Skip to main content

Advertisement

SpringerLink
Log in

Patient-Reported Outcome Instruments in Pediatric Deformity Surgery: A Bibliometric Analysis

  • Systematic Reviews
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Bibliometric analysis.

Objectives

To identify patient-reported outcomes instruments (PROIs) used in pediatric deformity surgery research over the past decade and their frequency and usage trends.

Summary of Background Data

The emphasis on PROIs is increasing along with the demand for evidence-based medicine and cost-effectiveness research. Therefore, investigators and PROI consensus writers should be aware of the PROIs used in pediatric deformity and usage trends.

Methods

Five top orthopedics journals were reviewed from 2004 to 2013 for clinical studies of surgical intervention in pediatric deformity that report PROIs. Publication year, level of evidence (LOE), and PROIs were reported for each article. Mean and range scores for the most frequently used PROIs were analyzed at 2-year follow-up.

Results

A total of 79 studies using PROIs were published in the pediatric deformity literature over the period studied. The researchers identified 21 named PROIs and 6 additional custom questionnaires. The Scoliosis Research Society (SRS)-22 was the most frequently used instrument (32.9%), followed by the SRS-24 (29.1%), Oswestry disability index (17.7%), visual analog scale (12.7%), SRS-30 (10.1%), and Short Form-36 (6.3%). Level of evidence III was most common (39.2%) and 1 LOE I study was identified. Mean preoperative and postoperative SRS instrument scores were 4.0 (95% confidence interval, 3.8-4.1) and 4.5 (95% confidence interval, 4.4-4.6), respectively, in SRS-22r equivalents. No studies met the criteria for mean and range calculation for the other top instruments.

Conclusions

Scoliosis Research Society instruments are used in 74.7% of pediatric deformity studies reporting PROIs. Therefore, there is a consensus that SRS instruments should be used in pediatric deformity outcome studies; yet, consistent use of the most up-to-date version, the SRS-22r, is still needed. General health questionnaires are currently underused in pediatric deformity research. Version reporting and use of the latest versions of PROIs need to be improved in future studies.

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

Similar content being viewed by others

References

  1. Sanders JO, Harrast JJ, Kuklo TR, et al. The Spinal Appearance Questionnaire: results of reliability, validity, and responsiveness testing in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 2007;32:2719–22.

    Article  Google Scholar 

  2. Bago J, Sanchez-Raya J, Perez-Graeso FJ, et al. The Trunk Appearance Perception Scale (TAPS): a new tool to evaluate subjective impression of trunk deformity in patients with idiopathic scoliosis. Scoliosis 2010;5:6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Auerbach JD, Lonner BS, Crerand CE, et al. Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire-Scoliosis version. J Bone Joint Surg Am 2014;96:e61.

    Article  PubMed  Google Scholar 

  4. Oxford Levels of Evidence 1. Oxford: Oxford Centre for Evidence-Based Medicine. Available at: http://www.cebm.net/?o=1025. Accessed June 6, 2014.

  5. Lai SM, Burton DC, Asher MA, et al. Converting SRS-24, SRS-23, and SRS-22 to SRS-22r: establishing conversion equations using regression modeling. Spine (Phila Pa 1976) 2011;36:E1525–33.

    Article  Google Scholar 

  6. Murray MR, Wang T, Schroeder GD, et al. The 100 most cited spine articles. Eur Spine J 2012;21:2059–69.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lefaivre KA, Shadgan B, O’Brien PJ. 100 most cited articles in orthopaedic surgery. Clin Orthop Relat Res 2011;469:1487–97.

    Article  PubMed  Google Scholar 

  8. Hunt KJ, Hurwit D. Use of patient-reported outcome measures in foot and ankle research. J Bone Joint Surg Am 2013;95. el 18(1-9).

    Article  Google Scholar 

  9. Zaidi R, Abbassian A, Cro S, et al. Levels of evidence in foot and ankle surgery literature: progress from 2000 to 2010? J Bone Joint Surg Am 2012;94. el 121–10.

    Article  Google Scholar 

  10. SRS outcomes. Scoliosis Research Society. Available at: http://www.srs.org/professionals/SRS_outcomes/srs-22.pdf. Accessed July 11 2014.

  11. Asher MA, Lai SM, Glattes RC, et al. Refinement of the SRS-22 Health-Related Quality of Life questionnaire Function domain. Spine (Phila Pa 1976) 2006;31:593–7.

    Article  Google Scholar 

  12. Dreyer NA, Tunis SR, Berger M, et al. Why observational studies should be among the tools used in comparative effectiveness research. Health Aff (Millwood) 2010;29:1818–25.

