Short Term Health Related Quality of Life and Family Burden after Surgical or

Casting Treatment

Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi, David P. Roye, Behrooz A. Akbarnia, Sumeet Garg, James O. Sanders, David L. Skaggs, John T. Smith,

Michael G. Vitale, Children’s Spine Study Group, and Growing Spine Study Group

-Disclosures-1. Hiroko Matsumoto: A; Children's Spine Foundation, Scoliosis Research Society, Pediatric OrthopaedicSociety of North America, Cerebral Palsy Foundation. B; Children's Spine Foundation2. Nick Feinberg: None 3. Julie Yoshimachi: None3. David Roye Jr.: A; Children's Spine Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, Cerebral Palsy Foundation, BroadWater, Inc., OMeGA Medical Grants, Biomet. B; Travel: Stryker, Cerebral Palsy Foundation, JBJS Reviewer, Other: Cerebral Palsy Foundation, Other: CMO Children of China, Other: CEO President International Healthcare Leadership, Other: CMO Global Health Pass. E; Travel: Biomet, Travel: Medtronic, Travel: DePuy Synthes, Travel: Stryker.4. Behrooz Akbarnia: A; DePuy Spine, Nuvasive, Ellipse. B; Board: Growing Spine Foundation, Editorial: Journal of Orthopaedic Science, Nuvasive, K2M, Ellipse, K Spine, Board: Scoliosis Research Society, Editorial: Spine, Editorial: Spine Deformity. D; Alphatec Spine, Nuvasive, Ellipse, K Spine, Nocimed. F; DePuy, A Johnson & Johnson Company, K2M, Nuvasive, Springer5. Sumeet Garg: B; Medtronic6. James O. Sanders: B; Board: AAOS, Board: Pediatric Orthopaedic Society of North America, Board: Scoliosis Research Society. D; Abbott, Abbvie, GE Healthcare, Hospira7. David L. Skaggs: B; Biomet, Grand Rounds, Board: Growing Spine Foundation, Board: Growing Spine Study Group,Editorial Board: Journal of Children's Orthopaedics, Medtronic, Orthobullets, Board: Scoliosis Research Society, Editorial: Spine Deformity, Zipline Medical Inc.. C; Paid Presenter/Speaker: Johnson & Johnson, Paid Presenter/Speaker: Medtronic. F; Biomet, Wolters Kluwer Health Lippincott Williams & Wilkins8. John T. Smith: B; Biomet, Ellipse Technologies, Globus Medical, Spineguard, Synthes, Board: Children's Spine Foundation. F; Synthes9. M.G. Vitale: A; Children's Spine Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, Orthopaedic Science Research Foundation, BroadWater, Inc., OMeGA Medical Grants, Biomet, Board: Children's Spine Foundation, Board: Pediatric Orthopaedic Society of North America, Board: International Pediatric Orthopaedic Symposium. B; Stryker, Biomet. E; Travel: Biomet, Travel: Medtronic, Travel: DePuy Synthes, Travel: Stryker, Travel: Fox, Travel: Children's Spine Foundation.10. Children’s Spine Study Group: A; Children's Spine Foundation, DePuy Synthes11. Growing Spine Study Group: A; Growing Spine Foundation

• To describe the changes HRQoL and Family Burden of patients with EOS who underwent treatment with surgery or casting

Purpose: Retrospective Study

vs.

Design: Retrospective, multi-center study of HRQoL after surgery or casting, measured via the EOSQ-24

Participants: •Inclusion:

• Early Onset Scoliosis (EOS)• 3.0 – 9.9 years of age• Undergoing treatment with growing instrumentation, or casting• Able to Complete EOS Questionnaire (EOSQ-24) in English or

Spanish• Exclusion:

• Unable to complete EOSQ-24Outcomes: • Health-Related Quality of Life

− EOSQ-24 pre-treatment− EOSQ-24 at 6 months post-treatment− EOSQ-24 at 12 months post-treatment

