Oeffinger Donna J, Iwinski Henry, Talwalkar Vishwas, Dueber David M
Shriners Children's Lexington, Lexington, KY, 110 Conn Terrace, Lexington, KY 40508, United States.
The Herb Innovation Center, University of Toledo, 3100 Gillham Hall, Toledo, OH 43606, United States.
N Am Spine Soc J. 2024 Jul 31;19:100545. doi: 10.1016/j.xnsj.2024.100545. eCollection 2024 Sep.
Despite widespread usage of the SRS-22r questionnaire (Scoliosis Research Society Questionnaire-22r), the English version has only sparingly been subjected to analysis using modern psychometric techniques for patients with adolescent idiopathic scoliosis (AIS). The study purpose was to improve interpretation and clinical utility of the SRS-22r for adolescents with AIS by generating additional robust evidence, using modern statistical techniques. Questions about (1) Structure and (2) Item and Scale Functioning are addressed and interpreted for clinicians and researchers.
This retrospective case review analyzed SRS-22r data collected from 1823 patients (mean age 14.9±2.2years) with a primary diagnosis of AIS who clinically completed an SRS-22r questionnaire.Individual SRS-22r questions and domain scores were retrieved through data queries. Patient information collected through chart review included diagnosis, age at assessment, sex, race and radiographic parameters. From 6044 SRS-22r assessments, 1 assessment per patient was randomly selected. Exploratory structural equation modeling (ESEM) and item response theory (IRT) techniques were used for data modeling, item calibration, and reliability assessment.
ESEM demonstrated acceptable fit to the data: χ (130)=343.73, p<.001; RMSEA=0.035; CFI=0.98; TLI=0.96; SRMR=0.02. Several items failed to adequately load onto their assigned factor. Item fit was adequate for all items except SRSq10 (Self-Image), SRSq16 (Mental Health), and SRSq20 (Mental Health). IRT models found item discriminations are within normal levels for items in psychological measures, except items SRSq1 (pain), SRSq2 (pain), and SRSq16 (mental health). Estimated reliability of the Function domain (ρ=0.69) was low, however, Pain, Self-Image and Mental Health domains exhibited high (ρ>0.80) reliability.
Modern psychometric assessment of the SRS-22r, in adolescent patients with AIS, are presented and interpreted to assist clinicians and researchers in understanding its strengths and limitations. Overall, the SRS-22r demonstrated good psychometric properties in all domains except function. Cautious interpretation of the total score is suggested, as it does not reflect a single HRQoL construct.
尽管脊柱侧凸研究学会问卷-22r（SRS-22r）被广泛使用，但针对青少年特发性脊柱侧凸（AIS）患者的英文版问卷，很少使用现代心理测量技术进行分析。本研究旨在通过运用现代统计技术生成更多有力证据，以提高SRS-22r对AIS青少年患者的解释力和临床实用性。针对临床医生和研究人员，探讨并解释了有关（1）结构以及（2）条目与量表功能的问题。
本回顾性病例分析对1823例初步诊断为AIS且临床完成SRS-22r问卷的患者（平均年龄14.9±2.2岁）所收集的SRS-22r数据进行了分析。通过数据查询获取各个SRS-22r问题及领域得分。通过病历审查收集的患者信息包括诊断、评估时的年龄、性别、种族和影像学参数。从6044份SRS-22r评估中，为每位患者随机选取1份评估。运用探索性结构方程模型（ESEM）和项目反应理论（IRT）技术进行数据建模、项目校准和信度评估。
ESEM显示数据拟合度可接受：χ（130）=343.73，p<.001；RMSEA=0.035；CFI=0.98；TLI=0.96；SRMR=0.02。有几个条目未能充分加载到其指定因子上。除了SRSq10（自我形象）、SRSq16（心理健康）和SRSq20（心理健康）外，所有条目的拟合度均足够。IRT模型发现，除了SRSq1（疼痛）、SRSq2（疼痛）和SRSq16（心理健康）外，心理测量条目的项目区分度处于正常水平。功能领域的估计信度（ρ=0.69）较低，然而，疼痛、自我形象和心理健康领域显示出较高（ρ>0.80）的信度。
展示并解释了对AIS青少年患者SRS-22r的现代心理测量评估，以帮助临床医生和研究人员了解其优势和局限性。总体而言，SRS-22r在除功能外的所有领域均表现出良好的心理测量特性。建议谨慎解释总分，因为它并不反映单一的健康相关生活质量结构。
