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      Reliability and validity of the Arabic version of the Early Onset Scoliosis 24 Items Questionnaire (EOSQ-24)


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          Introduction: Early Onset Scoliosis (EOS) is a complex pathology that covers a variety of etiologies, with onset before the age of 10 years. Surgical treatment of EOS should have the objectives of fulfilling maximum pulmonary function, spine length, with minimal hospitalizations, complications, and family burden. Radiographic parameters are an important standard in assessing treatment outcomes. However, the Early Onset Scoliosis Questionnaire-24 (EOSQ-24) was developed to measure the wider dimensions of outcomes involving the quality of life of patients and caregivers post-treatment. The aim of this study was to evaluate the validity and reliability of culturally adapted Arabic version of the EOSQ-24.

          Methods: Translation and cross-cultural adaptation, based on published guidelines, were performed on the original English EOSQ-24 by a committee. The Arabic version of EOSQ-24 was applied to the caregivers of all 58 EOS patients who were treated surgically after signing a consent form. Reliability was assessed using Cronbach’s α and item-total statistics for the whole questionnaire initially and for the each domain separately. Data quality was assessed by mean, median, percentage of missing data, ceiling and floor effects. Discriminative validity was examined using non parametric tests.

          Results: The response for all items was excellent with only 1.7% (0–1) of responses missing. The floor effect ranged from 0% to 36.2% of patients and the ceiling effect ranged from 0 to 46.6%. Cronbach’s α test reliability was found excellent (0.919), as was the internal consistency of all domains, with Cronbach α ranging from 0.903 to 0.918. Corrected item-total correlations were good for all domains (>0.3). Only one item (Question 21) showed low corrected item-total correlations ( r = 0.222). However, Cronbach’s α did not increase significantly when this item was deleted (0.920).

          Conclusion: The first adapted Arabic version of EOSQ-24 is found to have good validity and reliability, and it can be used to assess children in Arab societies with EOS.

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          Most cited references26

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          Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms.

          The mortality and causes of death in 115 patients (80 women), born 1902-1937, with untreated scoliosis were compared to the expected according to official Swedish statistics. Subgrouping for cause and onset of scoliosis was done. Fifty-five patients had died; 21 of respiratory failure and 17 of cardiovascular diseases. The mortality was significantly (P less than 0.001) increased. The increased risk was apparent at 40-50 years of age. The mortality was significantly increased in infantile (P less than 0.001) and juvenile (P less than 0.01) scoliosis but not in adolescent scoliosis. The mortality was also increased in post-polio scoliosis, scoliosis combined with rickets and scoliosis of unknown etiology indicating an increased mortality in idiopathic scoliosis. Among the surviving patients anti-hypertensive treatment was frequent (23 of 50).
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            Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study.

            A retrospective case review of children treated with dual growing rod technique at our institutions. Patients included had no previous surgery and a minimum of 2 years follow-up from initial surgery. To determine the safety and effectiveness of the previously described dual growing rod technique in achieving and maintaining scoliosis correction while allowing spinal growth. Historically, the growing rod techniques have used a single rod and the reported results have been variable. There has been no published study exclusively on the results of dual growing rod technique for early-onset scoliosis. From 1993 to 2001, 23 patients underwent dual growing rod procedures using pediatric Isola instrumentation and tandem connectors. Diagnoses included infantile and juvenile idiopathic scoliosis, congenital, neuromuscular, and other etiologies. All had curve progression over 10 degrees following unsuccessful bracing or casting. Of 189 total procedures within the treatment period, 151 were lengthenings with an average of 6.6 lengthenings per patient. Analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation included measured changes in scoliosis Cobb angle, kyphosis, lordosis, frontal and sagittal balance, length of T1-S1 and instrumentation over the treatment period, and space available for lung ratio. The mean scoliosis improved from 82 degrees (range, 50 degrees-130 degrees) to 38 degrees (range, 13 degrees-66 degrees) after initial surgery and was 36 degrees (range, 4 degrees-53 degrees) at the last follow-up or post-final fusion. T1-S1 length increased from 23.01 (range, 13.80-31.20) to 28.00 cm (range, 19.50-35.50) after initial surgery and to 32.65 cm (range, 25.60-41.00) at last follow-up or post-final fusion with an average T1-S1 length increase of 1.21 cm per year (range, 0.13-2.59). Seven patients reached final fusion. The space available for lung ratio in patients with thoracic curves improved from 0.87 (range, 0.7-1.1) to 1.0 (range, 0.79-1.23, P = 0.01). During the treatment period, complications occurred in 11 of the 23 patients (48%), and they had a total of 13 complications. Four of these patients (17%) had unplanned procedures. Following final fusion, 2 patients required extensions of their fusions because of curve progression and lumbosacral pain. The dual growing rod technique is safe and effective. It maintains correction obtained at initial surgery while allowing spinal growth to continue. It provides adequate stability, increases the duration of treatment period, and has an acceptable rate of complication compared with previous reports using the single rod technique.
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              Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS).

              Early-onset scoliosis is a heterogeneous condition, with highly variable manifestations and natural history. No standardized classification system exists to describe and group patients, to guide optimal care, or to prognosticate outcomes within this population. A classification system for early-onset scoliosis is thus a necessary prerequisite to the timely evolution of care of these patients.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                08 February 2019
                : 5
                : ( publisher-idID: sicotj/2019/01 )
                : 7
                [1 ] Faculty of Medicine and Health Sciences, An-Najah National University Nablus 41414 Palestine
                [2 ] Assistant Program Manager, Waltham Forest Clinical Commissioning Group London E11 UK
                [3 ] Asst. Prof. & Head of Department, Bio-Statistics, GD-PGMI 54000 Pakistan
                [4 ] Department of Orthopaedic Surgery, Columbia University Medical Center 630 West 168th Street, #1504 10032 New York City NY USA
                [5 ] Assistant Professor in Epidemiology, School of Public Health, Al-Quds University 90612 Palestine
                [6 ] Pediatric Orthopedic Surgeon, Associate Professor, Poly Technique University-Palestine PO Box 3985 Ramallah, West bank 602 Palestine
                Author notes
                [* ]Corresponding author: alaaahmad@ 123456hotmail.com
                sicotj180084 10.1051/sicotj/2019001
                © The Authors, published by EDP Sciences, 2019

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 14 July 2018
                : 08 January 2019
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 26, Pages: 7
                Original Article

                early onset scoliosis,arabic version,early onset scoliosis-24 questionnaire,health-related quality of life, validation,validation


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