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Shorter and sweeter: the 16-item version of the SRS questionnaire shows better structural validity than the 20-item version in young patients with spinal deformity

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A Correction to this article was published on 17 May 2022

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Abstract

Purpose

In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger (< 20y) patients, for whom the questionnaire was originally designed, is not currently known.

Methods

Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit.

Results

Compared with the 20-item version, the 16-item solution significantly increased the fit (p < 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French.

Conclusion

In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.

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Notes

  1. The official Spanish and Italian versions contained the SRS-22R formulation of item 18, while that of SRS-22 was used in all other languages. http://www.srs.org/professionals/online-education-and-resources/patient-outcome-questionnaires.

References

  1. Jain A, Sponseller PD, Negrini S, Newton PO, Cahill PJ, Bastrom TP, Marks MC, Harms Study G (2015) SRS-7: a valid, responsive, linear, and unidimensional functional outcome measure for operatively treated patients with AIS. Spine (Phila Pa 1976) 40:650–655. https://doi.org/10.1097/BRS.0000000000000836

    Article  Google Scholar 

  2. Caronni A, Zaina F, Negrini S (2014) Improving the measurement of health-related quality of life in adolescent with idiopathic scoliosis: the SRS-7, a Rasch-developed short form of the SRS-22 questionnaire. Res Dev Disabil 35:784–799

    Article  Google Scholar 

  3. Rothenfluh DA, Neubauer G, Klasen J, Min K (2012) Analysis of internal construct validity of the SRS-24 questionnaire. Eur Spine J 21:1590–1595. https://doi.org/10.1007/s00586-012-2169-3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jain A, Lafage V, Kelly MP, Hassanzadeh H, Neuman BJ, Sciubba DM, Bess S, Shaffrey CI, Ames CP, Scheer JK, Burton D, Gupta MC, Hart R, Hostin RA, Kebaish KM, International Spine Study G (2016) Validity, reliability, and responsiveness of SRS-7 as an outcomes assessment instrument for operatively treated patients with adult spinal deformity. Spine (Phila Pa 1976) 41:1463–1468. https://doi.org/10.1097/BRS.0000000000001540

    Article  Google Scholar 

  5. Monticone M, Baiardi P, Calabro D, Calabro F, Foti C (2010) Development of the italian version of the revised scoliosis research society-22 patient Questionnaire, SRS-22r-I. Spine 35:1412–1417

    Article  Google Scholar 

  6. Mannion AF, Elfering A, Bago J, Pellise F, Vila-Casademunt A, Richner-Wunderlin S, Domingo-Sabat M, Obeid I, Acaroglu E, Alanay A, Perez-Grueso FS, Baldus CR, Carreon LY, Bridwell KH, Glassman SD, Kleinstuck F, European Spine Study G (2018) Factor analysis of the SRS-22 outcome assessment instrument in patients with adult spinal deformity. Eur Spine J 27:685–699. https://doi.org/10.1007/s00586-017-5279-0

    Article  CAS  PubMed  Google Scholar 

  7. Bago J, Climent JM, Ey A, Perez-Grueso FJ, Izquierdo E (2004) The spanish version of the SRS-22 patient questionnaire for idiopathic scoliosis: transcultural adaptation and reliability analysis. Spine (Phila Pa 1976) 29:1676–1680

    Article  Google Scholar 

  8. Climent JM, Bago J, Ey A, Perez-Grueso FJ, Izquierdo E (2005) Validity of the spanish version of the scoliosis research society-22 (SRS-22) patient questionnaire. Spine (Phila Pa 1976) 30:705–709

    Article  Google Scholar 

  9. Asher MA, Min Lai S, Burton DC (2000) Further development and validation of the scoliosis research society (SRS) outcomes instrument. Spine (Phila Pa 1976) 25:2381–2386

    Article  CAS  Google Scholar 

  10. Asher MA, Lai SM, Glattes RC, Burton DC, Alanay A, Bago J (2006) Refinement of the SRS-22 health-related quality of life questionnaire function domain. Spine (Phila Pa 1976) 31:593–597. https://doi.org/10.1097/01.brs.0000201331.50597

    Article  Google Scholar 

  11. Beauséjour M, Joncas J, Goulet L, Roy-Beaudry M, Parent S, Grimard G, Forcier M, Lauriault S, Labelle H (2009) Reliability and validity of adapted french canadian version of scoliosis research society outcomes questionnaire (SRS-22) in Quebec. Spine 34:623–628

    Article  Google Scholar 

  12. Niemeyer T, Schubert C, Halm HF, Herberts T, Leichtle C, Gesicki M (2009) Validity and reliability of an adapted german version of scoliosis research society-22 questionnaire. Spine (Phila Pa 1976) 34:818–821. https://doi.org/10.1097/BRS.0b013e31819b33be

    Article  Google Scholar 

  13. Monticone M, Nava C, Leggero V, Rocca B, Salvaderi S, Ferrante S, Ambrosini E (2015) Measurement properties of translated versions of the scoliosis research society-22 patient questionnaire, SRS-22: a systematic review. Qual Life Res 24:1981–1998. https://doi.org/10.1007/s11136-015-0935-5

