Outcomes of bracing in juvenile idiopathic scoliosis until skeletal maturity or surgery.

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To evaluate the outcome of bracing in patients with juvenile idiopathic scoliosis (JIS) at either skeletal maturity or time of scoliosis surgery. SUMMARY OF BACKGROUND DATA: JIS is generally thought to have poor outcomes with high rates of surgical fusion. METHODS: All patients with JIS between the ages of 4 and 10 years treated with a brace at the Hospital for Sick Children (SickKids) between 1989 and 2011 were eligible. Data were collected from patient health records until either 2 years after skeletal maturity or date of surgery. RESULTS: The average age at diagnosis of 88 patients with JIS was 8.4 ± 1.4 years, with a female to male ratio of approximately 8:1. Pretreatment, Risser score was zero for 80 patients (91%); 72 (92%) of the females were premenarche; and primary Cobb angles ranged from 20° to 71°. Of the 88 patients, 60 (68%) had used a thoracolumbosacral orthosis exclusively; 28 (32%) patients used "other braces" (Milwaukee, Charleston, or a combination of braces), with an average treatment duration of 3.6 ± 1.9 years.As per Scoliosis Research Society definitions, a "non-curve-progression" (≤5° change) group consisted of 25 (28%) patients; and a "curve-progression" group consisted of 63 (72%) patients where the curve had progressed 6° or more.Of the 88 patients, 44 (50%) underwent surgery. The operative rate was higher for patients with curves 30° or more than those with curves 20° to 29° prior to brace treatment (37/58 [64%] vs. 7/30 [23%], respectively; P = 0.001); other braces compared with thoracolumbosacral orthosis (19/28 [68%] vs. 25/60 [42%], respectively; P = 0.02); Lenke I and III curves compared with Lenke VI curves (33/54 [61%] vs. 2/14 [14%], respectively; P = 0.007).

Simple bone cysts: better with age?

PURPOSE: The purpose of this study was to evaluate whether simple bone cysts (SBC) resolve with age. METHODS: Twenty four subjects with SBC who participated in a prior randomized clinical trial but had not healed at trial conclusion were evaluated for cyst healing. The following clinical and radiographic data were evaluated: age, sex, pain (Visual Analogue Scale), functional health (Short Form 36), subsequent fracture, involved bone, cyst area (cm), distance from physis (cm), endosteal thickening (yes/no), scalloping (no new scalloping/new scalloping), opacity/radiolucency (as is), loculation (yes/no), trabeculation (yes/no), tubulation (yes/no), transition zone (sharp/wide), geographic borders (geographic nonpermeative/nongeographic permeative), radiodense rim (>50%/no rim), and growth plate status (open/closed). Cyst healing was graded as: 1-cyst clearly visible; 2-cyst visible but multilocular and opaque; 3-sclerosis around or within a partially visible cyst; or 4-complete healing with obliteration of cyst. Healing was defined as grade 4. RESULTS: Of 24 subjects, 15 (63%) were male, 18 (75%) cysts were located in the humerus, and 4 (25%) in the femur. Patients were followed for 7.0±1.0 years following initial treatment with a mean age at follow-up of 17.2±3.2 years and 14 (87%) of growth plates were closed. Pain was minimal (0.6/10), function was high (91/100), and none of the patients had experienced subsequent fractures. Although distance from physeal scar had increased (P<0.0001), cyst area reduction (P<0.1) and overall cyst healing (P<0.2) had not changed. Of the 24 subjects, none were graded as healed at time of follow-up. Of the remaining radiographic variables, only decreased loculation (P<0.02) and increased endosteal thickening (P<0.04) showed significant changes. CONCLUSION: Despite the assumption that most SBC will resolve with skeletal maturity, this study indicates that none of the cysts were graded as completely healed although 87% of growth plates were closed. SIGNIFICANCE: Growth plate closure may not signify healing of SBC and although symptoms and fractures are rare, further studies are needed to follow patients with SBC through early adulthood.

Recent developments in treatment for simple bone cysts.