    Article  Google Scholar 

  13. Pearson SD, Bach PB. How Medicare could use comparative effectiveness research in deciding on new coverage and reimbursement. Health Aff (Millwood) 2010;29:1796–804.

    Article  Google Scholar 

  14. McCormick JD, Werner BC, Shimer AL. Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 2013;21:99–107.

    Article  PubMed  Google Scholar 

  15. Kamerlink JR, Quirno M, Auerbach JD, et al. Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases. J Bone Joint Surg Am 2010;92:1097–104.

    Article  PubMed  Google Scholar 

  16. McCormick J, Aebi M, Toby D, et al. Pedicle screw instrumentation and spinal deformities: have we gone too far? Eur Spine J 2013;22(suppl 2):S216–24.

    Article  PubMed  Google Scholar 

  17. Roach JW, Mehlman CT, Sanders JO. Does the outcome of adolescent idiopathic scoliosis surgery justify the rising cost of the procedures? J Pediatr Orthop 2011;31(1 suppl):S77–80.

    Article  PubMed  Google Scholar 

  18. Glattes RC, Burton DC, Lai SM, et al. The reliability and concurrent validity of the Scoliosis Research Society-22r patient questionnaire compared with the Child Health Questionnaire-CF87 patient questionnaire for adolescent spinal deformity. Spine (Phila Pa 1976) 2007;32:1778–84.

    Article  Google Scholar 

  19. Lai SM, Asher M, Burton D. Estimating SRS-22 quality of life measures with SF-36: application in idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:473–8.

    Article  Google Scholar 

  20. Richards BS, Sanders JO. Developing outcome measures for pediatric deformity surgery. Spine (Phila Pa 1976) 2007;32(19 suppl):S73–80.

    Article  Google Scholar 

  21. Tarride JE, Burke N, Bischof M, et al. A review of health utilities across conditions common in paediatric and adult populations. Health Qual Life Outcomes 2010;8:12.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wille N, Badia X, Bonsel G, et al. Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual Life Res 2010;19:875–86.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jalanko T, Rintala R, Puisto V, et al. Hemivertebra resection for congenital scoliosis in young children: comparison of clinical, radiographic, and health-related quality of life outcomes between the anteroposterior and posterolateral approaches. Spine (Phila Pa 1976) 2011;36:41–9.

    Article  Google Scholar 

  24. Rinella A, Lenke L, Peelle M, et al. Comparison of SRS questionnaire results submitted by both parents and patients in the operative treatment of idiopathic scoliosis. Spine (Phila Pa 1976) 2004;29:303–10.

    Article  Google Scholar 

  25. Haher TR, Gorup JM, Shin TM, et al. 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) 1999;24:1435–40.

    Article  CAS  Google Scholar 

  26. Haher TR, Merola A, Zipnick RI, et al. Meta-analysis of surgical outcome in adolescent idiopathic scoliosis: a 35-year English literature review of 11,000 patients. Spine (Phila Pa 1976) 1995;20:1575–84.

    Article  CAS  Google Scholar 

  27. Burton DC, Glattes RC. Measuring outcomes in spinal deformity Neurosurg Clin N Am 2007;18:403–5.

    Article  PubMed  Google Scholar 

  28. Bago J, Perez-Grueso FJ, Les E, et al. Minimal important differences of the SRS-22 Patient Questionnaire following surgical treatment of idiopathic scoliosis. Eur Spine J 2009;18:1898–904.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Carreon LY, Sanders JO, Diab M, et al. The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:2079–83.

    Article  Google Scholar 

  30. Liu S, Schwab F, Smith JS, et al. Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J 2014;14:67–77.

    PubMed  PubMed Central  Google Scholar 

  31. Merola AA, Haher TR, Brkaric M, et al. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine (Phila Pa 1976) 2002;27:2046–51.

    Article  Google Scholar 

  32. Paulus MC, Kalantar SB, Radcliff K. Cost and value of spinal deformity surgery. Spine (Phila Pa 1976) 2014;39:388–93.

    Article  Google Scholar 

  33. Fairbank JC, Couper J, Davies JB, et al. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271–3.

    CAS  PubMed  Google Scholar 

  34. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940–52; discussion 2952.

    Article  CAS  Google Scholar 

  35. Fairbank JC. Use and abuse of Oswestry Disability Index. Spine (Phila Pa 1976) 2007;32:2787–9.

    Article  Google Scholar 

  36. Patient-Reported Outcome and Quality of Life instruments database Ma-pi Research Trust. Available at: http://www.proqolid.org/instraments/oswestry_disability_index_odi#subtabs-4. Accessed July 2014.

  37. Jalanko T, Helenius I, Remes V, et al. Operative treatment of isthmic spondylolisthesis in children: a long-term, retrospective comparative study with matched cohorts. Eur Spine J 2011;20:766–75.

