Purpose: To evaluate the validity of seven PROMIS measures to assess HRQoL relevant to pediatric patients with LCPD. Methods: This was a multicenter prospective study (13 institutions) of patients with Perthes disease (age 8 to 18 years) who had non-surgical or surgical treatments > 6 months prior . Waldenstrom …

sagittal balance and predictive equations to determine lumbopelvic compensatory patterns (LPCP).These equations are used to guide surgical decision making and technique selection.Although other lumbopelvic compensation equations are available, these have not been compared with the SRS-Schwab equation. ObjectivesThe aim was to evaluate sagittal balance and LPCP in younger and older adults with scoliosis and to compare the two most commonly used LPCP predictive equations (SRS-Schwab and Legaye).Methods EOS radiographic data from 41 adults with scoliosis (coronal Cobb > 10°; 51 ± 19 years) stratified into younger (n = 20) and older (n = 21) groups above and below the mean age was retrospectively analysed.T-tests were used to compare group characteristics and Fisher's exact tests were used to evaluate differences in SVA (sagittal vertical axis), PT (pelvic tilt) and PI (pelvic incidence)-LL (lumbar lordosis) mismatch thresholds.Agreement between SRS-Schwab and Legaye classification was evaluated using Kappa tests and Bland Altman plots.Results and discussion 62% of the older group and 10% of the younger group exceeded the SVA threshold of 40 mm (p < .001).86% of the older group and 20% of the younger group exceeded the 20°pelvic retroversion threshold (p < 0.001).Normal PI-LL mismatch ranges were more prevalent in the younger group (70%) than the older group (28%) (p < .001)when analysed through the SRS-Schwab equation.Legaye equation analysis revealed no difference in the prevalence of normal PI-LL ranges between the younger (15%) and older group (10%) (P = .66).Lumbar hyperlordosis was more prevalent in the younger (25%) than older group (5%) (p < .001)when analysed through the SRS-Schwab equation but no difference was observed between the younger (10%) and older group (0%) (p > .05)when analysed through the Legaye equation.Lumbar hypolordosis was more prevalent in the older (67%) than the younger group (5%) (p < .001)but no difference was observed between the older (90%) and younger group (75%) when analysed through the Legaye predictive equation (P = .33).Agreement between the SRS-Schwab and Legaye equations was poor for the whole (κ = 0.148), older (κ = 0.277) and young groups (κ = 0.039). Conclusion and significanceThis study confirms that older patients more often exhibit higher SVA and pelvic retroversion than younger patients.Whilst analysis through SRS-Schwab classification reveals that younger patients more often exhibit lumbar hyperlordosis than older patients who more often exhibit lumbar hypolordosis, analysis through the Legaye equations revealed no differences.There is poor agreement between the SRS-Schwab and Legaye classification equations.Clinicians are cautioned to exercise clinical judgement when evaluating their patients with these equations until more research is done.

INTRODUCTION:The goal of early-onset scoliosis (EOS) treatment is to improve health-related quality of life (HRQoL) for patients and to reduce the burden on their parents or caregivers. The purpose of this study is to develop and finalize the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24), and examine the validity, reliability, and responsiveness of the EOSQ-24 in measuring patients' HRQoL, the burden on their caregivers, and the burden on their caregiver's finances. The study also established aged-matched normative values for the EOSQ-24.METHODS:The EOSQ-24 was administered to caregivers of male and female patients aged 0 to 18 years with EOS. Patients with EOS are diagnosed before 10 years of age. Criterion validity was investigated by measuring agreement between its scores and pulmonary function testing. Construct validity was established by comparing values across different etiology groups using the known-group method, and measuring internal consistency reliability. Content validity was confirmed by reviewing caregiver and health provider ratings for the relativity and clarity of the EOSQ-24 questions. Test-retest reliability was examined through intraclass correlation coefficients. Responsiveness of the EOSQ-24 before and after surgical interventions was also investigated. Age-matched, healthy patients, without spinal deformity, were enrolled to establish normative EOSQ-24 values.RESULTS:The pulmonary function subdomain score in the EOSQ-24 was positively correlated with pulmonary function testing values, establishing criterion validity. The EOSQ-24 scores for neuromuscular patients were significantly decreased compared with idiopathic or congenital/structural patients, demonstrating known-group validity. Internal consistency reliability of patients' HRQoL was excellent (0.92), but Family Burden was questionable (0.64) indicating that Parental Burden and Financial Burden should be in separate domains. All 24 EOSQ items were rated as essential and clear, confirming content validity. All EOSQ-24 domains demonstrated good to excellent agreement (0.68 to 0.98) between test and retest scores. Neuromuscular patients improved their HRQoL postoperatively, whereas idiopathic patients worsened their HRQoL postoperatively, indicating the ability of the instrument to respond to different trajectories of HRQoL according to etiology in patients with EOS.DISCUSSION:The developed and finalized EOSQ-24 is a valid, reliable, and responsive instrument that is able to serve as a patient-reported outcome measure evaluating health status for patients with EOS and burden of their caregivers. This instrument will be able to serve as an outcome measure for future research including clinical trials evaluating the effectiveness of various treatments. In addition, the EOSQ-24 allows assessment of patients' HRQoL, and the burden on their caregivers relative to age-matched healthy peers.LEVEL OF EVIDENCE:Level II-diagnostic study with consecutive patients enrolled in national registries.