PURPOSE OF REVIEW: The purpose of this paper is to review treatment strategies for simple bone cysts (SBCs). RECENT FINDINGS: Recent studies have focused on disrupting the wall of the cyst in combination with injectable bone substitutes. Bone substitutes are minimally invasive, provide an osteoconductive scaffold, and are relatively easy to use. Many of these studies, however, have methodological issues (uncontrolled, not randomized, unblinded outcome assessment, or short-term follow-up) and inconsistent radiographic outcomes making it difficult to determine the benefits of these newer treatment strategies. SUMMARY: Based on a single randomized clinical trial, steroids are the only evidence-based treatment for SBCs. Further basic science is needed to understand the pathoetiology and to develop future biologic solutions. Multimodal treatment strategies with opening of the medullary canal and disruption of the cyst wall, filling defect with a bone substitute, and possible biologic treatment of the cyst membrane may be the best strategy. When considering cysts of the lower extremity, structural support may be required in addition to treatment of the cyst.

Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers.

BACKGROUND: Adolescents with idiopathic scoliosis who are considering spinal surgery face a major decision that requires access to in-depth information and support. Unfortunately, most online resources provide incomplete and inconsistent information and minimal social support. The aim of this study was to develop an online information and support resource for adolescent idiopathic scoliosis (AIS) patients considering spinal surgery. Prior to website development, a user-based needs assessment was conducted. The needs assessment involved a total of six focus groups with three stakeholder groups: (1) post-operative AIS patients or surgical candidates (10-18 years) (n = 11), (2) their parents (n = 6) and (3) health care providers (n = 11). This paper reports on the findings from focus groups with health care providers. METHODS: Focus group methodology was used to invite a range of perspectives and stimulate discussion. During audio-recorded focus groups, an emergent table of website content was presented to participants for assessment of relevance, viability and comprehensiveness in targeting global domains of need. Specifically, effective presentation of content, desired aspects of information and support, and discussions about the value of peer support and the role of health professionals were addressed. Focus group transcripts were then subject to content analysis through a constant comparative review and analysis. RESULTS: Two focus groups were held with health care providers, consisting of 5 and 6 members respectively. Clinicians provided their perceptions of the information and support needs of surgical patients and their families and how this information and support should be delivered using internet technology. Health care providers proposed four key suggestions to consider in the development of this online resource: (1) create the website with the target audience in mind; (2) clearly state the purpose of the website and organize website content to support the user; (3) offer a professionally-moderated interactive support component; and (4) ensure accessibility of website information and support by considering the age, gender, reading level and geographic location of potential users. CONCLUSIONS: Health care providers collectively identified the need for the development of an online information and support resource for adolescents considering surgery for AIS and their families and described the proposed website as a positive and needed adjunct to current clinical care.

Treatment for unicameral bone cysts in long bones: an evidence based review.

The purpose of this paper is to perform an evidence based review for treatment of unicameral bone cysts. A search of MEDLINE (1966 to 2009) was conducted and the studies were classified according to levels of evidence. This review includes only comparative Level I-III studies. The systematic review identified 16 studies. There is one level I study, one level II study and the remaining 14 studies are level III. Seven of the sixteen studies had statistically different results: three studies indicated that steroid injection was superior to bone marrow injection or curettage and bone grafting; one study indicated that cannulated screws were superior to steroid injections; one study indicated resection and myoplasty was superior to steroid injection; one study indicated a combination of steroid, demineralized bone matrix and bone marrow aspirate, and curettage and bone grafting were superior to steroid injection; and one study indicated that curettage and bone grafting was superior to non-operative immobilization. Based on one Level I study, including a limited number of individuals, steroid injection seems to be superior to bone marrow injection. As steroid injections have already demonstrated superiority over bone marrow injections in a randomized clinical trial, the next step would be a prospective trial comparing steroid injections with other treatments.

Sharing clinical trial results with adolescent idiopathic scoliosis patients.

