Measuring meaningful outcomes for adolescent idiopathic scoliosis: a narrative review and critical appraisal of the Scoliosis Research Society-22 revised (SRS-22r) instrument.

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.