  • Excellent SAQ total score test-retest reliability (ICC = .89)

 

Adolescent idiopathic Scoliosis

(Misterska et al 2014, n=41 females, minimum duration of Cheneau brace application of at least 12 h a day, a Cobb angle of 20–40°, 10–17 years of age, patients and parents used assessment)

  • ICC= 0.99 (95 % CI 0.988–0.997) for parent form

 

Adolescent idiopathic Scoliosis

(Simony et al 2016, n=51, mean age=16±2 years old, 40.8±28.8 days between baseline and follow-up, Dutch Translation)

  • Excellent SAQ Appearance test-retest reliability: (ICC = .86)
  • Adequate SAQ Expectations test-retest reliability (ICC = .81)
  • Excellent SAQ total score test-retest reliability (ICC = .89)

Internal Consistency

Adolescent idiopathic Scoliosis

(Carreon et al 2017)

  • Excellent: Cronbach’s α was 0.81 for the SAQ Appearance scale,
  • Excellent: Cronbach’s α 0.88 for SAQ Expectations
  • Excellent: Cronbach’s α 0.88 for SAQ total score

 

Adolescent idiopathic Scoliosis

(Misterska et al 2014, n=41 females, minimum duration of Cheneau brace application of at least 12 h a day, a Cobb angle of 20–40°, 10–17 years of age, patients and parents used assessment)

  • Excellent Cronbach’s α?=?0.81-0.83 of parent form

 

Adolescent idiopathic Scoliosis

(Simony et al 2016, n=51, mean age=16±2 years old, 40.8±28.8 days between baseline and follow-up, Dutch Translation)

  • Excellent: Cronbach’s α was 0.93 for the SAQ Appearance scale,
  • Excellent: Cronbach’s α 0.88 for SAQ Expectations
  • Excellent: Cronbach’s α 0.89 for SAQ total score

Construct Validity

Adolescent idiopathic Scoliosis

(Roy-Beaudry et al 2011, n=182, mean age=15 years old, mean maximum Cobb angle =27 degree, French-Canadian version)

  • Comparison of scores between SAQ-fv items and SRS-22fv domains showed somewhat weak to moderate correlations (ρ = 0.35-0.53 P < 0.01) for the Self-Image domain. Consequently, this reflected in the correlation between the total scores of the 2 instruments which was ρ < 0.36 (P < 0.01). The correlations between SAQ and the other SRS domains were very weak: all inferior to ρ < 0.24 (P < 0.05).

 

Adolescent idiopathic Scoliosis

(Simony et al 2016, n=51, mean age=16±2 years old, 40.8±28.8 days between baseline and follow-up, Dutch Translation)

SAQ domains

Scoliosis-22 R domains

Pain

Self-image

Function

Mental health

Satisfaction

Subtotal

Total

Appearance

?0.29 

?0.40

?0.28 

?0.24 

?0.20 

?0.37

?0.36

Expectations

?0.49

?0.60

?0.41

?0.37

?0.41

?0.57

?0.58

Total

?0.46

?0.60

?0.41

?0.36 

?0.35 

?0.56

?0.55

All values are significant at α = .01, unless otherwise noted.

a Significant at the .05 level.

b Not significant.

Adolescent idiopathic Scoliosis

(Roy-Beaudry et al 2011, n=182, mean age=15 years old, mean maximum Cobb angle =27 degree, French-Canadian version)

  • The 7 domains were significantly positively related to Cobb angle (P < 0.001) as for total scores (P < 0.001). For postsurgical patients, Prominence domain (P = 0.015), Shoulders domain (P = 0.029), and Chest domain (P = 0.017) were significantly related to Cobb angle as for total scores (P = 0.037).

Content Validity

Adolescent idiopathic Scoliosis

(Misterska et al 2014, n=41 females, minimum duration of Cheneau brace application of at least 12 h a day, a Cobb angle of 20–40°, 10–17 years of age, patients and parents used assessment)