BACKGROUND: Results from clinical trials are generally not shared with participants unless they are thought to affect their future medical care. Few institutional review boards require that participants receive results of the research. Research in this area has largely focused on life-threatening medical conditions, and little is known about sharing clinical trial results in other populations. The purpose of this study was to determine the experience of patients with adolescent idiopathic scoliosis who had participated in a clinical trial and the best method for sharing clinical trial results. METHODS: The participants were adolescents with idiopathic scoliosis from a randomized clinical trial comparing 2 spinal implants. Patients, and their parents, were surveyed by mail before (May 2005) and after (January 2008) receiving the results of the study. The first survey focused on clinical trial experience, satisfaction with surgery, and eliciting the preferred method for receiving clinical trial results. The second survey examined patient and parent reactions to the trial results letter. RESULTS: Of 126 families who were mailed the pretrial results survey, 68% (86/126) of patients and 59% (74/126) of parents responded. Ninety-eight percent (84/86) of respondent patients and 96% (71/74) of respondent parents wanted to receive the results of the trial. Eighty-seven percent (75/86) of respondent patients and 86% (63/74) of respondent parents said the trial was a positive experience. Thirty-seven percent (32/86) of patients and 31% (23/74) of parents responded to the posttrial results survey, 25% (32/126) and 18% (23/126) of total trial participants, respectively. Sixty-three percent (20/32) of respondent patients and 70% (16/23) of respondent parents also felt that receiving the trial results by letter, with a telephone number for any questions, was the best way to receive the information. Seventy-two percent (23/32) of respondent patients and 70% (16/23) of respondent parents said they would participate in a future clinical trial. CONCLUSIONS: Participating patients and parents want to know the results of research studies. Researchers should plan to inform patients by informing them of this option during the informed consent process.

Towards an understanding of the information and support needs of surgical adolescent idiopathic scoliosis patients: a qualitative analysis.

BACKGROUND: Informed decision making for adolescents and families considering surgery for scoliosis requires essential information, including expected outcomes with or without treatment and the associated risks and benefits of treatment. Ideally families should also receive support in response to their individual concerns. The aim of this study was to identify health-specific needs for online information and support for patients with adolescent idiopathic scoliosis who have had or anticipate having spinal surgery. METHODS: Focus group methodology was chosen as the primary method of data collection to encourage shared understandings, as well as permit expression of specific, individual views. Participants were considered eligible to participate if they had either experienced or were anticipating surgery for adolescent idiopathic scoliosis within 12 months, were between the ages of 10 and 18 years of age, and were English-speaking. RESULTS: Two focus groups consisting of 8 adolescents (1 male, 7 female) and subsequent individual interviews with 3 adolescents (1 male, 2 female) yielded a range of participant concerns, in order of prominence: (1) recovery at home; (2) recovery in hospital; (3) post-surgical appearance; (4) emotional impact of surgery and coping; (5) intrusion of surgery and recovery of daily activities; (6) impact of surgery on school, peer relationships and other social interactions; (7) decision-making about surgery; (8) being in the operating room and; (9) future worries. CONCLUSION: In conclusion, adolescents welcomed the possibility of an accessible, youth-focused website with comprehensive and accurate information that would include the opportunity for health professional-moderated, online peer support.

What do patients and parents know about surgery for adolescent idiopathic scoliosis?: a knowledge questionnaire.

STUDY DESIGN: Questionnaire. OBJECTIVE: The purpose of this study was to develop a reliable and valid questionnaire to assess patient and parent knowledge concerning risks, benefits, and complications of surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Families of adolescents with moderate to severe AIS are required to make an important decision on whether to proceed with surgery. Prior research has found families have substantial need for information with regard to surgery, and these needs may not be met by the health care system. METHODS: The study sample consisted of AIS patients and their parents. The questionnaire was administered to patients (and their parents) who were either actively braced (Cobb angle 30 degrees-50 degrees) or were within 1 year of surgery. The questionnaires were completed 2 weeks apart to test reliability of responses. To test construct validity, we hypothesized that patients who were postoperative would know more about the risks and benefits of surgery for AIS than those who were currently braced. RESULTS: Postoperative patients' and parents' scores were significantly greater than bracing patients' and parents' scores (P < 0.0001). Parents and patients reliably completed the questionnaires 2 weeks apart (Intraclass coefficient 0.83 and 0.68; CI = 0.83-0.96 and 0.45-0.83, respectively). CONCLUSION: The questionnaire was valid and reliable in evaluating patients' and parents' knowledge of AIS surgery and may be used in evaluating educational interventions for patients and parents.

A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone cysts.

