Psychometric Validation and Responsiveness of the Cross-culturally Adapted Traditional Chinese Version of the Early-onset Scoliosis Self-report Questionnaire (EOSQ-SELF)

Abstract

<h3>Background: </h3><p>Patients with early-onset scoliosis (EOS) can experience compromised health-related quality of life (HRQoL). EOSQ-SELF was developed to assess HRQoL directly from patients, yet its responsiveness remains unclear. We aimed to evaluate the psychometric properties and responsiveness of the cross-culturally adapted traditional Chinese version of EOSQ-SELF.</p><h3>Methods: </h3><p>Patients were consecutively recruited at an orthopaedic specialist clinic. Included patients must be diagnosed with EOS, aged 8 to 18 years at recruitment, and could read traditional Chinese. EOSQ-SELF underwent double-forward single-backward translations. At recruitment and at 6-month follow-up, patients completed the traditional Chinese EOSQ-SELF, refined Scoliosis Research Society-22 item (SRS-22r) questionnaire, and EuroQol-5-dimension 5-level. Psychometric properties of the EOSQ-SELF were assessed, with sensitivity analysis via known group comparison. Responsiveness was evaluated through an anchor-based approach using a global rating of change (GRC) scale.</p><h3>Results: </h3><p>A total of 139 patients were recruited, with 132 (92.4% responsiveness) included for analyses. Traditional Chinese EOSQ-SELF has good internal consistency, test-retest reliability, convergent, and construct validity. The EOSQ-SELF total score showed no ceiling/floor effects, correlated with SRS-22r total score (<em>r</em>_<em>s</em>: 0.788, <em>P</em><0.001), EQ index score (<em>r</em>_<em>s</em>: 0.680, <em>P</em><0.001), and EQ VAS (<em>r</em>_<em>s</em>: 0.527, <em>P</em><0.001). Discriminative validity was demonstrated: syndromic EOS had a lower transfer domain score (vs. idiopathic and congenital), and a lower EOSQ-SELF total score (median: 71.3 vs. idiopathic 81.1, <em>P</em>=0.023). On the basis of the GRC, 7.4%, 46.7%, and 45.9% of patients had worsened, unchanged, and improved overall health, respectively. The improvement group showed significantly higher EOSQ-SELF total score at 6 months (median: 83.4 vs. baseline 78.7, <em>P</em>=0.015), and none had total scores decrease reaching MCID.</p><h3>Conclusions: </h3><p>Traditional Chinese EOSQ-SELF is a reliable instrument for assessing HRQoL and its changes reported by older patients (aged 8 years or above). It is sensitive in differentiating patients with improved overall health from those who are stable/worsened. EOSQ-SELF can enhance clinical care and monitoring of EOS patients through assessing their HRQoL and detecting changes effectively.</p><h3>Level of Evidence: </h3><p>Level II.</p>