Comparison of simultaneous static standing balance data on a pressure mat and force plate in typical children and in children with cerebral palsy.

BACKGROUND: Balance testing is an important component in treatment planning and outcome assessment for children with Cerebral Palsy (CP). Objective measurement for static standing balance is typically conducted in motion labs utilizing force plates; however, a plantar pressure mat may prove to be a viable alternative for this type of balance assessment. METHODS: This study examined static standing balance simultaneously on a force plate and a plantar pressure mat in 30 typically developing (TD) and 30 children with CP to determine if valid measures of static standing balance could be obtained in children with CP using a pressure mat. RESULTS: Examination of the data provided evidence that reliable and valid measures of static standing balance can be produced with a plantar pressure mat for both groups. Five variables out of the 21 variables examined were found to be reliable and valid on both devices (pressure mat and force plate) for both subgroups (TD and CP). The variables medial/lateral (ML) average radial displacement, range moved-ML, anterior/posterior average velocity, ellipse area, and area per second were found to have high test-retest reliability (ICC > .6) and possess discriminant validity between the subgroups (TD vs. CP). Additionally, the ellipse area and area per second variables also had the ability to discriminate between GMFCS levels. A normative center of pressure (CoP) balance data set using all 21 variables was also established for typically developing children for both devices (pressure mat and force plate) within this study. SIGNIFICANCE: The ability to utilize a portable plantar pressure mat for quick and reliable standing balance measurement allows for expanded ability to capture objective data in a variety of settings thereby increasing opportunity for outcomes analysis.

Rectus Femoris Transfer Versus Rectus Intramuscular Lengthening for the Treatment of Stiff Knee Gait in Children With Cerebral Palsy.

BACKGROUND: Rectus femoris transfer (RFT) is used to treat stiff knee gait in spastic cerebral palsy. Recently, rectus femoris lengthening has been reported as treatment for stiff knee gait. The purpose of this study was to compare short-term outcomes of 2 surgical procedures. METHODS: A retrospective chart review of 23 patients (42 limbs) with diplegic spastic cerebral palsy who had undergone rectus femoris intramuscular lengthening for treatment of stiff knee gait with a Gross Motor Function Classification System level I, II, or III was completed. These patients were matched with a cohort of 23 patients (42 limbs) who had undergone RFTs based on age, sex, Gross Motor Function Classification System level, diagnosis, preoperative Gait Deviation Index, and any simultaneous surgeries. Preoperative and 1 year postoperative motion analysis data and physical examination were compared. RESULTS: There were no significant differences in demographics between the groups. On physical examination, a positive postoperative Duncan-Ely test was seen significantly less often in the transfer limbs (20 vs. 37). Average postoperative quad tone score was 1.56 for the transfer group compared with 2.19 for the lengthening group. No significant postoperative difference was seen between groups in stride length, walking speed, cadence, knee flexion at initial contact, peak knee flexion during loading response, mean knee flexion in stance, peak knee flexion in swing, time to peak knee flexion (% swing), time to peak knee flexion (% gait cycle), Gait Deviation Index or total knee range of motion. There was a difference in time to achieve 90 degrees passive knee flexion with the lengthening group reaching this in 8.3 days and transfer group in 15.3 days (P<0.0001). CONCLUSIONS: Motion analysis parameters showed results of RFT and rectus femoris intramuscular lengthening to be equivalent 1 year postoperatively. Since rectus femoris lengthening is technically less difficult and rehabilitation faster, rectus femoris lengthening may be preferred if long-term follow-up supports these findings. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy.

AIM: The purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes. This study also investigated changes in GDI in children with spastic CP after surgery. METHODS: Data from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs. RESULTS: Differences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted. CONCLUSION: This paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients.

Preventing distracted driving among college students: Addressing smartphone use.

