Measuring meaningful outcomes for adolescent idiopathic scoliosis: a narrative review and critical appraisal of the Scoliosis Research Society-22 revised (SRS-22r) instrument
Bibliographic record
Abstract
Background and Objective: The Scoliosis Research Society-22 revised questionnaire (SRS-22r) is the most widely used patient-reported outcome measure (PROM) to evaluate health-related quality of life (HRQL) for patients with adolescent idiopathic scoliosis (AIS). Here, we seek to critically appraise the development process and psychometric properties of the SRS-22r. Methods: We evaluated the item generation, item reduction, sensibility and measurement properties including reliability, validity and responsiveness of the SRS-22r. To accomplish this, we examined available literature describing psychometric properties of the SRS-22r and summarized the findings in a narrative review format. Key Content and Findings: The SRS-22r represents a multi-dimensional outcome measure that demonstrates generally appropriate responsiveness to outcomes after surgical AIS deformity correction. Despite its strengths, several limitations were identified, including (I) absence of a conceptual framework for HRQL in AIS; (II) lack of direct patient involvement during development of the instrument; (III) minimal evidence of evaluation of the interpretation, appropriateness and importance, comprehensiveness of the items by adolescents; and (IV) the inclusion of a satisfaction with treatment (surgery) domain within a HRQL instrument. Though the SRS-22r is responsive to change after surgical intervention, its ability to discriminate between mild and moderate scoliosis remains limited. Conclusions: Our findings characterize the strengths and limitations of the SRS-22r. An ideal AIS HRQL measure should be guided by a conceptual framework informed by, and aligned with the priorities and goals of adolescents with idiopathic scoliosis based on their lived experience, complemented by parental perspectives and input from clinician experts with an understanding AIS management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.032 | 0.153 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.013 | 0.007 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".