Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May-Jun;45(5):e457-e463.
doi: 10.1097/BPO.0000000000002916. Epub 2025 Apr 9.

Correlation of the LLRS-AIM Index With LD-SRS and PROMIS in Pediatric Patients With Lower Limb Differences

Luke Sang  1 , Sarah Coufal  2 , Ishaan Swarup  2 , Sanjeev Sabharwal  2
Affiliations

Correlation of the LLRS-AIM Index With LD-SRS and PROMIS in Pediatric Patients With Lower Limb Differences

Luke Sang et al. J Pediatr Orthop. 2025 May-Jun.

Abstract

Background: The purpose of this study was to assess the reliability of the Limb Lengthening and Reconstruction Society AIM (LLRS-AIM) index, a scale for grading the severity of lower limb deformities by the physician, and its concordance with 2 patient-reported outcome measures, the Limb Deformity-Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) tools in pediatric patients with lower limb differences.

Methods: This was a retrospective review of patients 18 years old or younger who presented to our institution with lower limb differences for surgical reconstruction between 2019 and 2024. All patients received the LD-SRS and PROMIS for completion before surgery. The LLRS-AIM index for patients was assessed by 2 independent evaluators, with intraclass correlation coefficients (ICCs) calculated to determine inter-rater agreement. Spearman correlations were performed between the LLRS-AIM Index with all LD-SRS and PROMIS domains. The Benjamini-Hochberg procedure was conducted to reduce the false discovery rate.

Results: A total of 81 patients were included in this study. The LLRS-AIM Index had good and near-perfect inter-rater reliability across different levels of medical training (ICC=0.9). Overall, there were no correlations between the LLRS-AIM Index with LD-SRS and PROMIS domains (LD-SRS function: P=-0.26, P=0.18; PROMIS pain interference: P=0.10, P=0.63). Mental health-related LD-SRS and PROMIS domains showed no correlations with the physician-reported LLRS-AIM index (LD-SRS self image: P=0.10, P=0.63; PROMIS depression: P=-0.05, P=0.63).

Conclusions: There is a high level of reproducibility for the LLRS-AIM index to evaluate the complexity of lower limb differences in pediatric patients. However, there are no correlations between the LLRS-AIM index with LD-SRS and PROMIS across all relevant domains. Further modifications to the LLRS-AIM index criteria and scoring weights may allow it to better assess patient outcomes in the pediatric population.

Level of evidence: Level III.

Keywords: LD-SRS; LLRS-AIM index; PROMIS; correlation; lower limb deformity; lower limb differences; patient-reported outcome measures.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Similar articles

See all similar articles

References

    1. Marshall S, Haywood K, Fitzpatrick R. Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract. 2006;12:559–568.
    1. Wilson I, Bohm E, Lübbeke A, et al. Orthopaedic registries with patient-reported outcome measures. EFORT Open Rev. 2019;4:357–367.
    1. Asher M, Min Lai S, Burton D, et al. The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine. 2003;28:63–69.
    1. Wajngarten D, Campos JÁDB, Garcia PPNS. The disabilities of the arm, shoulder and hand scale in the evaluation of disability—a literature review. Med Lav. 2017;108:314–323.
    1. Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the hip outcome score. Arthrosc. 2006;22:1304–1311.

LinkOut - more resources