The Early-Onset Scoliosis Questionnaire (EOSQ) Reflects Improvement in Quality of Life After Growth Rod Surgery
Traditional measures of outcome following treatment for early onset scoliosis (EOS), such as correction of Cobb angle, fail to capture the patient and caregiver experience. The Early Onset Scoliosis Questionnaire (EOSQ) has been developed to reflect quality of life (QOL) and caregiver impact in children with EOS before and after treatment interventions. In the continuing process of validating this instrument, we sought to assess the responsiveness of the EOSQ to repetitive surgeries and to establish normal reference values through a prospective, multicenter study. The purpose of the current study is to further validate the EOSQ by examining the responsiveness this measure to surgical interventions, and to establish normative reference scores.
In this prospective, multicenter study, 64 EOS patients (age 5.7 years, 0-11) undergoing treatment with traditional growing rods (GR, n=26), Vertical Expandable Prosthetic Titanium Rib (VEPTR, n=34) or Shilla (n=4) were enrolled from 5 centers. Parents of GR and VEPTR patients completed the EOSQ at 3 visits: pre-implantation and prior to first and second expansions. Total, domain, and item scores with differences and effect sizes were calculated for VEPTR, GR, and all patients. 145 healthy patients were recruited to serve as normative references.
Significant improvements in EOSQ scores were noted across multiple domains in patients before and 6 months after surgery. Effect sizes were small to medium. Patients with EOS of neuromuscular etiology exhibited the largest improvements in QOL. 9 of 10 domains and 20/22 items had good distribution with no floor or ceiling effects. Norms for the EOSQ were developed across a range of ages, and normative patients showed no flooring effects and significant differences were noted between norms and patients with EOS across all ages. A 2-item ‘Satisfaction' domain was added to reflect perceived treatment effectiveness.
The current work further validates the now finalized EOSQ-24. This measure shows differences in QOL before and after surgery and appears to be an appropriate measure of outcome in comparing treatment options in this group of patients. It is applicable to children aged 0-18 years. Psychometrics, including few ceiling or floor effects, appear excellent. Future efforts include applying the EOSQ-24 to non-surgical patients and translating into foreign languages.