BACKGROUND: Simple bone cysts are common benign lesions in growing children that predispose them to fracture and are sometimes painful. The purpose of this trial was to compare rates of healing of simple bone cysts treated with intralesional injections of bone marrow with rates of healing of those treated with methylprednisolone acetate. METHODS: Of ninety patients randomly allocated to treatment with either a bone-marrow or a methylprednisolone acetate injection, seventy-seven were followed for two years. The primary outcome, determined by a radiologist who was blind to the type of treatment, was radiographic evidence of healing. The cyst was judged to be either not healed (grade 1 [a clearly visible cyst] or grade 2 [a cyst that was visible but multilocular and opaque]) or healed (grade 3 [sclerosis around or within a partially visible cyst] or grade 4 [complete healing with obliteration of the cyst]). Patient function was assessed with use of the Activity Scale for Kids, and pain was assessed with the Oucher Scale. RESULTS: Sixteen (42%) of the thirty-eight cysts treated with methylprednisolone acetate healed, and nine (23%) of the thirty-nine cysts treated with bone marrow healed (p = 0.01). There was no significant difference between the treatment groups (p > 0.09) with respect to function, pain, number of injections, additional fractures, or complications. CONCLUSIONS: Although the rate of healing of simple bone cysts was low following injection of either bone marrow or methylprednisolone, the latter provided superior healing rates.

Are surgeons' preferences for instrumentation related to patient outcomes? A randomized clinical trial of two implants for idiopathic scoliosis.

BACKGROUND: Although many techniques for the surgical treatment of scoliosis have been described, we are not aware of any randomized trials that have compared implant systems. The relationship between surgeons' preferences for implants and patient outcomes is unknown. The purpose of the present study was to compare quality of life and curve correction associated with use of the Moss Miami system and the Universal Spine System for spinal fusion in patients with adolescent idiopathic scoliosis. METHODS: The present study was a double-blind, randomized clinical trial. All adolescent patients with idiopathic scoliosis who were scheduled for posterior instrumentation and arthrodesis with or without anterior release were screened for eligibility. Patients were randomly allocated to treatment with either the Moss Miami system or the Universal Spine System. The primary outcome measure for this trial was Quality of Life Profile for Spinal Disorders. RESULTS: Of the 129 subjects who were enrolled in the trial, sixty (95%) of sixty-three from the Universal Spine System group and sixty (91%) of sixty-six from the Moss Miami group were included in the final analysis. Two years postoperatively, the total Quality of Life score did not differ by the clinically important value of 5.5 between the two groups (difference, 1.07; 95% confidence interval, -3.67 to 5.82; p = 0.66). The percentage of Cobb angle correction was not significantly different for thoracic curves (55.1% +/- 18.3% for the Moss Miami system group, compared with 54.1% +/- 18.7% for the Universal Spine System group) (difference, -1%; 95% confidence interval, -7% to 5%; p = 0.77) or lumbar curves (45.4% +/- 24.6% for the Moss Miami system group, compared with 41.9% +/- 26.8% for the Universal Spine System group) (difference, -4%; 95% confidence interval, -16% to 11%; p = 0.57). Although surgeons were more satisfied with the Universal Spine System (difference, 42%; 95% confidence interval, 29% to 55%; p < 0.0001), satisfaction ratings were not related to any surgical outcomes. CONCLUSIONS: The Moss Miami system and the Universal Spine Systems provided similar quality of life and curve correction. Surgeon preference may be an unreliable means of selecting implants from the patient outcomes perspective.

Improvement in quality of life following surgery for adolescent idiopathic scoliosis.

STUDY DESIGN: We used the Climent Quality of Life for Spinal Deformities Scale prospectively in a nonrandomized prospective comparative cohort of operative versus observational management of adolescent idiopathic scoliosis. OBJECTIVE: To compare the change in disease-specific quality of life associated with operating on adolescents with idiopathic scoliosis, to the change in disease-specific quality of life among observed scoliosis patients with a similar 2-year follow-up period. SUMMARY OF BACKGROUND DATA: The immediate effect of scoliosis surgery on quality of life from a patient perspective has not been properly documented but should play a role in the patient's decision to operate. METHODS: At a single tertiary referral children's hospital spinal clinic, 119 patients undergoing scoliosis surgery and 42 patients undergoing observation only for scoliosis were enrolled in a prospective study, including preoperative and postoperative spine-specific quality of life. Change in quality of life after 2 years of follow-up among operated versus observed patients (adjusted for baseline quality of life) was used to estimate the short-term benefit of scoliosis surgery. RESULTS: The operated group experienced an increase in quality of life of 4.3 points (95% confidence interval, 0.69-7.88) on the 115-point Climent scale. Although statistically significant, this increase was lower than the 5.5-point cutoff we had defined a priori as clinically significant. CONCLUSION: Scoliosis surgery results in a small increase in spine-related quality of life at 2 years. This increase is of questionable clinical significance. Decisions to operate on adolescents with scoliosis should acknowledge modest expectations about short-term gains in quality of life.