    Article  PubMed  Google Scholar 

  14. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22

    Article  Google Scholar 

  15. Knekta E, Runyon C, Eddy S (2019) One size doesn’t fit all: using factor analysis to gather validity evidence when using surveys in your research. CBE Life Sci Educ 18:rm1. https://doi.org/10.1187/cbe.18-04-0064

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schermelleh-Engel K, Moosbrugger H, Müller H (2003) Evaluating the fit of structural equation models: test of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online 8:23–74

    Google Scholar 

  17. Alanay A, Cil A, Berk H, Acaroglu E, Yazici M, Akcali O, Kosay C, Genc Y, Surat A (2005) Reliability and validity of adapted turkish version of scoliosis research society-22 (SRS-22) questionnaire. Spine 30:2464–2468

    Article  Google Scholar 

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Acknowledgements

We would like to thank Daniel Larrieu for his assistance with the data collection from the French site. We are grateful to the contributors to the German Spine Registry, the British Spine Registry, and the European Spine Study group for sharing their data with us.

Funding

No funding was received for this particular work, but the European Spine Study Group receives funding support from DePuy Synthes and Medtronic. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland

    A. F. Mannion, L. Zimmermann & S. Richner-Wunderlin

  2. Institute of Psychology, University of Bern, Bern, Switzerland

    A. Elfering

  3. Spine Centre, Schulthess Klinik, Zürich, Switzerland

    T. F. Fekete & F. S. Kleinstück

  4. North Bristol NHS Trust, Bristol, UK

    I. J. Harding

  5. Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

    M. Monticone

  6. Dept. of Orthopaedics and Orthopaedic Surgery, Greifswald, University Hospital, Ferdinand-Sauerbruch-Strasse, Greifswald, 17475, Germany

    P. Obid

  7. Spine and Scoliosis Center, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany

    T. Niemeyer

  8. Department Spine Surgery, St Franziskus Hospital, Münster, Germany

    U. Liljenqvist

  9. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

    A. Boss

  10. Spine Research Unit, Vall d’Hebron Institute of Research, Barcelona, Spain

    A. Vila-Casademunt & J. Bagó

  11. Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain

    F. J. Sánchez Pérez-Grueso & J. Pizones

  12. Spine Unit, Hospital Vall d’Hebron, Barcelona, Spain

    F. Pellisé

  13. Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France

    I. Obeid & L. Boissiere

  14. Dept. Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    A. Alanay

Authors
  1. A. F. Mannion
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  2. A. Elfering
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  3. T. F. Fekete
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  4. I. J. Harding
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  5. M. Monticone
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  6. P. Obid
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  7. T. Niemeyer
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  8. U. Liljenqvist
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  9. A. Boss
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  10. L. Zimmermann
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  11. A. Vila-Casademunt
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  12. F. J. Sánchez Pérez-Grueso
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  14. F. Pellisé
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  15. S. Richner-Wunderlin
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  16. F. S. Kleinstück
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  17. I. Obeid
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  18. L. Boissiere
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  19. A. Alanay
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  20. J. Bagó
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Contributions

AFM and AE contributed substantially to the conception/design of the work; analysis and interpretation of the data; and drafting of the manuscript. JB contributed substantially to the conception/design of the work; acquisition and interpretation of the data; and revising of the manuscript for important intellectual content. TFF, IJH, MM, PO, TN, UL, AB, LZ, AVC, FSP, JP, FP, SR, FK, IO, LB, and AA contributed to the acquisition of data for the work; and revising of the work critically for important intellectual content. All the authors give their final approval of the version to be published and agree to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to A. F. Mannion.

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Conflict of interest

Anne F. Mannion None. Achim Elfering None. Tamas F. Fekete Speaking and Teaching: Depuy Synthes Spine. Ian J. Harding Speaking/teaching: Medtronic Royalties: Medtronic. Mario Monticone None. Peter Obid None. Thomas Niemeyer None. Alba Vila-Casademunt None. Francisco J. Sánchez-Grueso None. Javier Pizones Grants: Depuy Synthes, Medtronic. Consultancy: Medtronic. Ferran Pellisé Grants: Depuy Synthes, Medtronic, Stryker. Consultancy: Stryker, Medtronic. Sarah Richner-Wunderlin None. Laura Zimmermann None. Frank Kleinstück Grants: Depuy Synthes. Speaking/teaching: Depuy Synthes. Ibrahim Obeid Grants: Depuy Synthes Spine. Consultancy: Depuy Synthes and Medtronic. Royalties: Alphatec, Clariance, Spineart. Louis Boissiere Grants: Depuy Synthes Spine. Consultancy: Neo, Medtronic. Ahmet Alanay Grants: Depuy Synthes. Consultancy: Zimmer Biomet, Globus Medical. Royalties: Zimmer Biomet. Joan Bagó None.

IRB/research ethics committee

Approval was given for the original studies whose data were used for the secondary analyses reported in this paper.

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The original online version of this article was revised: Author affilitiations were assigned incorrectly and have been corrected.

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Mannion, A.F., Elfering, A., Fekete, T.F. et al. Shorter and sweeter: the 16-item version of the SRS questionnaire shows better structural validity than the 20-item version in young patients with spinal deformity. Spine Deform 10, 1055–1062 (2022). https://doi.org/10.1007/s43390-022-00509-5

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