Introduction: Scoliosis Research Society-22 revised (SRS-22r) is the common questionnaire used to evaluate health related quality of life (HRQOL) for young people with adolescent idiopathic scoliosis (AIS). The aim of this study is to evaluate its content validity for this population.Methods: In-depth semi-structured interviews were conducted with a purposive sample of young people with AIS (Cobb angle ≥25˚, aged 10–18 years). Concept elicitation was used to evaluate the influence of AIS on participants’ HRQOL. Participant information sheets and consent/assent forms were age relevant. Topic guide was informed by the SRS-22r and existing evidence. Interviews were audio and video recorded, transcribed verbatim, coded, and analysed using thematic analysis. Derived themes/codes were compared with SRS-22r contents (domains/items).Results: Eleven participants (mean age 14.9 years [SD = 1.8]; 8 female) were recruited. The mean curve size was 47.5° [SD = 18°] and participants had been managed via different approaches. Four main themes emerged with associated subthemes: 1) Physical effects related to physical symptoms (back hurt, stiffness) and body asymmetry (uneven shoulders), 2) Activity-related effects showed impact on mobility (sitting for long periods), self-care (dressing), and school activities (focus during lessons), 3) Psychological effects revealed emotional (feel worried), mental (sleep quality), and body image effects (hide back from others), 4) Social effects (participation in school and leisure activities), and school, friends and mental health support. A weak association was found between items of the SRS-22r and the identified codes.Conclusion: The SRS-22r does not adequately capture important concepts that relate to HRQOL of adolescents with AIS. These findings support revision of the SRS-22r, or the development of a new patient reported outcome measure to evaluate HRQOL of adolescents with AIS.

Study Design.: A systematic review. Objective.: To summarize evidence on measurement properties of Outcome Measures (OM) used to assess physical functioning in adolescents with idiopathic scoliosis (AIS). Summary of Background Data.: The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems (e.g., back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with patient-reported outcome measures (PROM), performance-based outcome measures (PBOM), and body structure and function OM. Adequate measurement properties of OM are important for precision in research and practice. Methods.: A two-staged search strategy was performed on electronic databases up to December 2019. Search one revealed a list of OM was used for physical functioning assessment in AIS. Search two identified studies that evaluated the measurement properties of OM in AIS; using the list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] checklist), and performed data extraction. The level of evidence was established using a modified GRADE approach. Results.: Search one yielded: 28 PROM, 20 PBOM, and 10 body structure and function OM. Search two revealed: 16 measurement properties studies for PROM, one for PBOM, and three for body structure and function measures. Construct validity, reliability, and responsiveness of most PROM has been established in AIS, but not content validity or internal consistency (moderate evidence). Construct validity was sufficient for the Timed Up and Go test and body structure and function measures (very low to low evidence). Conclusion.: Currently, physical functioning is evaluated with a variety of measures in AIS. The majority of measurement properties studies evaluated PROM with a paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of the OM identified in this review can be recommended with confidence in individuals with AIS. Level of Evidence: 2

Introduction Content validity is the most important measurement property for any patient-reported outcome measure (PROM). It being the extent that the PROM measures important concepts that are relevant to the population of interest. Adolescent with idiopathic scoliosis (AIS) is the most common spinal deformity in paediatric populations, with the Scoliosis Research Society questionnaire-22 revised (SRS-22r) a commonly used PROMof quality of life. In the absence of existing evidence, a content validity study for SRS-22r is needed to confirm its suitability for AIS. Thus, this study aims to investigate the content validity of SRS-22r for AIS. A secondary aim is to explore healthcare professional (HCP) perspectives of the barriers and facilitators to using outcome measures in AIS. Methods and analysis Qualitative study reported according to COnsolidated criteria for Reporting Qualitative Studies. A purposive sample of AIS (n=10–15, Cobb angle >25°, aged 10–18 years) will be recruited for online semi-structured interviews. A convenience sample (n=10–12) of HCP with clinical and/or research experience in AIS will be recruited for a focus group discussion. Topic guides and age-relevant documents are informed by existing evidence and developed using a framework of concept elicitation and cognitive debriefing. Audio-recordings will be transcribed verbatim, coded, analysed and synthesised using interpretive phenomenology analysis. Themes that generated from the analysis will be used as codes that will then be mapped to the SRS-22r contents. Ethics and dissemination The Health Research Authority and Health and Care Research Wales approval have been granted (IRAS 289888). Study findings will be disseminated through publications in peer-reviewed journals and conference presentations.