Surgical decision making in adolescent idiopathic scoliosis.

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: The objective of this paper was to assess the reliability of surgeons' decision-making in adolescent idiopathic scoliosis (AIS) based on patient photographs and clinical and radiographic data. SUMMARY OF BACKGROUND DATA: Orthopedic spine surgeons rated severity of deformity as the most important surgical consideration in AIS. However, studies have shown that surgeon reliability is highly variable when rating physical deformity. Surgeons' unreliable ratings of patients' physical deformity may lead to inconsistent decision-making. METHODS: Four pediatric spine surgeons viewed 40 patients with varying severity of AIS on three occasions, 2 weeks apart. In the first viewing, surgeons viewed only patient photos and body image scores. In the second viewing, surgeons viewed patient photos, body image scores, and clinical data. In the third viewing, surgeons viewed patient photos, body image scores, a 3-ft anteroposterior spinal radiograph, and corresponding radiographic data. After viewing each patient, surgeons were asked if: 1) spinal fusion with or without thoracoplasty would improve the patient's appearance; and 2) whether they would recommend this patient for spinal fusion with or without thoracoplasty. RESULTS: Surgeons' concordance in recommending patients for surgery and if they thought it would improve their appearance varied widely with kappa scores ranging from poor (0.34) to good (0.76). Recommendations for surgery were more consistent with the addition of radiographs but were not influenced by patients' body image perceptions. Surgeons' recommendations for surgery were also inconsistent with treatment actually received with overall kappa scores ranging from poor (0.32) to good (0.73). CONCLUSION: Surgical decision-making for AIS is inconsistent.

Surgeon reliability in rating physical deformity in adolescent idiopathic scoliosis.

STUDY DESIGN: Cross sectional survey. OBJECTIVES: To compare pediatric spine surgeons' relative rankings of the importance of surgical considerations, and their reliability of ratings of the physical deformity of patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Adolescents' appearance is a factor in surgical decision-making. Although the reliability of the Cobb angle has been extensively studied, less attention has been directed toward the reliability of surgeons' assessment of physical appearance. METHODS: Five surgeons ranked the relative importance of 13 surgical considerations. While viewing clinical photographs of 40 patients, surgeons rated the following: shoulder blades, shoulders, waist asymmetry, and the "overall appearance" of the back. RESULTS: "Severity of deformity" was consistently ranked the most important surgical consideration. Surgeons, however, varied widely in their reliability of their ratings of physical appearance: shoulder blades (kappa = 0.34), shoulders (kappa = 0.22), waist (kappa = 0.24), and overall appearance (kappa = 0.40). CONCLUSION: Because patients' physical appearance is an important element of surgical decision-making, differences among surgeons could be contributing to inconsistent recommendations.

Rush University guidelines and protocols for the management of hyperglycemia in hospitalized patients: elimination of the sliding scale and improvement of glycemic control throughout the hospital.

The management of inpatient hyperglycemia has received much recent attention because of an expanding literature supporting the benefits of quality improvement and the creation of guidelines in this area. The authors began a process in 2002 to create modern protocols for glycemic control with intravenous insulin in their intensive care units and with subcutaneous basal-prandial insulin in all of their non-intensive care units. In this report, they describe both the process employed and the current protocols they are using. They also describe the process, perpetually ongoing, for educating nurses and residents in a large academic medical center. The annual cycle of senior residents passing on the regular insulin sliding scale to first-year interns and students can be broken. The hospital ward can be a valuable setting in which to teach basal/prandial insulin protocols, which will readily translate into the outpatient clinic. Where better to teach the importance and real-time usefulness of HbA1c than on the inpatient ward of a teaching hospital? Protocols to prevent and treat hypoglycemia can also be taught and widely accepted, hospital insulin formularies can be streamlined, and modern information technology can be used to track and improve multiple metrics of care for inpatients with hyperglycemia. The inpatient encounter with diabetic care can be a golden window of opportunity for patient as well as physician and nurse education.

