Body Appearance and Quality of Life in Adult Patients With Adolescent Idiopathic Scoliosis Treated With a Brace or Under Observation Alone During Adolescence

Study Design. The Scoliosis Research Society (SRS) brace study (published in the JBJS-A, 1995) was comprised of patients with adolescent idiopathic scoliosis with moderate curve sizes (25 degrees-35 degrees). Forty observed and 37 braced patients (77% of the original group) attended a follow-up, a mean of 16 years after onset of maturity. Objective. To analyze whether the subjectively evaluated present body appearance affects outcome as measured by quality of life in adult patients, previously treated by observation alone (nonbraced) or with a brace during adolescence. Summary of Background Data. Few reports exist where validated outcome measures for body appearance have been used. Methods. Two quality-of-life questionnaires, the Scoliosis Research Society-22 (SRS-22) questionnaire and the 36-Item Short-Form Survey Instrument (SF-36), were answered. The patient's opinion on body appearance was evaluated pictorially (i.e., sketches) using the spinal appearance questionnaire, in which 7 aspects of asymmetry are graded. These scores were compared with curve sizes, scoliometer measurements for grading trunk asymmetry, and quality-of-life measures. Results. At follow-up, both groups were similar in terms of age (mean = 32 years) and curve size (mean = 35). Distortion was inversely related to SRS-22 total score and satisfaction/dissatisfaction with management subscore, but not related to the SRS-22 function subscore. No difference was found between the groups in terms of trunk rotation, where the means were 10.7 degrees and 10.8 degrees for the nonbraced and braced patients, respectively. The nonbraced patients estimated that their body appearance was significantly less distorted than the braced patients (mean = 12.9 and 15.0, respectively; P = 0.0028). Conclusion. Patients who experienced less body asymmetry were more satisfied with treatment and had a better quality of life. In spite of similar curve sizes and trunk rotation in both groups, the nonbraced patients felt that their body appearance was less distorted than that of the braced patients.