Health-related quality of life and physical self-concept of adolescents with idiopathic scoliosis during brace wearing

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Alaina Barrett
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1 The International Congress for Scoliosis Orthopaedic Rehabilitation and Treatment Health-related quality of life and physical self-concept of adolescents with idiopathic scoliosis during brace wearing Alina Silvane, Anita Vetra, Evita Dubinina, Alina Ivakina

wearing complience and efficacy of an individualized exercise program. 1 1.

2 Background There have been some studies on patients with scoliosis impacting their body image and subjective assessment of quality of life, which is likely to affect both brace wearing complience and efficacy of an individualized exercise program Weinstein SL, Dolan LA, Cheng JCY et al. Adolescent idiopathic scoliosis. Lancet 2008;371(9623): ; 2

3 Physical self-concept: main idea PSC is an important indicator of physical skills and activity improvement in adolescents, as well as being a valuable outcome in itself. 2 General self concept A fragment of a hierarchical multidimensional physical self-concept model 2 Physical self concept Physical ability Physical appearance 2. Marsh H et al. Causal ordering of physical self-concept and exercise behavior: Reciprocal effects model and the influence of physical education teachers. Health Psychology 2006;25(3): ; 3

4 The aim of the study To investigate the correlation between the healthrelated quality of life and physical self-concept of the adolescents with idiopathic scoliosis (AIS) during the brace wearing period. 4

5 Methods Study design: Quantitative non-experimental cross-sectional correlation study. Inclusion criteria: Clinical diagnosis Adolescent idiopathic scoliosis (ICD-10 Version: M41.1); Age of the participants from 10 to 18 years old; Length of brace wearing period more than 6 months; Regimen 12 to 23 hours/day of brace wearing prescribed. 5

6 Tools (1): SRS22r Scoliosis Research Society 22 questionnaire (Cronbach s Alpha 0,791); 3 BrQ Brace Questionnaire (Cronbach s Alpha 0,804); 4 BSSQ (brace) Bad Sobernheim Stress Questionnaire (Cronbach s Alpha 0,859); 5 3. Asher M, Lai SM, Burton D, Manna B. The reliability and concurrent validity of the SRS22 patient questionnaire for idiopathic scoliosis. Spine 2003;28: 63-9; 4. Vasiliadis E, Grivas TB, Gkoltsiou K. Development and preliminary validation of Brace Questionnaire (BrQ): a new instrument for measuring quality of life of brace treated scoliotics. Scoliosis 2006;1(7); 5. Botens-Helmus C, Klein R, Stephan C. The reliability of the Bad Sobernheim Stress Questionnaire (BSSQbrace) in adolescents with scoliosis during brace treatment. Scoliosis 2006;1(22); 6

7 Tools (2): PSDQ Physical Self-Description Questionnaire (Cronbach s Alpha 0,879); 6 The structured interview; The Visual analogue scale; X-ray image analysis; ATR in forward-bending sitting position (scoliometer), rib hump height. 6. Marsh HW, Cheng J. Physical self-concept. In: Measurement in Sport and Exercise Psychology, Ed. by Tenenbaum G, Eklund R, Kamata A. Canada et. al: Human Kinetics, p ; 7

8 Research participants (1) Results Assessment criteria Mean score ± SD Min/max value Number, gender 30 girls Age 14,6 ± 1,9 years Min=11; max=17 Primary curve Cobb angle 34,4 º ± 10,4 º Min =18, max=55 Length of brace wearing 16,1 ± 8,6 months Min=6, max=36 Length of brace wearing per day 16,5 ± 3,7 hours Min=12, max=23 Pain intensity (VAS) 2,4 ± 2,6 points Min=0, max=8 8

9 Research participants (2) Daily physical activities Sport at school Physiotherapy Exercising at home Swimming Other physical activities (floorball (2), basketball (2), volleyball (2), cycling (2)) Frequency, intensity 1 2 times a week, minutes 1 2 times a week, from 45 to 60 minutes 2 7 times a week, from 20 to 70 minutes 1 2 times a week, 60 minutes 1 2 times a week, from 40 to 60 minutes Number of people

10 HRQL reported in SRS22r SRS22r scales Total Self image 003 Mental health Function Satisfaction/Dissatisfaction with management Pain Mean Score ± Standard Deviation 10

11 HRQL reported in BrQ Brace Questionnaire results BrQ scales Total Emotional functioning Vitality Self-esteem and aesthetics 069 General health perception 072 Social functioning 073 Physical functioning 081 Bodily pain 085 School activity Mean Score ± Standard Deviation 11

12 Stress level reported in BSSQ (brace) Bad Sobernheim Stress Questionnaire results Little stress 4 participants (13,3%) Medium stress 9 participants (30%) High stress 17 participants (56,7%) 12

13 Physical self-concept assesment reported in PSDQ Physical Self-Description Questionnaire results PSDQ scales Average Endurance / Fitness Physical Activity Strength Sports Competence Flexibility General Physical Self-Concept Health Coordination Appearance Self-Esteem Body Fat Mean Score ± Standard Deviation 13

14 Correlation between HRQL assesment results (according to SRS22r, BrQ, BSSQ) and physical self-concept (according to PSDQ) (1) PSDQ scales SRS22r Total BrQ Total BSSQ Total Self-Esteem r=0,676, p<0,001 r=0,576, p=0,001 r=0,472, p=0,008 Health r=0,676, p<0,001 r=0,603, p<0,001 r=0,542, p=0,002 Coordination r=0,511, p=0, r=0,559, p=0,001 r=0,580, p=0,001 General Physical Self- Concept r=0,552, p=0,002 r=0,496, p=0,005 r=0,507, p=0, Endurance/Fitness r=0,562, p=0,001 r=0,389, p=0,034 r=0,319, p=0,086 14

15 Correlation between HRQL assesment results (according to SRS22r, BrQ, BSSQ) and physical self-concept (according to PSDQ) (2) PSDQ scales SRS22r Total BrQ Total BSSQ Total Body Fat Appearance Strength Sports Competence Physical Activity Flexibility r=0,382, p=0,037 r=0,474, p=0,008 r=0,385, p=0,036 r=0,374, p=0,042 r=0,350, p=0,058 r=0,408, p=0,025 r=0,374, p=0,042 r=0,348, p=0,060 r=0,375, p=0,041 p> 0,05 p> 0,05 p> 0,05 15

16 Factors influencing HRQL & PSC in the study Primary curve Cobb angle, Length of brace wearing per day, regular physiotherapy, regular physical activities (floorball, basketball, volleyball, cycling). r, r s = [0,4 0,6], p<0,05. + rib hump hight, angle of trunk rotation, sport at school, exercising at home, swimming. p>0,05 HRQL & PSC self-assesment - Age, length of treatment, presence and intensity of the pain syndrome. r, r s = - [0,5 0,7], p<0,05. 16

17 Conclusions 1. Adolescents with idiopathic scoliosis wearing braces show medium stress level and lower self-assessment of mental health and emotional functions (quality of life), but have higher self-assessment of physical and social functions. 17

18 Conclusions 2. There is a correlation between the quality of life and perception of adolescents physical health, coordination, self-esteem and general physical self-concept. 3. There is no correlation between the quality of life and perception of their sport competence, level of physical activity and flexibility. 18

19 Thank you!

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