Parents' and patients' perceptions of postoperative appearance in adolescent idiopathic scoliosis.

STUDY DESIGN: A cross-sectional evaluation of patients after surgery for adolescent idiopathic scoliosis (AIS). OBJECTIVES: To determine the agreement between patients' and parents' perceptions of the patient's postoperative appearance and to compare those perceptions with physical and radiographic measures of deformity. SUMMARY OF BACKGROUND DATA: Improving cosmesis is an important aim of surgery. Patients' appearances may influence their evaluation of its outcome. METHODS: Physical and radiographic data were collected 2 years after surgery for 128 patients with AIS. Patients and parents independently rated shoulder blades, shoulders, waist, and overall appearance. Additionally, patients completed the Quality of Life Profile for Spinal Disorders (QLPSD). Agreement was evaluated with the weighted kappa statistic ranging between 0 and 1 where higher values indicate better agreement. RESULTS: Fair to moderate agreement was found between patient and parent ratings of the patient's shoulder blades (kappa = 0.39; 95% confidence interval [CI], 0.29-0.48), shoulders (kappa = 0.38; 95% CI, 0.26-0.50), waist (kappa = 0.45; 95% CI, 0.25-0.55), and overall appearance (kappa = 0.22; 95% CI, 0.04-0.40). Patients rated the appearance of their waist (P = 0.013) and overall appearance (P = 0.039) significantly worse than their parents. Patients' perceptions of their overall appearance had higher correlations with the body image subscale score (r = 0.45, P = 0.000) and the total quality of life score on the QLPSD (r = 0.37, P = 0.000) than did parents' perceptions of those same measures (r = 0.21, P = 0.025; and r = 0.08, P = 0.369, respectively). CONCLUSIONS: Radiographic and physical measures of deformity do not correlate well with patients' and parents' perceptions of appearance. Patients and parents do not strongly agree on the cosmetic outcome of AIS surgery. Therefore, given that the adolescents themselves undergo the surgery, patients' assessments of their deformity, rather than radiographic measures or parents' assessments, should play a major role in the evaluation of surgical success.

Construction and validation of the scoliosis quality of life index in adolescent idiopathic scoliosis.

STUDY DESIGN: A prospective cross-sectional design was used to evaluate the Scoliosis Quality of Life Index (SQLI). SQLI is a 22-item self-reporting health-related quality-of-life questionnaire for idiopathic scoliosis patients. OBJECTIVE: The goal of this study was to evaluate the psychometric qualities of SQLI. SUMMARY OF BACKGROUND DATA: SQLI, a modification of the Scoliosis Research Society-22 (SRS-22) questionnaire, is intended to be more applicable to patients with adolescent idiopathic scoliosis (AIS) between 10 and 18 years of age. METHODS: Eighty-four subjects with a mean age of 14.9 years participated. We determined reliability, validity, distribution of scores, and clinical utility of SQLI in a hospital setting. Seventy patients were AIS patients (16 postsurgical, 30 braced, 24 unbraced) with a mean Cobb angle of 30.7 degrees, and 14 patients were sibling controls. RESULTS: Reliability: Intraclass correlation coefficient for test-retest reliability of the global index was very good (ICC 2,1 = 0.80); Spearman's rho correlations between items and domains was 0.39 to 0.89 and between domains and global index was 0.55 to 0.78; Cronbach's alpha scores were more than 0.80 (0.82-0.89). VALIDITY: construct validity was established by correlations between SQLI's global index and Quality of Life Profile for Spine Deformities (QLPSD) global index (Spearman's rho, 0.79) and between SQLI domains and QLPSD domains (0.46-0.81); discriminate validity was established by SQLI's global index successfully partitioned controls and AIS subjects (Kruskal-Wallis test, P = 0.0013). Time required by the patient averaged 2.5 minutes per administration. CONCLUSIONS: SQLI is reliable and valid and demonstrates satisfactory distribution of scores. SQLI is a promising instrument in the assessment of AIS patients.