Correlation between results of SAQ-pl parent and SAQ-pl patient forms

SAQ-pl patient form

Domains

General

Curve

Prominence

Trunk shift

Waist

Shoulders

Kyphosis

Chest

Total score

SAQ-pl parent form

General

rs = 0.52*

rs = 0.26

rs = 0.16

rs = 0.05

rs = 0.40*

rs = 0.30

rs = 0.04

rs = 0.37*

rs = 0.43*

Curve

rs = 0.39*

rs = 0.69*

rs = 0.03

rs = 0.32*

rs = 0.32*

rs = 0.45*

rs = 0.15

rs = 0.13

rs = 0.48*

Prominence

rs = 0.29

rs = 0.09

rs = 0.40*

rs = 0.51*

rs = 0.24

rs = 0.35*

rs = 0.27

rs = 0.18

rs = 0.41*

Trunk shift

rs = 0.36*

rs = 0.33*

rs = 0.01

rs = 0.25

rs = 0.29

rs = 0.35*

rs = 0.26

rs = 0.36*

rs = 0.43*

Waist

rs = 0.56*

rs = 0.06

rs = 0.06

rs = 0.18

rs = 0.58*

rs = 0.19

rs = 0.02

rs = 0.19

rs = 0.42*

Shoulders

rs = 0.51*

rs = 0.13

rs = 0.02

rs = 0.09

rs = 0.48*

rs = 0.50*

rs = 0.17

rs = 0.48*

rs = 0.58*

Kyphosis

rs = 0.35*

rs = 0.39*

rs = 0.07

rs = 0.16

rs = 0.13

rs = 0.13

rs = 0.55*

rs = 0.23

rs = 0.31

Chest

rs = 0.29

rs = 0.15

rs = 0.15

rs = ?0.06

rs = 0.25

rs = 0.34*

rs = 0.13

rs = 0.55*

rs = 0.41*

Total score

rs = 0.62*

rs = 0.25

rs = 0.15

rs = 0.13

rs = 0.56*

rs = 0.43*

rs = 0.17

rs = 0.49*

rs = 0.62*

* p < 0.05; SAQ-pl-Polish version of the SAQ

Floor/Ceiling Effects

Adolescent idiopathic Scoliosis

(Misterska et al 2014, n=41 females, minimum duration of Cheneau brace application of at least 12 h a day, a Cobb angle of 20–40°, 10–17 years of age, patients and parents used assessment)

  • There were no floor or ceiling effects, regarding the total score of SAQ. However, a moderate floor effect was observed in 5 domains: Trunk shift (9.80 %), Waist (9.80 %), Shoulders (14.60 %), Kyphosis (29.30 %) and Chest (31.70 %). Meanwhile, a moderate ceiling effect was observed in the following two domains of the SAQ-pl parent form: Waist (19.50 %) and Chest (29.30 %).

 

Adolescent idiopathic Scoliosis

(Roy-Beaudry et al 2011, n=182, mean age=15 years old, mean maximum Cobb angle =27 degree, French-Canadian version)

  • moderate floor effect was observed in only 2 domains, Waist and Chest. However, high ceiling effect was observed in 2 domains: Kyphosis and Chest; and moderate ceiling effect in 4 domains: Prominence, Trunk shift, Waist, and Shoulders.

 

Adolescent idiopathic Scoliosis

(Simony et al 2016, n=51, mean age=16±2 years old, 40.8±28.8 days between baseline and follow-up, Dutch Translation)

Although there were no floor or ceiling effects for the SAQ Appearance domain, there was a low floor effect and moderate ceiling effect in the Expectations domain. This may be attributed to the larger number of items and responses in the Appearance domain compared to the Expectations domain.

Bibliography

Carreon, L., Sanders, J., Polly, D., Sucato, D., Parent, S., Roy-Beaudry, M., . . . Spinal Deformity Study Group. (2011). Spinal appearance questionnaire: Factor analysis, scoring, reliability, and validity testing. Spine, 36(18), 1240-4. doi:10.1097/BRS.0b013e318204f987

Guo, J., Lau, A. H. Y., Chau, J., Ng, B. K. W., Lee, K. M., Qiu, Y., … Lam, T. P. (2016). A validation study on the traditional Chinese version of Spinal Appearance Questionnaire for adolescent idiopathic scoliosis. European Spine Journal, 25(10), 3186–3193. doi: 10.1007/s00586-016-4590-5

Lee, J., Shin, J., Goh, T., Son, S., & An, S. (2017). Validation of the Korean version of the spinal appearance questionnaire. Journal of Back and Musculoskeletal Rehabilitation, 30(6), 1203-1208. doi:10.3233/BMR-150480

 

Matamalas, A., Bago, J., D'Agata, E., & Pellise, F. (2014). Body image in idiopathic scoliosis: a comparison study of psychometric properties between patient-reported outcome instruments. Health and Quality of Life Outcomes, 12(81), 1-8.

 

Misterska, E., Glowacki, M., Adamczyk, K., & Jankowski, R. (2014). Patients’ and parents’ perceptions of appearance in scoliosis treated with a brace: A cross-sectional analysis. Journal of Child & Family Studies (23), 1163-1171. doi:10.1007/s10826-013-9776-4

Misterska, E., Glowacki, M., & Harasymczuk, J. (2011). Assessment of spinal appearance in female patients with adolescent idiopathic scoliosis treated operatively. Medical Science Monitor, 17(7), CR404-410.

 

Roy-Beaudry, M., Beauséjour, M., Joncas, J., Forcier, M., Bekhiche, S., Labelle, H., … Parent, S. (2011). Validation and Clinical Relevance of a French-Canadian Version of the Spinal Appearance Questionnaire in Adolescent Patients. Spine, 36(9), 746–751. doi: 10.1097/brs.0b013e3181e040e7

 

Sanders, J. O., Harrast, J. J., Kuklo, T. R., Polly, D. W., Bridwell, K. H., Diab, M., et al. (2007). The Spinal Appearance Questionnaire: Results of reliability, validity, and responsiveness in patients with idiopathic scoliosis. Spine , 32 (24), 2719-2722.

 

Simony, A., Carreon, L. Y., Hansen, K. H., & Andersen, M. O. (2016). Reliability and Validity Testing of a Danish Translated Version of Spinal Appearance Questionnaire (SAQ) v 1.1. Spine Deformity, 4(2), 94–97. doi: 10.1016/j.jspd.2015.08.007

 

Thielsch, M. T., Wetterkamp, M., Boertz, P., Goesheger, G., & Schulte, T. L. (2018). Reliability and validity of the Spinal Appearance Questionnaire (SAQ) and the Trunk Appearance Perception Scale (TAPS). Journal of Orthopaedic Surgery and Research, 13 (274), 1-9.

 

Xianzhao, W., Xiaodong, Z., Yushu, B., Dajiang, W., Jiayu, C., Chuanfeng, W., . . . Ming, L. (2012). Development of the simplified chinese version of the spinal appearance questionnaire. Spine (03622436), 37(17).

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