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Brox J. I., Lange J. E., Steen H.
Orthopedic Department, Rikshospitalet Oslo University Hospital, Oslo, Norway
Background: Comorbidity is common in patients with low back pain and is associated with a poorer prognosis, but this has not been evaluated in patients with idiopathic scoliosis.
Aim: To evaluate comorbidity and health-related quality of life in scoliosis patients.
Design: Cross-sectional study.
Setting: Outpatient clinic.
Population: Four hundred and ninety-six patients treated with Boston brace for idiopathic scoliosis were invited for long-term follow-up. 390 patients (361 women and 29 men) responded. Mean age was 39.2 (SD 4.6) years; mean follow-up time 23.4 (SD 4.3) years after brace weaning. Twenty-eight patients had been operated, 27 of these had long-term follow-up.
Methods: Radiographs at baseline, brace weaning, and follow-up. Validated questionnaires for evaluation of health-related quality of life including Scoliosis Research Society (SRS-22) and EuroQol (EQ-5D) were applied at follow-up.
Results: 122 (31%) patients reported that they had at least one comorbid condition at long-term follow-up. The most common diseases were: asthma (N.=14); migraine (N.=13); lower extremity disorders (N.=10); anxiety/depression (N.=9); allergy (N.=9); cardiovascular disease (N.=8); lumbar disc herniation (N.=8); neck pain or injury (N.=8); and widespread pain (N.=8). Age at bracing and at menarche, compliance, curve sizes, and the number of patients operated, were not different in those who did have and those who did not have comorbidity. Sixty-one percent with comorbidity versus 78% without (P<0.001) had excellent or good back function, and 57% versus 86% worked full-time. Those with comorbidity had significantly (P<0.001) worse SRS-22 scores for pain, function, self-image, and mental health, but not for satisfaction with bracing. Mean EQ-5D was 0.74 with comorbidity and 0.85 (normal for age and gender) without (P<0.001). Curve size was not significantly associated with any health-related quality of life outcome, while operated patients had worse SRS-22 scores for self-image and function (P=0.03).
Conclusion: About one-third of middle aged patients with idiopathic scoliosis reported to have at least one comorbid condition. Results indicate that comorbidity influences health related quality of life.
Clinical Rehabilitation Impact: Comorbidity should be considered when interpreting scores of health-related quality of life in patients with idiopathic scoliosis.