Background: Physical activity is an effective treatment for paediatric spinal pain. However, participation rates remain low and review evidence is needed to establish why. This review identifies factors influencing participation in sports, exercise, and physical activity in those aged 18 or under with spinal pain or spinal conditions. Trends or differences between discrete sub-populations are identified. Methods: A meta-ethnographic review was undertaken. Qualitative papers were identified and appraised using the JBI checklist. Thematic trends were mapped onto the biopsychosocial model and subthemes identified. Uniqueness was calculated and the confidence in the evidence was evaluated using the GRADE-CERQual tool. Results: Data were gathered from nine qualitative papers (384 participants). Three themes were identified: (1) biological: physical challenges and bladder and bowel care; (2) psychological: perceptions of differences to peers, struggle, anger, sadness, adjustment, and acceptance; and (3) sociological: influence of friends, social acceptance, negative attitudes from others, and the influence of their disability on family routine. Conclusions: Sociological factors were most influential on exercise participation alongside related psychological and biological factors. Adolescents over 14 years offered greater critical insight compared to the younger children. Results are best applied to neuromuscular conditions with further robust evidence required in paediatric musculoskeletal spinal pain.

Study Design.: Retrospective analysis of longitudinal data. Objective.: To evaluate clinically relevant change in surgical outcomes for Adolescents with Idiopathic Scoliosis (AIS), comparing those who achieved smallest detectable change (SDC) in pain and function at 1-year post-surgery with those who did not, and to evaluate the influencing factors. Summary of Background Data.: The SDC is recommended to evaluate the surgical outcomes of AIS. However, little is known about the use of SDC in AIS and its influencing factors. Materials and Methods.: This was a retrospective analysis of longitudinal data from patients who underwent surgical correction at a tertiary spinal centre from 2009 to 2019. Surgical outcomes were assessed at short-term (6 wk, 6 mo) and long-term (1- and 2-years) post-surgery using the Scoliosis Research Society questionnaire (SRS-22r). The difference between “successful” (≥SDC) and “unsuccessful” (<SDC) groups was assessed using an independent t-test. Univariate and logistic regression analyses enabled the assessment of influencing factors. Results.: All SRS-22r domains decreased in the short term, except for self-image and satisfaction. In the long term, self-image increased by 1.21 and function increased by 0.2, and pain decreased by 0.1. In all SRS-22r domains “successful” group had low pre-surgery scores and were statistically different to the “unsuccessful group”. The difference remained statistically significant at 1-year for most SRS-22r domains. Being older and having low pre-surgery SRS-22r scores increased the chances of achieving SDC in function at 1-year. Achieving SDC in the pain domain was significantly associated with age, sex, length of hospital stay, and SRS-22r pre-surgery scores. Conclusion.: Notably, the self-image domain showed the largest change compared to other SRS-22r domains. A low pre-surgery score increases the likelihood of clinical benefit from surgery. These findings demonstrate the utility of SDC for assessing the benefits and factors that may underpin surgical benefit in AIS.

Background/Objectives: Physical therapists’ use of various balance assessment tools is essential for accurately identifying deficits and guiding rehabilitation plans. This study aimed to investigate clinical balance assessment practices in Saudi Arabia, examine physical therapists’ preferences for different balance assessment tools, and analyze how participant characteristics—such as age, experience, and practice setting—affect these preferences. Methods: A descriptive cross-sectional study was conducted between April and July 2024 in Saudi Arabia. A total of 194 physical therapists (62.9% male; 45.9% with 1–5 years of experience) who actively manage individuals with balance disorders were recruited using a convenience sampling technique. Data were collected through a self-structured questionnaire. Participants reported their use of balance assessment tools on a six-point Likert scale, incorporating both numeric and descriptive anchors. Results: The Single-Leg Stance was the most regularly used tool (54.6%), followed by the Berg Balance Scale and Functional Gait Assessment (FGA) (both 43.8%). Conversely, tools such as the Performance-Oriented Mobility Assessment (68.1%), Mini Balance Evaluation System (65.4%), and Fall Efficacy Scale International (56.2%) were the most underutilized. Significant associations were observed between tool preferences and participant characteristics, including area of practice, academic qualification, experience level, and work environment (p < 0.05). However, several validated assessment tools remain underutilized, highlighting gaps in awareness and training. Conclusions: The findings of this study highlight the need for greater standardization in balance assessment practices. Improving training programs, establishing clear clinical guidelines, and standardizing assessment protocols across healthcare settings can help make balance evaluations more consistent and effective.