Is the SRS-22 a Good Tool to Guide Treatment of Scoliosis?

Every medical condition needs a tool to measure success of treatment. With idiopathic scoliosis (curvature of the spine with no known cause), the Scoliosis Research Society (SRS)-22 survey is often used. This tool was first published as a valid, reliable instrument back in the late 1990s.

The SRS-22 questionnaire has been used to measure health-related quality of life (HRQOL) in teens and young adults. It is a simple and practical way to assess how patients with this particular condition perceive themselves in terms of pain, self-image, and function.

Since idiopathic scoliosis is not life-threatening, the goals of treatment are not to save the life of the child or even cure him or her of this problem. Treatment is more of a management approach to limit how severe the spinal curve becomes, to prevent deformity, and to minimize any effect of the condition on daily function and quality of life. The question naturally arises: can the SRS-22 be used (and relied upon) to guide management decisions? In other words, how useful is the SRS-22 in making treatment decisions?

That’s what the researchers who published this study tried to find out. They gave the SRS-22 survey to 155 patients ages 10 to 21. The entire group was made up of two separate subgroups: those patients who were treated without surgery (nonoperative group) and those who had surgery. There were further subdivisions among the groups based on severity of their spinal curves.

They found that the questionnaire was a good tool to use when assessing differences in pain and body image between patients with small versus large spinal curves. But it did not sort out differences between the two groups when it came to measuring effects on function or mental health. And the SRS-22 really could not show differences with small changes in the severity of the spinal curvatures.

The authors suggest that the SRS-22 is still a good tool for measuring some things (body image and pain between small and large curves) but it does have some limits. Different scores are not as likely with small changes in curves. It’s easier to use the SRS-22 to identify patients with larger curves who will need surgery but not as effective for smaller (mild to moderate) curves.

Results of treatment may be affected by other factors that are not measured by the SRS-22 (e.g., socioeconomic status, body mass index as a measure of obesity, self-esteem, self-confidence, mood). In this age group, self-image is often more important than physical pain or loss of motion. Since these other behavioral, psychologic, and social health-related qualities are also important, it may be necessary to use more than just the SRS-22 to assess change.