Methods

Non-Idiopathic Patient CharacteristicsTotal (n) = 58 Casting Surgery P-value

Subjects (n) 9 49

Age@Index (yo) 2.8 ± 1.6 6.2 ± 2.8 <0.005

Gender 56% male 49% male

Cobb (deg) 54.0 ± 24.2 67.0 ± 18.1 0.065

Etiology

Congenital 2 17

Neuromuscular 4 20

Syndromic 3 12

Days between 1st and last intervention EOSQ

157.8 ± 63.9 418.3 ± 83.1 <0.001

Completed Pre-EOSQ (n)

9 49

Completed Post EOSQ (n)

9 48

Completed Post-Lengthening EOSQ (n)

- 39

Idiopathic Patient CharacteristicsTotal (n) = 22 Casting Surgery P-value

Subjects (n) 14 8

Age@Index (yo) 1.7 ± 1.2 8.5 ± 2.9 <0.001

Gender 57% male 22 % male

Cobb (deg) 50.1 ± 26.3 64.1 ± 16.8 0.19

Etiology IDIOPATHIC IDIOPATHIC

Days between 1st and last intervention EOSQ

291.1 ± 241.8 395.3 ± 76.1 0.25

Completed Pre-EOSQ (n) 14 8

Completed Post EOSQ (n) 14 8

Completed Post-Lengthening EOSQ (n)

- 6

Non-Idiopathic Surgery

Total Complications 15

Minor Complications 12

Major Complications 3

Results: Surgical ComplicationsIdiopathic Surgery

Total Complications 2

Minor Complications 2

Major Complications -

• No records of complications were kept for the casting groups

Results: Non-Idiopathic Casting PatientsTotal (n) = 9 Pre-EOSQ Post-EOSQ P-Value

HRQoL Subdomain

General Health 70.8 ± 26.4 66.7 ± 16.7 0.694

Pain/Discomfort 81.9 ± 13.3 77.8 ± 21.9 0.632

Pulmonary Function 87.5 ± 25 81.9 ± 22.9 0.629

Transfer 77.8 ± 32.2 66.7 ± 16.7 0.374

Physical Function 68.5 ± 39.0 51.9 ± 27.2 0.309

Daily Living 52.8 ± 42.8 39.1 ± 40.2 0.494

Fatigue/Energy Level 76.4 ± 32.5 63.9 ± 36.5 0.454

Emotion 87.5 ± 17.7 69.6 ± 18.7 0.054

Parental Burden 67.8 ± 26.6 55.3 ± 20.3 0.279

Financial Burden 61.1 ± 37.5 62.5 ± 21.6 0.924

Overall HRQoL 74.2 ± 21.9 62.2 ± 15.5 0.199

Overall Parental Domain 67.8 ± 26.6 55.3 ± 20.3 0.276

Overall Financial Domain 56.3 ± 36.9 62.5 ± 21.7 0.668

Results: Non-Idiopathic Surgery Patients

Total (n) = 49 Pre-EOSQ Post-EOSQ 3rd EOSQP-Value (Pre vs.

3rd EOSQ)

