Measurement Properties of Outcome Measure Evaluating Physical Functioning among Adolescent with Idiopathic Scoliosis: A Systematic Review


Physical functioning (PF) is the ability to carry out the physical activity of daily living such as walking and self-care. It is an important outcome that provides a meaningful evaluation of individuals’ life. Adolescent Idiopathic Scoliosis (AIS) is the most common deformity among the paediatric population. Limitations in PF are reported by indviduals with AIS as well as pain, which may cause functional limitation. This review aims to summarise outcome measures used for assessment of PF (patient-reported, performance-based and body structure and function ) for individuals with AIS and their respective measurement properties.


A systematic review was conducted according to the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) guidelines and registered with PROSPERO (CRD42019142335). A two-staged search strategy was performed on MEDLINE, PsycINFO, EMBASE, CINAHL, SPORTdiscus, Web of Science and PubMed, from inception until December 2019. Search one: included terms to identify all outcome measures (OM) of physical functioning in AIS. Search two: from OM identified in search one studies investigating the measurement properties of OM was performed. Two reviewers independently performed studies screening, study selection, and evaluated studies’ methodological quality using COSMIN risk of bias tool. Data extraction included important study characteristics as well as the results of measurement properties. Modified Grading of Recommendations, Assessment, Development and Evaluation approach was used to summarise the overall level of evidence for each measurement property per outcome measure


Results: From search one, 30 Patient-Reported OM (PROM), 20 Performance-Based OM (PBOM) and 9 outcome measures of body structure and function were identified. From search two, 15 measurement properties studies for PROM, two for PBOM and three for body structure and function were included for qualitative synthesis. Construct validity was sufficient for 2 PROMs and insufficient for 5 PROMs (High to moderate quality of evidence). Reliability was sufficient for 3 PROMs, while internal consistency was indeterminate in 3 PROMs (Very low to low quality of evidence). Responsiveness was sufficient for Scoliosis Research Society (SRS)-22 and insufficient for SRS-22 revised (Very low to low quality of evidence). Content validity was sufficient for Scoliosis Quality of Life Index (Very low quality of evidence). Construct validity was sufficient for Timed up and Go test (Very low quality of evidence). Body structure and function measures have sufficient construct validity and reliability but indeterminate criterion validity (Very low to low quality of evidence).

Conclusion(s): A wide range of measures has been used for evaluating PF in individuals with AIS. Future research should investigate the content and structural validity of PROMs as well as other measurement properties of PBOM and body structure and function measures.

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This review highlights the gaps in the current research agenda regarding the measurement properties of PF measures in AIS. Outcome measures should have adequate psychometric properties, to ensure accuracy in the evaluation of test results and to avoid the risk of bias. Thus, more high-quality studies are needed to better define the measurement properties of OM used for assessment of PF in individuals with AIS.

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Funding acknowledgements

No funding was received for conducting this work. SA is a PhD student, supported by a scholarship form University of Tabuk, Tabuk, Saudi Arabia.