Demographic Factors Affect Scoliosis Research Society-22 Performance in Healthy Adolescents A Comparative Baseline for Adolescents With Idiopathic Scoliosis

Study Design. Prospective analysis. Objective. The purpose of this study was to: (1) evaluate the influence of variable demographic factors on the Scoliosis Research Society (SRS)-22 performance and (2) evaluate SRS-22 performance in normal adolescents without scoliosis to establish a comparative baseline for adolescent idiopathic scoliosis. Summary of Background Data. The SRS-22 instrument has been used widely to evaluate patients with scoliosis but no study has characterized how variable patient demographics in normal, unaffected individuals may influence SRS-22 scores. Methods. Healthy adolescents at a high school clinic and at referring pediatricians' private offices were asked to anonymously complete the SRS-22 instrument: 22 questions scaled 1-5 (highest). Additional questions assessed household income, race (white, Hispanic, African-American, other), gender, household status (single vs. dual parent), and body mass index. ANOVA and multivariate regression analyses were used to identify statistically significant factors (P < 0.05). Results. Four hundred fifty unaffected adolescents completed the SRS-22 (62% female, 38% male; mean age 16 (range, 9.3-21.8), mean body mass index 22.8 (range, 13.5-47.5). Mean SRS-22 performance was 4.1 +/- 0.5 (Activity: 4.0 +/- 0.6; Pain: 4.3 +/- 0.6; Image: 4.2 +/- 0.6; Mental: 3.8 +/- 0.8, Mean: 4.1 +/- 0.5). Whites scored higher in the activity domain than Hispanic and other ethnicities, while African Americans scored higher in the pain domain than Hispanics (P < 0.05 for both). From the lowest income range to 125,000 dollars/yr, household income had a positive effect on the activity, image and mean SRS-22 score (P < 0.05 for all). Males scored higher than females in the mental health domain and mean SRS-22 (P < 0.0001). Dual parent versus single parent households had higher activity and mean SRS-22 scores (P < 0.005). Conclusion. We report that male gender, dual parent household, white race and increased household income were predictive of higher SRS-22 scores in healthy adolescents without scoliosis. The impact of these factors represents a meaningful clinical difference in SRS-22 performance.