HRQoL Subdomain

General Health 67.3 ± 20.7 70.1 ± 19.6 68.9 ± 20.2 0.722

Pain/Discomfort 74.7 ± 22.9 74.2 ± 23.2 73.0 ± 22.5 0.727

Pulmonary Function 74.7 ± 22.9 85.4 ± 22.1 87.5 ± 17.7 0.005

Transfer 75.5 ± 28.9 77.2 ± 27.3 77.0 ± 24.9 0.799

Physical Function 65.3 ± 40.6 66.1 ± 33.9 72.0 ± 29.9 0.392

Daily Living 50 ± 33.4 50.8 ± 35.1 50.7 ± 33.4 0.926

Fatigue/Energy Level 67.8 ± 27.5 74.2 ± 24.5 69.6 ± 23.8 0.761

Emotion 76.1 ± 22.2 82.5 ± 20.8 73.2 ± 20.5 0.530

Parental Burden 58.1 ± 20.5 62.4 ± 23.2 61.9 ± 21.9 0.407

Financial Burden 65.6 ± 25.3 60.1 ± 34.1 60.5 ± 32.8 0.412

Overall HRQoL 66.8 ± 19.1 68.5 ± 19.7 68.0 ± 17.8 0.765

Overall Parental Domain 58.1 ± 20.5 62.4 ± 23.2 61.9 ± 21.9 0.407

Overall Financial Domain 65.6 ± 25.3 60.1 ± 34.1 60.5 ± 32.8 0.412

Results: Idiopathic Casting PatientsTotal (n) = 14 Pre-EOSQ Post-EOSQ P-Value

HRQoL Subdomain

General Health 73.2 ± 18.2 74.10 ± 17.9 0.897

Pain/Discomfort 91.9 ± 17.4 87.5 ± 14.9 0.474

Pulmonary Function 93.8 ± 11.3 87.5 ± 19.5 0.309

Transfer 98.2 ± 6.4 85.7 ± 18.2 0.02

Physical Function 88.1 ± 19.3 69.0 ± 22.6 0.02

Daily Living 82.1 ± 23.9 61.6 ± 12.9 0.009

Fatigue/Energy Level 84.6 ± 15.6 83.9 ± 14.5 0.905

Emotion 96.6 ± 7.7 89.3 ± 9.3 0.034

Parental Burden 78.7 ± 20.3 77.5 ± 19.2 0.878

Financial Burden 75 ± 29.9 69.6 ± 27.0 0.623

Overall HRQoL 85.2 ± 13.0 79.8 ± 9.7 0.224

Overall Parental Domain 78.7 ± 20.3 77.5 ± 19.2 0.878

Overall Financial Domain 75 ± 29.9 69.6 ± 27.0 0.623

Results: Idiopathic Surgery Patients

Total (n) = 8 Pre-EOSQ Post-EOSQ 3rd EOSQP-Value (Pre vs.

3rd EOSQ)

HRQoL Subdomain

General Health 82.8 ± 15.2 90.6 ± 10.4 77.1 ± 25.4 0.608

Pain/Discomfort 70.3 ± 26.5 64.1 ± 21.1 68.8 ± 23.7 0.911

Pulmonary Function 70.3 ± 26.5 87.5 ± 16.5 91.7 ± 9.3 0.08

Transfer 100 ± 0 91.7 ± 18.6 95 ± 10 0.177

Physical Function 95.2 ± 8.7 86.3 ± 12.7 95 ± 10 0.964

Daily Living 89.1 ± 14.6 89.1 ± 14.6 83.3 ± 18.6 0.529

Fatigue/Energy Level 90.6 ± 12.1 73.4 ± 26.8 70.8 ± 25.7 0.077

Emotion 81.3 ± 13.9 60.9 ± 15.9 79.2 ± 18.6 0.814

Parental Burden 79.0 ± 9.5 75.7 ± 10.5 75 ± 19.7 0.622

Financial Burden 45.8 ± 26.7 35.7 ± 32.3 37.5 ± 40.2 0.533

Overall HRQoL 81.9 ± 9.6 76.2 ± 9.1 78.6 ± 21.1 0.703

Overall Parental Domain 79.0 ± 9.6 75.7 ± 10.5 75 ± 19.7 0.622

Overall Financial Domain 45.8 ± 26.7 35.7 ± 32.3 37.5 ± 40.2 0.648

Result HighlightsEtiology Treatment Domain Change (%) P-Value

Idiopathic

Surgical

Pulmonary Function

+30 0.08

Fatigue / Energy Level

-22 0.077

Casting

Transfer -13 0.02

Daily Living -25 0.009

Physical Function

-22 0.02

Emotion -8 0.034

Non-IdiopathicSurgical

Pulmonary Function

+17 0.005

Casting Emotion -20 0.054

Conclusions

• Patients treated surgically (idiopathic and

not idiopathic) had an improved parental

impression of patient pulmonary function

but little change in other aspects of HRQoL

• By contrast, casting appears to be associated

with decreasing QoL scores in multiple

domains