Table 2 Studies Evaluating Radiographic/Topographic and Treatment Indicators against Body Image and HRQL Outcomes in Adolecents with Scoliosis

Donaldson et al [5]

40 patients (32 female, mean age 14.5 years). 14 surgically treated. Mean Cobb angle for surgical candidates 63.9°, non surgical candidates 37.4°

Described in findings

3 questions: shame connected to body and appearance in swimsuit, poor shape

Radiographic indicators: Patients were classified according to severity of deformity as evaluated by radiographic indicators of curvature pattern/magnitude, coronal and sagittal measures and angle of trunk inclination. There was no correlation between patient body image and surgical recommendation. Patients not recommended for surgery had a slightly poorer body image than patients recommended for surgery.

Weiss et al [36]

63 patients (59 girls, mean age 13.6 years). Conservatively treated. Mean Cobb angle 43.7°

Treatment type

BSSQ – Brace

Treatment type: Distress associated with brace wear was reduced in the Cheneau light brace compared to previous bulkier brace models.

Kotzicki et al [12]

111 girls (mean age 14.2 years). 51 treated via exercises, 10 awaiting surgery, 50 treated by brace. Mean Cobb angle 42.8°

Curvature magnitude, angle of trunk inclination, treatment type

BSSQ – Brace, BSSQ – Deformity

Curvature magnitude: negative correlation between Cobb angle (r = -.34) and BSSQ-D

Angle of trunk inclination: negative correlation between Bunnell primary curve rotation (r = -.34) and Bunnell sum of rotation (r = -.33) and BSSQ-D

Treatment type: Conservatively treated patients experienced lower stress associated with their deformity (BSSQ-D = 17–18) than presurgical patients (BSSQ-D = 12). Patients treated via brace experienced greater stress associated with brace wear (BSSQ-B = 9) than deformity (BSSQ-D = 18).

Botens- Helmus et al [37]

62 patients (55 girls, mean age 14.5 years). Treated via brace. Mean Cobb angle 40°

Treatment

BSSQ – Brace

Treatment: 23% of patients reported strong stress associated with brace wear (BSSQ-B: 0–8), 50% reported medium stress (BSSQ-B: 9–16), and 23% reported low stress (BSSQ-B: 17–24). The most stressful part of brace wear was concealment of the brace with clothing and hair style, while the least stressful element was avoidance of activities and hobbies due to brace wear.

Weiss et al [13]

206 patients (gender unspecified, mean age was 15.7 years. Treatment not specified. Mean Cobb angle 35.8°

Curvature magnitude/pattern

BSSQ – Deformity

Curve magnitude/pattern: Patients meeting plausibility criteria reported low stress associated with deformity (BSSQ-D = 19.97), while patients who did not meet plausibility criteria reported medium stress (BSSQ-D = 15.9). Negative correlation between Cobb angle and BSSQ-D (r = -0.19 plausible met; r = -0.54 plausible not met). Negative correlations between Cobb angle and BSSQ-D scores were strongest for thoracic curvatures (r = -0.49), and weakest for lumbar curvatures (r = -0.27)

Vasiliadis et al [38]

36 patients (32 female, mean age 13.9 years). Treated via brace. Mean Cobb angle 28.2°

Curvature pattern, magnitude and angle of trunk inclination

BraceQ

Areas of HRQL most affected in patients were physical functioning and vitality, followed by emotional functioning and self esteem/aesthetics.

Curvature pattern/magnitude: negative correlation between lumbar Cobb angle and school activity scale (r = -0.72)

Curvature pattern/angle of trunk inclination: negative correlation between social functioning scale and both lumbar (r = -0.67) and thoracolumbar (r = -0.66) ATI

Vasiliadis et al [39]

28 children (25 female, aged 9 to 18 years). Treated via brace. Mean Cobb angle approx 25°

Curvature magnitude, change in magnitude

BraceQ

Curvature magnitude: Mild scoliosis (curvature less than 30 degrees) was associated with better scores on the BrQ than moderate scoliosis (curvature of 30 to 38 degrees). Reduction in curvature magnitude over time was associated with increases in BrQ scores, while deterioration of curvature was associated with decreases in BrQ scores.

Smith et al [40]

128 patients (111 female, mean age 16.4 years). Surgically treated. Mean Cobb angle 56.1° preoperative, 33° postoperative

Curvature pattern/magnitude, rib prominence, other radiographic measures

Appearance of shoulder blades, shoulders, waist and body image (QLPSD)

Curvature pattern/magnitude: Magnitude of King type 1 curvature (thoracic) and King Type 3 curvature correlated with appearance of shoulder blades (1: r = 0.56; 3: r = 0.49).

