Cognitive testing of the spinal appearance questionnaire with typically developing youth and youth with idiopathic scoliosis.

BACKGROUND: The Spinal Appearance Questionnaire (SAQ) underwent initial psychometric studies, which suggested good reliability and discriminative ability. Although the SAQ is used as a self report of appearance, our center was concerned about its use with youth owing to complex words and vague questions. We conducted this cross-sectional study to evaluate the readability, comprehension, and interpretation of items on the SAQ. METHODS: Cognitive interview methodology of 76 youths (8 to 16 y; average age 13) included 31 with scoliosis and 45 typically developing. Subjects were required to read each SAQ item and think aloud to capture cognitive processes about the items and responses. Interviews were audiotaped and transcribed verbatim. Problems were categorized and frequencies for each category were calculated. RESULTS: There were reading and comprehension problems and problems understanding the illustration with every written and pictorial SAQ item, respectively. The percent of subjects who encountered at least one problem ranged from 16% to 96%. Subjects had difficulty with understanding the intent of every SAQ item and with understanding the meaning of specific words such as "prominence" and "flank." The pictorial illustrations for items 2 and 3 were problematic for 58% and 49% of subjects, respectively. The illustrations of the lungs (item 4) and hips (items 4 and 5) were problematic for 42% and 27% of subjects, respectively. These results were consistent regardless of age or diagnoses. CONCLUSION: This study does not support the use of the SAQ as currently used with youth owing to use of complex medical words, vague questions, difficult illustrations, and various interpretations of the intent of many of the items. LEVEL OF EVIDENCE: Not applicable (not an intervention study).

Perceptions of self-image and physical appearance: conversations with typically developing youth and youth with idiopathic scoliosis.

PURPOSE: To report how youths, both with and without idiopathic scoliosis (IS), respond to questions about their self-image and perceptions of body shape. An additional purpose is to describe themes that emerged as important to youths with IS to better understand scoliosis from their perspective. METHODS: Descriptive qualitative and quantitative methods were utilized. Subject interviews were conducted, as part of a larger cognitive interviewing study on the Spinal Appearance Questionnaire, using a cross-sectional sample of 76 females between 8 and 16 years of age with IS and who were typically developing (TD), without scoliosis. RESULTS: IS and TD subjects revealed similar findings when asked what makes them look good versus their peers; self-image ratings were also positive. Predominant themes from open-ended responses include physical appearance, feelings, brace wear, and discomfort. CONCLUSION: Self-image and body shape did not differ significantly between groups. The identified themes warrant further exploration as they are significant and important to youth with scoliosis.