Patient and Parent’s Knowledge, Emotion and Expectation Evaluation in Conservatively Treated Adolescent Idiopathic Scoliosis: A Prospective Randomized Study in 200 Children by a Simple Questionnaire

Volume 3 | Issue 2 | October 2022-March 2023 | page: 96-108 | Hitesh N. Modi, Seung-Woo Suh, Jae-Young Hong, Jae-Hyuk Yang


Authors: Hitesh N. Modi [1, 2], Seung-Woo Suh [1], Jae-Young Hong [1], Jae-Hyuk Yang [1]


[1] Scoliosis Research Institute, Department of Orthopaedics, Korea University Guro Hospital, Seoul, South Korea.
[2] Department of Orthopaedics, Zydus Hospital and Healthcare Research Pvt Ltd, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr Seung-Woo Suh,
Scoliosis Research Institute, Department of Orthopaedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul, South Korea.


Objectives: To find out if any disparity of the knowledge regarding the scoliosis, treatment, psychological status and treatment satisfaction between different groups of children based on age, follow-up or treatment modality (bracing or observation) and, between patients and their parents.
Summary of Background Data. There are numerous questionnaires available in scoliosis which specifically measures either operative outcome or bracing outcomes in terms of general appearance, psychological appearance or pain scores. There is no questionnaire available that evaluate the overall general knowledge, their psychological status regarding the treatment, knowledge regarding future such as progression of curve, marriage, pregnancy and health status as well as their expectations and choices from the treatment in conservatively treated AIS patients.
Methods: Study was conducted in 200 children with adolescent idiopathic scoliosis (AIS) with age between 10 and 16 years. All 30 questions were divided into four subgroups to evaluate 1) General knowledge (Q 1-9); 2) Emotional and psychological status (Q 10-16); 3) Treatment knowledge (Q 17-25); and 4) Treatment satisfaction (Q 26-30). Results were evaluated based on treatment modality (bracing or observation); duration of follow-up (less than or more than 12 months), and age (less than or more than 13 years), and also between patients and parents.
Results: General knowledge remains the same (p>0.05) in all subgroups, while treatment knowledge was higher in parents (p<0.0001) and in patients with follow-up more than 12 months (p=0.0009) while age of patients didn’t show any difference (p=0.083). Psychological disturbances were found more in parents (p=0.046), and patients with longer follow-up (p=0.001) and higher age (p=0.002). Similarly, parents (p<0.0001), and patients with follow-up more than 12 months (0.011) and age more than 13 years (p=0.009) had higher treatment dissatisfaction. However, the treatment modality (bracing or observation) didn’t exhibit any difference (p>0.05) in any questionnaire.
Conclusion: We evaluated general and treatment knowledge, psychological and mental status and treatment satisfaction from a single and simple questionnaire in conservatively treated AIS subjects, which would provide useful information to handle the different issues involved with the disease.
Keywords: Adolescent idiopathic scoliosis, Conservative treatment, Questionnaire, Evaluation.


1. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 1984; 66:1061–71.
2. Stagnara P: Les deformations du rachis. Paris,; 1976.
3. Osmond-Clarke H: Scoliosis. In The Milwaukee Brace Edited by: Blount WP and Moe JH. Baltimore, The William and Wilkins Company; 1973.
4. Hall JE: Controversial issues in spinal deformity surgery. J Pediatr Orthop 1997, 17:701-702.
5. Jacob J. Consumer access to health care information: its effect on the physician- patient relationship. Alaska Med 2002; 44:75–82.
6. Uong EC, Jeffe DB, Gozal D, et al. Development of a measure of knowledge and attitudes about obstructive sleep apnea in children (OSAKA-KIDS). Arch Pediatr Adolesc Med 2005; 159:181–6.
7. Wagner J, Lacey K, Chyun D, et al. Development of a questionnaire to measure heart disease risk knowledge in people with diabetes: the Heart Disease Fact Questionnaire. Patient Educ Couns 2005; 58:82–7.
8. Brosnan H. Nursing management of the adolescent with idiopathic scoliosis. Nurs Clin North Am 1991;26:17–31.
9. Roach JW. Nonsurgical treatment. In: Weinstein SL, ed. The Pediatric Spine: Principles and Practice. New York, NY: Raven Press; 1994: chap 23.
10. Weinstein SL, Dolan LA, Spratt KF, et al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003; 289:559–67.
11. Sanders JO, Harrast JJ, Kulo TR et al. The spinal appearance questionnaire. Results of reliability, validity, and responsiveness testing in patients with idiopathic scoliosis. Spine 2007; 32(24):2719-22.
12. Bridwell KH, Shufflebarger HL, Lenke LG, et al. Parents’ and patients’ preferences and concerns in idiopathic adolescent scoliosis: a cross-sectional preoperative analysis. Spine 2000; 25:2392–9.
13. 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 2004; 29:303–10.
14. Smith PL, Donaldson S, Hedden D, et al. Parents’ and patients’ perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine 2006; 31: 2367–74.
15. Climent JM, Reig A, Sanchez J, et al. Construction and validation of a specific quality of life instrument for adolescents with spine deformities. Spine 1995; 20:2006–11.
16. Climent JM, Sanchez J. Impact of the type of brace on the quality of life of adolescents with spine deformities. Spine 1999; 24:1903–8.
17. Weiss HR, Werkmann M, Stephan C. Brace related stress in scoliosis patients- comparison of different concepts of bracing. Scoliosis 2007; 2:10.
18. Lai SM, Asher M, Burton D. Estimating SRS-22 quality of life measures with SF-36. Application in idiopathic scoliosis. Spine 2006; 31(4):473-478.
19. Khetani N, Donaldson S, Wright JG. What do patients and parents know about surgery for adolescent idiopathic scoliosis? A knowledge questionnaire. Spine 2008; 33(20):E754-758.
20. Guyatt G, Bombardier C, Tugwell P. Measuring disease-specific quality of life in clinical trials. Can Med Assoc J. 1986;134:889-895.
21. Patrick D, Deyo R. Generic and disease-specific measures in assessing health status and quality of life. Med Care. 1989;27:S217-S232.
22. Haher T, Gorup J, Shin T, et al. Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. Spine 1999; 24:1435–1440.
23. White S, Asher M, Lai S, et al. Patients’ perceptions of overall function, pain and appearance after primary posterior instrumentation and fusion for idiopathic scoliosis. Spine 1999; 24:1693–1700.
24. Whati LH, Senekal M, Steyn NP, et al. Development of a reliable and valid nutritional knowledge questionnaire for urban South African adolescents. Nutrition 2005;21:76–85.
25. Clayson D, Luz-Alterman S, Cataletto M, Levine DB: Long term psychological sequalae of surgically versus nonsurgically treated scoliosis. Spine 1984, 12(10):983-986.
26. MacLean WE, Green NE, Pierre CB, Ray DC: Stress and Coping with scoliosis, Psychological effects on adolescents and their families. Journal of Paediatric Orthopaedic 1989, 9(3):257-261.
27. Payne WK 3rd, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW: Does scoliosis have a psychological impact and does gender makes a difference? Spine 1997, 22(12):1380-4.
28. Freidel K, Petermann F, Reichel D, Steiner A, Warschburger P, Weiss HR: Quality of Life in Women With Idiopathic Scoliosis. Spine 2002, 27(4):87-91.
29. Ugwonali OF, Lomas G, Choe JC, Hyman JE, Lee FY, Vitale MG, Roye DP Jr: Effect of bracing on the quality of life of adolescents with idiopathic scoliosis. Spine 2004, 4(3):254-60.
30. Weiss HR: How much stress do scoliosis patients have because of their brace? Proceedings of the 3rd. International Conference on Conservative Management of Spinal Deformities & Scientific meeting of the SOSORT, April 7th. – 8th., Poznan, 2006 .
31. Kotwicki T, Kinel E, Stryła W, Szulc A: Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires. Scoliosis 2007, 2:1.
32. Linderman M, Behm K. Cognitive strategies and self esteem as predictors of brace-wear noncomplicance in patients with idiopathic scoliosis and kyphosis. J Pediatr Orthop 1999; 19:493-499.

How to Cite this Article: Modi HN, Suh SW, Hong JY, Yang JH | Patient and Parent’s Knowledge, Emotion and Expectation Evaluation in Conservatively Treated Adolescent Idiopathic Scoliosis: A Prospective Randomized Study in 200 Children by a Simple Questionnaire | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 96-108.

(Abstract Text HTML)      (Download PDF)