1. Reliability and validity of the adapted Spanish version of the Early Onset Scoliosis-24 questionnaire
María del Mar Pozo-Balado, PhD
Hiroko Matsumoto PhD
Michael G Vitale, MD
Juan Manuel Praena-Fernández
David M Farrington, MD

2. INTRODUCTION Early Onset Scoliosis (EOS)
EOS may negatively impact life expectancy of children.
Even without severe progression, the deformity may interfere with daily life and might have significant effects on health-related quality of life.
Radiographic parameters are insufficient to evaluate the severity and efficacy of treatment in these patients.
Early Onset Scoliosis Questionnaire (EOSQ-24)
EOSQ-24 is a health-related quality of life disease specific measure for EOS.
It needs to be translated into many languages, while maintaining the original meaning.

3. OBJECTIVE
To translate and transculturally adapt the original EOSQ-24 to produce a Spanish version according to internationally published recommendations and to test the reliability and discriminative validity of the Spanish version of EOSQ-24.

4. PATIENTS AND METHODS I Study Design
Translation and transcultural adaptation of EOSQ into the European Spanish language.
Beaton et al., Spine (2000)
Validity testing of the Spanish version of EOSQ in a cross-sectional study validation.
The EOSQ-24
Principal disease-specific instrument to be used for studies involving children with EOS.
Comprised of 24 items in 11 domains.
Item scores ranged between 1 and 5 for all items, with lower scores meaning higher disability.
Domain scores were calculated as (value of item choice-1)/4 *100 for 1 item domains and (algebraic mean of items-1)/4*100 for domains composed for more than 1 item, ranging from 0 to 100.
The 11 domains were also averaged into a summary score called total score, which also may range from 0 to 100.

5. PATIENTS AND METHODS II
Cross-cultural adaptation and translation process
Translation
Synthesis
Back Translation
Expert Committee Review
Pretesting
Beaton et al., Spine (2000)
Reliability
Cronbach’s a and Cronbach’s a if item/domain deleted ( indicates good internal consistency).
Item-total correlations (>0.3 indicates good internal consistency).
Inter-item correlations ( indicates good internal consistency).
Terwee et al, J Clin Epidemiol (2007)
Floor and ceiling effects
Values lower than 30% were considered acceptable.
Kane, Aspen Publishers (2007)

6. PATIENTS AND METHODS III
Discriminative validity
Analysis of the relationship between clinical and demographical variables and questionnaire total scores, under the assumption that unfavorable characteristics are associated with poor scores.
Kruskar Wallis and Bonferroni corrections for multiple comparisons and Mann Whitney-U test for comparisons between two groups.
Spearman correlations for quantitative variables.
p<0.05 considered statistically significant for all tests.

7. RESULTS I
Demographic and clinical characteristics of 44 children with EOS.
Characteristic
Value
Male sex (%)
22 (50)
Age, median months (IQR)
76 [ ]
Age at diagnosis, median months (IQR)
39 [16 -69]
Age at surgery, median months (IQR)
76 [58 – 91]
Cobb angle, median degrees (IQR)
31.1 [24.8 – 45.3]
Diagnose (%)
Congenital
18 (40.9)
Neuromuscular
10 (22.7)
Idiopathic
9 (20.5)
Syndromic
7 (15.9)
Treatment (%)
Observation
24 (54.5)
Bracing
2 (4.6)
Casting
4 (9.1)
Surgical
14 (31.8)
Ambulation Status (%)
Non-ambulatory
8 (18.2)
Ambulatory
36 (81.8)

8. Good internal consistency for items and domains.
RESULTS II
Domains
Corrected Item-total Correlation
Cronbach’s a if Item Deleted
General Health
0.415
0.825 Q1
0.496
0.893 Q2
0.413
0.895
Pain
0.553
0.816 Q3
0.502 Q4
0.455
0.894
Pulmonary Function
0.472
0.821 Q5
0.254
0.898 Q6
0.412
Mobility
0.826 Q7
0.435
Physical function
0.607
0.808 Q8
0.482 Q9
0.484
Q10
0.661
0.888
Daily living
0.675
0.802
Q11
0.689
0.887
Q12
0.691
Fatigue
0.522
Q13
0.476
Q14
0.474
Emotion
0.592
0.812
Q15
0.471
Q16
0.519
0.892
Parental Burden
0.655
Q17
0.670
0.890
Q18
0.518
Q19
0.550
0.891
Q20
0.724
Q21
0.179
Financial Burden
0.353
0.831
Q22
0.356
0.896
Satisfaction
0.418
Q23
Q24
0.392
Demographic and clinical characteristics of 44 children with EOS.
Cronbach’s a for 24 items = 0.897
Cronbach’s a for domains = 0.832
Good internal consistency for items and domains.

9. RESULTS III
RESULTS IV
Domains
Mean (SD)
Median
Missing (n)
Missing (%)
Floor (%)
Ceiling (%)
General Health
65.6
62.5
11.4 Q1
3.50 (1.04) 4
4.5
15.9 Q2
3.79 (0.89) 1
2.3 7
23.3
Pain
77.9
75.0
31.8 Q3
4.02 (0.86)
32.6 Q4
4.22 (0.69) 3
6.8
36.6
Pulmonary Function
86.3
100
59.1 Q5
4.40 (1.18) 5
4.7
74.4 Q6
4.50 (0.86)
68.2
Transfer
90.9
72.7 Q7
4.64 (0.65)
Physical function
72.2
83.3
29.5 Q8
3.82 (1.38)
9.2
45.5 Q9
4.23 (1.41)
Q10
3.74 (1.53) 2
11.9
52.4
Daily living
56.8
13.6
25.0
Q11
3.05 (1.57)
22.7
27.3
Q12
3.50 (1.80)
52.3
Fatigue
73.3
Q13
3.95 (0.94)
36.4
Q14
3.88 (1.28)
46.5
Emotion
76.4
Q15
4.11 (0.87)
40.9
Q16
4.00 (1.03)
Parental Burden
61.3
65.0
Q17
2.98 (0.93)
9.1
Q18
3.16 (1.16)
Q19
3.23 (1.33)
Q20
3.68 (1.27)
34.1
Q21
4.26 (0.79)
44.2
Financial Burden
75.6
Q22
4.02 (1.13)
Satisfaction
Q23
3.98 (1.08)
41.9
Q24
3.93 (1.23)
43.2
Data quality with the Floor and Ceiling Effect of the EOSQ-24.
No floor effects, but ceiling effects observed in some items and domains, probably because…
Young age
Mostly mild curves
More than 50% under observation

10. RESULTS IV
RESULTS II
Discriminative validity of the EOSQ-24 questionnaire: Total Score and Cobb Angle.
p=0.001
Comparison of total scores between EOS patients with Cobb angle >30° and ≤30° were performed using Mann Whitney U-test, and correlations between total scores and Cobb angles were evaluated using a Spearman rank correlation coefficient test .

11. RESULTS V
RESULTS II
Discriminative validity of the EOSQ-24 questionnaire: Total Score and Diagnosis
K-W *p=0.006 * * * *
C=Congenital; I= Idiopathic; N= Neurological; S= Syndromic
Comparisons were made by using Kruskal-Wallis test and Mann Whitney U-test *p<0.05

12. CONCLUSIONS
The Spanish version of the EOSQ-24 is reliable and a valid tool for the psychometric assessment of children with EOS, and can be applied in routine clinical practice and for research purposes.