Skip to main content
SpringerLink
Log in

A validation study on the traditional Chinese version of Spinal Appearance Questionnaire for adolescent idiopathic scoliosis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

“Simplified Chinese” version of Spinal Appearance Questionnaire (SC-SAQ) for patients with adolescent idiopathic scoliosis (AIS) was available but did not fit for communities using “Traditional Chinese” as their primary language. We developed a traditional Chinese version of SAQ (TC-SAQ) and evaluated its reliability and validity.

Methods

TC-SAQ was administered to 112 AIS patients, of which 101 bilingual (English and Chinese) patients completed E-SAQ and the traditional Chinese version of Scoliosis Research Society-22 questionnaire (TC-SRS-22). Internal consistency and test–retest reliability were evaluated. Concurrent validity was evaluated by comparing TC-SAQ score with E-SAQ score, and convergent validity by comparing TC-SAQ score with TC-SRS-22 self-image domain score, and discriminant validity by analyzing the relationship between TC-SAQ score and patients’ characteristics.

Results

Internal consistency of individual TC-SAQ domain was high (Cronbach’s α = 0.785 to 0.940), except for general (Cronbach’s α = 0.665) and shoulders (Cronbach’s α = 0.421) domain. Test–retest reliability of TC-SAQ was good (ICCs of each domain from 0.798 to 0.865). Concurrent validity demonstrated an excellent correlation between TC-SAQ and E-SAQ scores (r = 0.820 to 0.954, P < 0.0001 for all domains). Correlation between TC-SAQ domains and TC-SRS-22 self-image domain was weak to moderate. TC-SAQ total score and individual domain scores (except waist and chest domains) were positively correlated to major curve magnitude.

Conclusions

TC-SAQ had good internal consistency and test–retest reliability. Concurrent validity evaluated against the original English version was excellent. TC-SAQ was both reliable and valid for clinical use for AIS patients using traditional Chinese as their primary language.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537

    Article  PubMed  Google Scholar 

  2. Guo J, Liu Z, Lv F, Zhu Z, Qian B, Zhang X, Lin X, Sun X, Qiu Y (2012) Pelvic tilt and trunk inclination: new predictive factors in curve progression during the Milwaukee bracing for adolescent idiopathic scoliosis. Eur Spine J 21:2050–2058. doi:10.1007/s00586-012-2409-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Guo J, Lam TP, Wong MS, Ng BK, Lee KM, Liu KL, Hung LH, Lau AH, Sin SW, Kwok WK, Yu FW, Qiu Y, Cheng JC (2014) A prospective randomized controlled study on the treatment outcome of SpineCor brace versus rigid brace for adolescent idiopathic scoliosis with follow-up according to the SRS standardized criteria. Eur Spine J 23:2650–2657. doi:10.1007/s00586-013-3146-1

    Article  PubMed  Google Scholar 

  4. Smith PL, Donaldson S, Hedden D, Alman B, Howard A, Stephens D, Wright JG (2006) Parents’ and patients’ perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31:2367–2374. doi:10.1097/01.brs.0000240204.98960.dd

  5. Theologis TN, Jefferson RJ, Simpson AH, Turner-Smith AR, Fairbank JC (1993) Quantifying the cosmetic defect of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 18:909–912

  6. Raso VJ, Lou E, Hill DL, Mahood JK, Moreau MJ, Durdle NG (1998) Trunk distortion in adolescent idiopathic scoliosis. J Pediatr Orthop 18:222–226

    CAS  PubMed  Google Scholar 

  7. Sanders JO, Harrast JJ, Kuklo TR, Polly DW, Bridwell KH, Diab M, Dormans JP, Drummond DS, Emans JB, Johnston CE, 2nd, Lenke LG, McCarthy RE, Newton PO, Richards BS, Sucato DJ (2007) The Spinal Appearance Questionnaire: results of reliability, validity, and responsiveness testing in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 32:2719–2722. doi:10.1097/BRS.0b013e31815a5959

  8. Sanders JO, Polly DW, Jr., Cats-Baril W, Jones J, Lenke LG, O’Brien MF, Stephens Richards B, Sucato DJ (2003) Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale. Spine (Phila Pa 1976) 28:2158–2163. doi:10.1097/01.brs.0000084629.97042.0b

  9. Carreon LY, Sanders JO, Polly DW, Sucato DJ, Parent S, Roy-Beaudry M, Hopkins J, McClung A, Bratcher KR, Diamond BE (2011) Spinal appearance questionnaire: factor analysis, scoring, reliability, and validity testing. Spine (Phila Pa 1976) 36:E1240–1244. doi:10.1097/BRS.0b013e318204f987

  10. Mulcahey MJ, Chafetz RS, Santangelo AM, Costello K, Merenda LA, Calhoun C, Samdani AF, Betz RR (2011) Cognitive testing of the spinal appearance questionnaire with typically developing youth and youth with idiopathic scoliosis. J Pediatr Orthop 31:661–667. doi:10.1097/BPO.0b013e318221ea8b