Frontal spinal balance: correlated with waist appearance (r = 0.25)

Shift from apex to central sacral line: Type 1 (lumbar) correlated with waist (r = 0.68) and body image (r = 0.67); Type 2 (lumbar) curvatures correlated with appearance of shoulders (r = 0.39), waist (r = 0.40) and body image (r = 0.34); Type 3 correlated with shoulder blade appearance (r = 0.55)

Pelvic balance: correlated with waist appearance (r = 0.31) and body image (r = 0.32)

Climent et al [14]

175 patients with AIS (152 female, mean age 18.9 years). 85 treated via surgery, 45 orthosis, 45 observation. Mean Cobb angle 28°

Curvature pattern, curve magnitude, treatment type

SRS-22

Curve pattern: higher pain for patients with single curvatures

Curve magnitude: negatively correlated with Pain (r = -0.41), Function (r = -0.29), Self Image (r = -0.28), Mental Health (r = -0.33), Satisfaction (r = -0.30) and Total RS Scores (r = -0.43)

Treatment type: surgically treated patients had a better self image and were more satisfied with treatment than patients treated via orthosis (attributable to reduction in curve magnitude)

Asher et al [15]

61 patients with AIS (50 female, mean age 15.5 years) Preoperative. Mean Cobb angle 63°

Curvature pattern, curve magnitude, radiographic and typographic indicators

SRS-22

Curvature pattern: Suzuki Hump Indices 3 and 5 differed according to curvature pattern, although there were no differences in SRS Outcomes for curvature pattern. King Mode Type III and IV are strongly correlated with Function (r = -0.53), Self Image (r = -0.46) and Total SRS scores (r = -0.45)

Curvature magnitude: negatively correlated with Function (r = -0.39)

Typographic indicators: negative correlation between Suzuki Hump Index 1 (rib hump at scapula level) and Function (r = -0.45), Self Image (r = -0.36) and Total SRS score (r = -0.37) There was no relationship between waist crease asymmetry, angle of trunk inclination, or posterior trunk symmetry index measures and SRS-22 outcomes.

Asher et al [16]

168 patients with AIS (145 female, mean age of 14 years). Not surgically treated. Mean Cobb angle of 30° (braced/observation) and 61° (surgical candidates).

Curvature pattern, curve magnitude, angle of trunk inclination (ATI), treatment type

SRS-22

Curve pattern: no relationship between curve pattern and SRS outcomes

Curve magnitude: negatively correlated with Pain (r = -0.37), Self Image (r = -0.50), Function (r = -0.27), Mental Health (r = -0.27) and Total SRS score (r = -0.48).

ATI: negatively correlated with Pain (r = -0.30), Self Image (r = -0.47), and Total SRS score (r = -0.39).

Treatment factors: Patients with curvatures exceeding 40 degrees had poorer self image if surgery was recommended, compared to current conservative management.

Wilson et al [11]

265 patients with AIS (86% female, mean age 14.7 years). Surgically treated. Mean Cobb angle 52.5° preoperative, postoperative not stated

Curvature pattern/magnitude, coronal and sagittal indicators of deformity

SRS-24

Curve pattern/magnitude: Thoracic curvature magnitude and Pain (r = -0.22), General Self Image (r = -0.23) and Function (r = -0.18) and Total SRS (r = -0.22). Upper thoracic curvature and Function (r = -0.19). Lumbar curve and Pain (r = -0.20), General Self Image (r = -0.23) and Total SRS (r = -0.26).

Coronal-axial deformity: Correlates with Pain (r = 0.24), General Self Image (r = 0.24), Function (r = 0.17) and Total SRS (r = 0.26).

Sagittal deformity: No correlation.

Koch et al [7]

42 adolescents (32 female); mean age, 14.5 yr (range, 12–18 yr); postsurgical

Curvature pattern and magnitude Satisfaction with treatment

OFFER Self-image Q Revised; Multidimensional Body Self Relations Questionnaire postsurgery questionnaire

Curvature pattern: Patients with King Type II/III curvatures also had a lower BMI and were lower in menarchal status. They were more likely to report neutrality or dissastifaction with surgical outcomes.

Satisfaction with surgery: Neutrality/dissatisfaction with surgery was related to lower scores on the OFFER Self Image Q prior to surgery, and lower scores on the Body Self Relations Q post surgery (especially low satifaction with mid/upper torso).