Parental Adherence to Cranial Remolding Orthotic Treatment of Infants with Positional Cranial Deformities: A Qualitative Content Analysis.

Background: This qualitative study was designed to investigate parental adherence to cranial remolding orthotic (CRO) treatment of infants with positional cranial deformities. Methods: A qualitative content analysis was employed in this study. Researchers sought to find parental behavior while using a CRO for their infant with cranial deformity. Through in-depth and in-person interviews, researchers collected data from 22 participants using semi-structured questions regarding adherence to CRO treatment. Data were examined for patterns until saturation occurred, yielding categories that focused on the parents' main barriers and facilitators. Results: Two general themes of "potential barriers to CRO treatment adherence" and "potential facilitators to CRO treatment adherence" were extracted from 12 subthemes of parental burden, transportation, availability of CRO services in hometown, financial responsibility, maternal/paternal attachment attitudes, CRO-related problems, others feedback, adjustment to the treatment, motivation and self-confidence, aesthetic satisfaction, communication with orthotist, and wife's empathy/spousal support. Conclusion: Getting time off work, transportation to the orthotics' clinic, the lack of medical insurance coverage for CRO, reduced physical contact between parents and their child, and getting negative feedback from others were the most reported challenges. However, overcoming the initial difficulties and adjustment to the treatment with CRO, the high motivation of parents during therapy, an orthosis with good fitting and minor complications, a strong relationship between the parents and orthotist, and the father's companionship were revealed to facilitate the treatment process and increase adherence of treatment with CRO.

Assessment of reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire in adolescents with idiopathic scoliosis.

PURPOSE: This study investigates the reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire (P-SAQ). METHODS: The stages of cross-cultural adaptation were conducted according to an internationally accepted guidelines. Reliability of the P-SAQ was measured by evaluating internal consistency and test-retest reproducibility using Cronbach's α and intraclass correlation coefficient (ICC). Validity of the P-SAQ was assessed by factor analysis, and convergent and known-groups validities. Convergent validity was assessed through participant response on the P-SAQ and the revised 22-item Persian version of the Scoliosis Research Society (SRS-22r) questionnaire. Known-groups validity was assessed by comparing the P-SAQ scores according to the patients curve magnitude and treatment type. RESULTS: A total of 106 patients with a diagnosis of adolescent idiopathic scoliosis (AIS) were included. The P-SAQ demonstrated an acceptable internal consistency with a Cronbach's α of 0.77 (range 0.65-0.72). The test-retest reliability was excellent (range ICC 0.85-0.98). There was a correlation between the total score, average scores of the general, curve, rib prominence, kyphosis, and trunk shift subscales of the P-SAQ and subtotal and total scores of the SRS-22r, r = - 0.2 to - 0.4, p < 0.05. The P-SAQ discriminated between patients with differing Cobb angle magnitudes and treatment types (p < 0.01). Factor analysis supported the use of the appearance and expectations items as separate scales for the P-SAQ. CONCLUSION: The P-SAQ is a valid and reliable tool that could be utilized to evaluate the perception of appearance for Persian-speaking AIS patients with different curve magnitude and treatment strategies. LEVEL OF EVIDENCE: Level I- diagnostic studies.

The Italian Spine Youth Quality of Life questionnaire: reliability and validity of the Persian version in adolescents with spinal deformities.

PURPOSE: To assess the reliability and validity of the Persian version of the Italian Spine Youth Quality of Life (P-ISYQOL) questionnaire. METHODS: Forward/backward translations and cultural adaption processes of the ISYQOL questionnaire into Persian were conducted by an expert committee. We recruited 178 adolescents with idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) and 103 age-matched adolescents with no spinal deformity. Reliability was assessed by evaluating internal consistency and test-retest reliability using Cronbach's alpha and intraclass correlation coefficient (ICC). Convergent construct validity was assessed by measuring the association between the ISYQOL and revised 22-item Scoliosis Research Society (SRS-22r) questionnaires scores. Known-groups construct validity was assessed regarding curve magnitude, deformity, age, sex, and treatment type. RESULTS: Cronbach's alpha and ICC for P-ISYQOL total score was 0.8 and 0.9, respectively. An acceptable association was observed between P-ISYQOL and SRS-22r total scores (r = - 0.5, p < 0.01). The P-ISYQOL could discriminate between adolescents with spinal deformities and adolescents with no spinal deformity as well as those with different types of deformity and treatment (p < 0.01). CONCLUSIONS: The P-ISYQOL is a reliable and valid survey to assess the outcomes of adolescents with spinal deformities. LEVEL OF EVIDENCE: Level I-diagnostic studies.

Disease-Specific Outcome Measures Evaluating the Health-Related Quality of Life of Children and Adolescents with Idiopathic Scoliosis and Scheuermann's Kyphosis: A Literature Review.

Adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) are the most common types of spinal deformities in adolescents, and both have substantial ramifications on health-related quality of life (HRQoL) parameters. Various questionnaires have been developed to assess HRQoL in age-group populations with spinal deformity. Nevertheless, there remains a lack of consensus across the literature as to which instrument is the most suitable for evaluating the HRQoL of this cohort. Thus, this literature review was conducted to present disease-specific questionnaires for children and adolescents with AIS and SK to provide their psychometric characteristics (validity, reliability, and responsiveness) across different languages. A literature search was performed in the Medline (PubMed), Scopus, EMBASE, and Google Scholar databases. Studies that outlined the development and application of questionnaires evaluating HRQoL of children and adolescents with spinal deformity were included, and data on their validity and reliability in different translated languages were collected. A total of 10 disease-specific questionnaires were identified. Except for one questionnaire that was a proxy-reported measure, the other questionnaires were self-reported. We determined that selecting the proper questionnaire for clinical and research purposes requires careful consideration of various factors including the type of treatment intervention planned as well as various patient demographic factors. For children with early-onset scoliosis, the ideal questionnaire to evaluate their HRQoL is the Early-Onset Scoliosis Questionnaire-24. For adolescents with AIS and SK who are potential candidates for surgical intervention, the use of Scoliosis Research Society-22, Scoliosis Japanese-27, and Quality of Life Profile Spinal Deformity questionnaires is appropriate. For patients who are under nonsurgical treatment, the Brace Questionnaire and Italian Spine Youth Quality of Life questionnaires can be utilized. Nonetheless, when the specific intent of a study is to evaluate the self-image perception of patients, the use of drawing-based questionnaires may be the optimal choice.

Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis.

PURPOSE: To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS). METHODS: In this retrospective multicenter study, the patient's sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up. RESULTS: A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11. CONCLUSION: C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS. LEVEL OF EVIDENCE: IV.

The comprehensive lower limb amputee socket survey: Reliability and validity of the persian version.

BACKGROUND: The Comprehensive Lower limb Amputee Socket Survey (CLASS) is a self-reported measure developed to assess prosthetic socket fit in individuals with lower limb amputation. OBJECTIVE: To assess the reliability and validity of the Persian version of the CLASS. STUDY DESIGN: Cross-sectional and repeated-measures. METHODS: We evaluated the translation and back translation of the CLASS and made the required changes according to expert committee feedback. Then, we recruited 124 participants with unilateral lower limb amputation (89.5% men). Internal consistency was analyzed with Cronbach's alpha and test-retest reliability using intra-class correlation coefficients. Convergent construct validity was assessed by comparing the CLASS scores with the Persian version of the Trinity Amputation and Prosthesis Experience Scales (TAPES) scores. In addition, known groups construct validity was assessed by comparing CLASS scores between groups with different causes and levels of amputation. RESULTS: Cronbach's alpha coefficient represented a very good internal consistency for all domains of the Persian CLASS (ranged from 0.86 to 0.92). The intra-class correlation coefficient for test-retest reliability for the Persian CLASS was good to excellent (ranged from 0.73 to 0.97). There was a significant correlation between the subscales of the Persian CLASS and satisfaction subscales of the Persian TAPES (p < 0.001). There was significant difference between comfort subscale of the Persian CLASS scores by level of amputation. CONCLUSION: The Persian CLASS is a reliable and valid measure for evaluating prosthetic socket fit.

Success Rate of Brace Treatment for Juvenile-Onset Idiopathic Scoliosis up to Skeletal Maturity.

BACKGROUND: Natural history studies have reported that the progression rate of juvenile idiopathic scoliosis (JIS) curves larger than 20° is high and tends to progress. The aim of this study was to investigate the outcome of bracing on JIS and to determine the prognostic factors on the success rate of brace treatment. METHODS: From March 1985 to February 2015, the clinical data of all JIS patients with referral age from 4 to 10 years who received brace treatment were reviewed. Those patients with a prebrace Cobb angle >20° and a Risser sign of 0 to 2 were included and followed up a minimum of 2 years after discontinuation of the brace or time of spinal fusion. The Cobb angle was recorded at the time of diagnosis, before initiation of bracing, weaning time, brace discontinuation, and final follow-up. RESULTS: From 297 patients with JIS, a total of 75 cases (18 boys, 57 girls) with an average curve magnitude of 31.9° at the time of diagnosis met the inclusion criteria of the study. For successfully treated patients, the average best in-brace correction was 55% for Lenke I curves, 59% for Lenke II curves, 41% for Lenke III curves, and 62% for Lenke V curves. For a total of 27 patients (36%), the brace treatment failed. Of these, 21 patients (78%) reached spinal fusion, and curves of 6 patients (22%) increased to ≥50°. The progression rate was highest in patients with Lenke type III curves (67%), and also in those with a curve magnitude of ≥46° (94%). CONCLUSIONS: Brace treatment is an effective strategy for controlling the curve progression and avoiding spinal fusion in JIS. LEVEL OF EVIDENCE: 4.