    Article  PubMed  Google Scholar 

  11. Roy-Beaudry M, Beausejour M, Joncas J, Forcier M, Bekhiche S, Labelle H, Grimard G, Parent S (2011) Validation and clinical relevance of a French–Canadian version of the spinal appearance questionnaire in adolescent patients. Spine (Phila Pa 1976) 36:746–751. doi:10.1097/BRS.0b013e3181e040e7

  12. Wei X, Zhu X, Bai Y, Wu D, Chen J, Wang C, Chen Z, Yang C, Li J, Li M (2012) Development of the Simplified Chinese Version of the Spinal Appearance Questionnaire: cross-cultural adaptation and psychometric properties evaluation. Spine (Phila Pa 1976) 37:1497-1504. doi:10.1097/BRS.0b013e3182407e25

  13. Carreon LY, Sanders JO, Diab M, Polly DW, Diamond BE, Sucato DJ (2013) Discriminative properties of the Spinal Appearance Questionnaire compared with the Scoliosis Research Society—22 Revised. Spine Deformity 1:328–338

    Article  Google Scholar 

  14. Wikipedia traditional Chinese characters. Wikipedia. http://en.wikipedia.org/wiki/Traditional_Chinese_characters. Accessed Feb 5 2015

  15. Liu H, Tao H, Luo Z (2009) Validation of the simplified Chinese version of the Oswestry Disability Index. Spine (Phila Pa 1976) 34:1211–1216. doi:10.1097/BRS.0b013e31819e2b34 (discussion 1217)

  16. Li M, Wang CF, Gu SX, He SS, Zhu XD, Zhao YC, Zhang JT (2009) Adapted simplified Chinese (mainland) version of Scoliosis Research Society-22 questionnaire. Spine (Phila Pa 1976) 34:1321–1324. doi:10.1097/BRS.0b013e31819812b7

  17. Cheung KM, Senkoylu A, Alanay A, Genc Y, Lau S, Luk KD (2007) Reliability and concurrent validity of the adapted Chinese version of Scoliosis Research Society-22 (SRS-22) questionnaire. Spine (Phila Pa 1976) 32:1141–1145. doi:10.1097/01.brs.0000261562.48888.e3

  18. Lue YJ, Hsieh CL, Huang MH, Lin GT, Lu YM (2008) Development of a Chinese version of the Oswestry Disability Index version 2.1. Spine (Phila Pa 1976) 33:2354–2360. doi:10.1097/BRS.0b013e31818018d8

  19. Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46:1417–1432

    Article  CAS  PubMed  Google Scholar 

  20. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 25:3186–3191

  21. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42. doi:10.1016/j.jclinepi.2006.03.012

    Article  PubMed  Google Scholar 

  22. Nunnally JC (1978) Psychometric theory, 2nd edn. McGraw-Hill, New York

    Google Scholar 

  23. Lee JS, Lee DH, Suh KT, Kim JI, Lim JM, Goh TS (2011) Validation of the Korean version of the Scoliosis Research Society-22 questionnaire. Eur Spine J 20:1751–1756. doi:10.1007/s00586-011-1872-9

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  CAS  PubMed  Google Scholar 

  25. Haher TR, Gorup JM, Shin TM, Homel P, Merola AA, Grogan DP, Pugh L, Lowe TG, Murray M (1999) Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine (Phila Pa 1976) 24:1435–1440

  26. Howard A, Donaldson S, Hedden D, Stephens D, Alman B, Wright J (2007) Improvement in quality of life following surgery for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 32:2715–2718. doi:10.1097/BRS.0b013e31815a51cd

Download references

Author information

Author notes

    Authors and Affiliations

    1. Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

      Jing Guo & Yong Qiu

    2. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong

      Jing Guo, Ajax Hong Yin Lau, Jack Chau, Bobby Kin Wah Ng, Kwong Man Lee, Jack Chun Yiu Cheng & Tsz Ping Lam

    3. The Joint Scoliosis Research Center of The Chinese University of Hong Kong and Nanjing University, Hong Kong, China

      Jing Guo, Bobby Kin Wah Ng, Kwong Man Lee, Yong Qiu, Jack Chun Yiu Cheng & Tsz Ping Lam

    4. SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

      Bobby Kin Wah Ng, Jack Chun Yiu Cheng & Tsz Ping Lam

    Authors
    1. Jing Guo
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Ajax Hong Yin Lau
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jack Chau
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Bobby Kin Wah Ng
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Kwong Man Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Yong Qiu
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Jack Chun Yiu Cheng
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Tsz Ping Lam
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Tsz Ping Lam.

    Ethics declarations

    Conflict of interest

    None.

    Additional information

    Jing Guo and Ajax Hong Yin Lau contributed equally to this work.

    Electronic supplementary material

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Guo, J., Lau, A.H.Y., Chau, J. et al. A validation study on the traditional Chinese version of Spinal Appearance Questionnaire for adolescent idiopathic scoliosis. Eur Spine J 25, 3186–3193 (2016). https://doi.org/10.1007/s00586-016-4590-5

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00586-016-4590-5

    Keywords

    Search

    Navigation