Body Image Disturbance Improvement After Operative Correction of Adolescent Idiopathic Scoliosis

Hypothesis: Body Image Disturbance Questionnaire–Scoliosis version (BIDQ-S) is a sensitive outcomes instrument to evaluate improvements in body image–related psychosocial effects with surgical correction. Design: Prospective observational study. Introduction: The BIDQ-S was previously validated (convergent validity, internal consistency) as a tool to assess body image–related distress and psychosocial impairment in adolescent idiopathic scoliosis (AIS). This study was conducted to evaluate responsiveness to change in the BIDQ-S associated with surgical treatment of AIS two years postoperatively to complete the validation of this questionnaire. Methods: Seventy-five consecutive operative AIS patients were enrolled and completed BIDQ-S and Scoliosis Research Society–22 (SRS-22) at preoperative and two-year postoperative visits. Demographic and radiographic data were collected. Preoperative and two-year postoperative BIDQ-S (1 = best, 5 = worst) and SRS-22 scores (1 = worst, 5 = best) were compared using paired t test. Correlations between BIDQ-S and SRS-22 scores were evaluated by linear regression. Results: Eighty-four percent of the subjects were females, with average age at surgery of 14.4 ± 1.6 years. The mean follow-up was 2.26 years (range 2.0-4.5). The major Cobb was corrected from 50.0° ± 7.2° to 14.2° ± 5.8° (Δ = 71.3% ± 12.1%; p <.0001). There was a significant improvement in BIDQ-S scores after surgery (1.64 ± 0.51 to 1.21 ± 0.38, p <.0001). BIDQ-S improvements were correlated with change in SRS self-image (p =.0055), activity (p =.0057), mental (p =.0018), and overall mean (p =.0007) domains. Preoperative, two-year postoperative, and Δ BIDQ-S score were not associated with major Cobb magnitude, truncal rotation, or Lenke curve type. Patients who reached SRS-22r minimal clinically important difference (MCID) in activity and self-image domains had worse preoperative BIDQ scores than those who did not reach MCID (activity 1.91 vs. 1.54 [1 = best, 5 = worst], p =.0099; self-image 2.08 vs. 1.51, p <.0001). Greater improvement in BIDQ-S was noted in patients who reached MCID in SRS-22 self-image than those who did not (Δ = 0.77 vs. 0.38, p =.0052). Conclusion: BIDQ-S is responsive to surgical correction of AIS. The BIDQ-S is a valuable clinical outcome tool to assess the psychosocial effects of scoliosis in adolescents augmenting existing outcome instruments.