What a Patient Sees in the Mirror: Validation of the Truncal Anterior Asymmetry Scoliosis Questionnaire

ABSTRACT Introduction Self-image and body shape are important to adolescent idiopathic scoliosis (AIS) patients. The impact of scoliosis on anterior trunk shape has been incompletely studied. The Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) was developed to assess anterior truncal appearance concerns and mental preoccupation and behavioral modification related to those concerns. The purpose of this study is to validate TAASQ in AIS. Methods A total of 105 female surgical AIS patients (average age, 14.9 years; mean Cobb, 53°) completed the TAASQ, Spinal Appearance Questionnaire (SAQ), and Scoliosis Research Society Questionnaire (SRS-22) questionnaires. TAASQ was developed with breast cancer researchers and piloted in 13 perioperative adolescent and adult idiopathic scoliosis patients. TAASQ contains 14 questions, both response scale and free response. Questions are categorized into three domains: breast, appearance, and clothing. Internal consistency/reliability (Cronbach's α) and concurrent validity were determined. Results Internal consistency was 0.86, 0.77, and 0.84 for clothing, appearance, and breast domains, respectively (good to excellent). Domains and subdomains of the TAASQ correlate well with the image domain of the SRS-22 but not with the SAQ. However, given that the TAASQ was designed to assess concerns with anterior appearance, the correlation with the image domain establishes concurrent validity of the questionnaire. Conclusions TAASQ is a reliable and valid measure of the concerns and behavioral modifications related to anterior truncal appearance in female AIS patients. Further study of TAASQ will help clinicians counsel patients on the impact of surgery on anterior truncal deformity. Clinical Relevance There is a clinical lack of knowledge about the significant self-image and anterior body shape concerns of adolescent females with AIS. The TAASQ has been developed to assess concerns related to anterior truncal appearance and mental preoccupation and behavioral modification.