    Article  PubMed  Google Scholar 

  38. Bourassa-Moreau E, Mac-Thiong JM, Joncas J, et al. Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments. Spine J 2013;13:770–4.

    Article  PubMed  Google Scholar 

  39. Helenius I, Remes V, Lamberg T, et al. Long-term health-related quality of life after surgery for adolescent idiopathic scoliosis and spondylolisthesis. J Bone Joint Surg Am 2008;90:1231–9.

    Article  PubMed  Google Scholar 

  40. Bridwell KH, Cats-Baril W, Harrast J, et al. The validity of the SRS-22 instrument in an adult spinal deformity population compared with the Oswestry and SF-12: a study of response distribution, concurrent validity, internal consistency, and reliability. Spine (Phila Pa 1976) 2005;30:455–61.

    Article  Google Scholar 

  41. Copay AG, Glassman SD, Subach BR, et al. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 2008;8:968–74.

    Article  PubMed  Google Scholar 

  42. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 1992;30:473–83.

    Article  PubMed  Google Scholar 

  43. SF-36 health survey update. Quality Metric. Available at: http://www.sf-36.org/tools/sf36.shtml. Accessed June 6, 2014.

  44. Guilfoyle MR, Seeley H, Laing RJ. The Short Form 36 health survey in spine disease-validation against condition-specific measures. Br J Neurosurg 2009;23:401–5.

    Article  PubMed  Google Scholar 

  45. Hayes V, Morris J, Wolfe C, et al. The SF-36 health survey questionnaire: is it suitable for use with older adults? Age Ageing 1995;24:120–5.

    Article  CAS  PubMed  Google Scholar 

  46. SF health surveys. Quality Metric. Available at: http://www.qualitymetric.com/WhatWeDo/SFHealthSurveys/tabid/184/Default. aspx. Accessed July 11, 2014.

  47. Rihn JA, Currier BL, Phillips FM, et al. Defining the value of spine care. J Am Acad Orthop Surg 2013;21:419–26.

    PubMed  Google Scholar 

  48. Bago J, Climent JM, Perez-Grueso FJ, et al. Outcome instruments to assess scoliosis surgery. Eur Spine J 2013;22(suppl 2):S195–202.

    Article  PubMed  Google Scholar 

  49. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002;21:271–92.

    Article  PubMed  Google Scholar 

  50. Szende A, Oppe M, Devlin N. EQ-5D value sets: inventory, comparative review and user guide. Dordrecht: Germany: Springer; 2007.

    Book  Google Scholar 

  51. Canaway AG, Frew EJ. Measuring preference-based quality of life in children aged 6-7 years: a comparison of the performance of the CHU-9D and EQ-5D-Y-the WAVES pilot study. Qual Life Res 2013;22:173–83.

    Article  PubMed  Google Scholar 

  52. Ratcliffe J, Flynn T, Terlich F, et al. Developing adolescent-specific health state values for economic evaluation: an application of profile case best-worst scaling to the Child Health Utility 9D. Pharmacoe-conomics 2012;30:713–27.

    Article  Google Scholar 

  53. Sponseller PD, Yazici M, Demetracopoulos C, et al. Evidence basis for management of spine and chest wall deformities in children. Spine (Phila Pa 1976) 2007;32(19 suppl):S81–90.

    Article  Google Scholar 

  54. Stevens K. Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qual Life Res 2009;18:1105–13.

    Article  PubMed  Google Scholar 

  55. Stevens K. Valuation of the Child Health Utility 9D Index. Pharma-coeconomics 2012;30:729–47.

    Article  Google Scholar 

  56. Stevens KJ. Working with children to develop dimensions for a preference-based, generic, pediatric, health-related quality-of-life measure. Qual Health Res 2010;20:340–51.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Holt S. Cutler BSE, Javier Z. Guzman BS, James Connolly BA, Motasem Al Maaieh MD, Abigail K. Allen MD & Samuel K. Cho MD

Authors
  1. Holt S. Cutler BSE
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Z. Guzman BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Connolly BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Motasem Al Maaieh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abigail K. Allen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samuel K. Cho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel K. Cho MD.

Additional information

Author disclosures: HSC (none); JZG (none); JC (none); MAM (none); AKA (none); SKC (none).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cutler, H.S., Guzman, J.Z., Connolly, J. et al. Patient-Reported Outcome Instruments in Pediatric Deformity Surgery: A Bibliometric Analysis. Spine Deform 3, 136–143 (2015). https://doi.org/10.1016/j.jspd.2014.08.009

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2014.08.009

Keywords

Search

Navigation