Based on the National Highway Traffic Safety Association's (NHTSA) Report, fatalities due to distracted driving are on the rise and the highest proportion of fatalities by age group is the 20-29 year old category. To date little has been done to educate college students about the dangers of distracted driving and engage these students in promoting a safe driving culture. Intervening among college students has the potential for making real-time behavior change, can foster a lifetime of safe driving habits among these students, and can help contribute to a culture of safe driving that can be created and sustained through positive messages from peers. The goals of this study were to develop, implement and evaluate a distracted driving presentation for college students to change knowledge, attitude and behavior on distracted driving. A 30-min, multi-media presentation on distracted driving was presented to 19 colleges and universities, totaling 444 college students (mean age 23.7±7.0 years of age, 61% females, 39% males). Students completed three surveys: prior to the workshop (interview 1), immediately after the workshop (interview 2), and 3 months following the workshop (interview 3). We assessed changes between interview 1 and interview 2 and found 15 of the 15 attitude-knowledge based questions significantly improved after the course. In addition, we assessed changes from interviews 1 and 3, and found 11 of the 15 attitude-knowledge based questions maintained their significance. Responses to behavior related questions at three months were also compared to baseline, and significant improvements were found for 12 of the 14 questions. While this study was successful in improving the short-term attitude-knowledge and behaviors on distracted driving, work is needed to sustain (and evaluate) long-term effects.

Low 25-Hydroxyvitamin D Levels in Children with Spina Bifida.

OBJECTIVE: To determine vitamin D status in children with spina bifida (SB). METHODS: Charts of all patients with SB at the Shriners Hospital for Children in Houston, Texas, seen between July 2011 and June 2013 were retrospectively reviewed. Daily intake of milk, vitamins, amount of screen time, and time spent outdoors were recorded along with height, weight, body mass index, and serum vitamin D levels. RESULTS: A total of 38 patients were identified. The mean level of vitamin D was 58.8 nmol/L (23.5 ng/dL); 30 (81%) had insufficient levels, 50 to 75 nmol/L (20 to 30 ng/mL), or deficient levels, <50 nmol/L (<20 ng/mL). African American and Hispanic descent correlated with decreased levels (P = 0.017). Daily vitamin D supplementation correlated with increased levels (P = 0.046). CONCLUSIONS: Most children with SB have suboptimal vitamin D levels. Despite living in a sunny climate and spending at least 15 minutes per day outdoors, children with SB have suboptimal vitamin D levels. Healthcare providers should consider the routine measurement of vitamin D levels and advise supplementation accordingly in this patient population.

Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature.

BACKGROUND: Ankle valgus is frequently encountered in skeletally immature patients in association with a variety of musculoskeletal disorders. Guided growth with temporary medial malleolar transphyseal screw (MMS) hemiepiphysiodesis is an established surgical treatment capable of correcting the angular deformity, but is often complicated by symptomatic screw head prominence and difficult hardware removal. Tension-band plate (TBP) hemiepiphysiodesis has recently been advocated as an alternative; however, the relative efficacy of these 2 techniques has not been directly investigated. Thus, the purpose of this study was to compare MMS and TBP in treatment of pediatric ankle valgus deformity. METHODS: Medical records and radiographs of all patients undergoing distal tibial medial hemiepiphysiodesis for ankle valgus between January 1, 2005 and November 1, 2010 at a pediatric orthopaedic specialty hospital were retrospectively reviewed. Radiographs obtained preoperatively and at 6-month intervals postoperatively were reviewed and the tibiotalar angle was measured. Patient age, sex, underlying diagnosis, concurrent surgical procedures, surgical and postoperative complications, and the presence or absence of symptomatic hardware complaints were documented. RESULTS: Sixty ankles in 42 patients met the inclusion criteria, with adequate radiographs and minimum postoperative follow-up of 12 months (mean: 34 mo). Thirty-five ankles were treated with MMS, and 25 with TBP. Good mean correction of the tibiotalar angle was achieved in both groups (MMS: pre-77.1 degrees to post-87.8 degrees over 25.2 mo; TBP: pre-81.3 to post-87.6 over 20.0 mo). The mean rate of correction was faster in ankles treated with MMS than TBP, but differences did not reach statistical significance (0.55 vs. 0.36 degrees/mo, respectively; P=0.057). Complications included 6 hardware-related surgical complications in MMS ankles (17.1%) and 1 in TBP ankles (4.0%). The incidence of symptomatic hardware complaints was low in both groups (MMS, 5.7%; TBP, 0%). CONCLUSIONS: Both MMS and TBP techniques can result in successful correction of ankle valgus in the growing child. Although the rate of deformity correction may be faster with MMS, TBP seems to be associated with fewer hardware-related complications. This information may aid the clinician in selecting the surgical option most appropriate for each individual patient. LEVEL OF EVIDENCE: Level II-retrospective study.

