Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires

Abstract

Background: Adolescent girls treated with a brace for scoliosis are submitted to prolonged stress related to both the disease and the therapy. Currently proposed quality of life questionnaires are focused on the outcome of therapy. Bad Sobernheim Stress Questionnaire (BSSQ) enables monitoring of patients being under treatment with a brace or exercises. The aim of the study was to assess the stress level in conservatively managed scoliotic girls using BSSQ.

Materials and methods: 111 girls, aged 14.2 +/- 2.2 years, mean Cobb angle of the primary curve 42.8 degrees +/- 17.0 degrees and mean Bunnell angle of 11.4 degrees +/- 4.5 degrees were examined with two versions of BSSQ (Deformity and Brace). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle.

Results: The BSSQ Deformity revealed the median of 17 points in patients managed with exercises (from 4 to 24 points), 18 in patients managed with a brace (from 8 to 24 points) and 12 in patients before surgery (from 3 to 21 points). Braced patients who completed both questionnaires (n = 50) revealed significantly higher score with BSSQ Deformity (median = 18) comparing to BSSQ Brace (median = 9). There was a correlation between the total score of BSSQ Deformity and the Cobb angle (r = -0.34), Bunnell primary curve rotation (r = -0.34) and Bunnell sum of rotation (r = -0.33) but not with the age of patients.

Conclusion: Scoliotic adolescents managed with exercises and brace suffered little stress from the deformity. The brace increased the level of stress over the stress induced by the deformity. The stress level correlated with clinical deformity (Bunnell angle), radiological deformity (Cobb angle) and the type of treatment (exercises, bracing, surgery). Bad Sobernheim Stress Questionnaires are simple and helpful in the management of girls treated conservatively for idiopathic scoliosis.

Figure 1

Distribution of patients according to the type of the curve. The single curves were analyzed separately for the thoracic and lumbar location. Double curves were grouped together.

Figure 2

Distribution of patients according to the type of management. Braced patients received specific physiotherapy. Exercise managed patients received exercises of various types, often unspecific, out of our Institution.

Figure 3

The median of the score of the questionnaire: (a) the patients treated with a brace, examined with the BSSQ-Brace, (b) the patients managed with exercises, examined with the BSSQ-Deformity. The ten patients admitted for spinal surgery were divided into groups (a) or (b), depending on whether they previously had brace treatment or not. The squares indicate the value of the median; the slim lines indicate the minimum and maximum.

Figure 4

The median of the score achieved with the BSSQ-Deformity by the patients admitted for surgical correction of scoliosis (a), treated with a brace (b) or managed with exercises (c). The squares indicate the value of the median; the slim lines indicate the minimum and maximum.

Figure 5

The scores of two questionnaires: BSSQ-Brace and BSSQ-Deformity applied to the same population of patients treated with a brace. The squares indicate the value of the median; the slim lines indicate the minimum and maximum. Difference highly significant. The patients reveal more stress because of the orthosis than because of the disease.

Figure 6

Correlation of BSSQ Deformity total score and Cobb angle.