Risk factors for vitamin D deficiency in children with osteogenesis imperfecta.

BACKGROUND: The purpose of this study was to evaluate the prevalence of vitamin D deficiency and possible risk factors influencing the vitamin D serum levels in patients with osteogenesis imperfecta (OI). METHODS: Charts of all children with OI seen at Shriners Hospitals for Children in Houston, TX, between November 2008 and June 2011 were reviewed for daily milk and soda consumption, multivitamin and vitamin D supplementation, time spent outside, use of sunscreen, amount of screen time, ambulatory status, height, weight, body mass index (BMI), serum 25 hydroxyvitamin D (25OHD), parathyroid hormone levels, and history of bisphosphonate treatment. RESULTS: Of the 80 children with OI, charts of 44 children (26 female) had documentation of the variables of interest. Mean level of 25OHD was 23 ng/mL (±11) (range, 7 to 58) and 35 (79.5%) patients had insufficient or deficient levels. Significant correlations with low vitamin D levels were found for older age (P<0.001), African American descent (P=0.01), BMI (P<0.001), BMI percentile (P=0.30), consumption of soda (P=0.009), and pamidronate therapy (P=0.004). Evaluated together, the studied variables accounted for a large proportion of the variability of 25OHD levels in patients with OI (P=0.004). CONCLUSIONS: To optimize bone health in children with OI, health care providers need to be aware of patients' risk factors for low vitamin D levels and educate families on the modifiable risk factors of milk and soda consumption, obesity, and vitamin D supplementation. Future research is needed to address the relationship between fractures and vitamin D levels in patients with OI and on the cause and effect relationship between bisphosphonate therapy and vitamin D. LEVEL OF EVIDENCE: Level II.

Correction and recurrence of ankle valgus in skeletally immature patients with multiple hereditary exostoses.

BACKGROUND: Ankle valgus is encountered in children with a variety of congenital musculoskeletal disorders, including multiple hereditary exostoses (MHE). Guided growth with temporary distal tibial medial hemiepiphysiodesis (DTMH) may correct the deformity; however, exostoses about the ankle commonly observed in MHE patients may hinder correction and increase the risk of recurrence. Thus, the purpose of this study was to review the outcomes of DTMH in treatment of ankle valgus in MHE versus other diagnosis (non-MHE). METHODS: Medical records and radiographs of patients undergoing DTMH for ankle valgus between January 1, 2005, and November 1, 2010, at a single pediatric orthopedic hospital were retrospectively analyzed. Radiographs obtained preoperatively and at 6-month intervals postoperatively were reviewed and the tibiotalar angle was measured. RESULTS: Fifty-eight ankles in 41 patients met inclusion criteria, with minimum follow-up of 12 months (mean, 34 months). Mean age was 10 years (range, 4-14 years). MHE was the most common underlying diagnosis (19 ankles, 33%). The rate of tibiotalar angle correction (mean ± standard deviation) with hardware in place was 0.37 ± 0.28 deg/mo in MHE ankles and 0.51 ± 0.42 deg/mo in non-MHE ankles (P = .161). Following hardware removal, the rate of recurrence was faster in MHE (0.29 ± 0.25 deg/mo) compared with non-MHE ankles (0.12 ± 0.19 deg/mo) (P = .059), and more total recurrent valgus deformity was observed in MHE (7.8 ± 8.2 degrees) than non-MHE ankles (3.4 ± 4.6 degrees) (P = .08) over a similar follow-up period (mean 23.4 vs 23.6 months, respectively), with differences approaching statistical significance. CONCLUSION: MHE is a common cause of ankle valgus in children. Guided growth interventions in this population can be successful but require special consideration given the potential for relatively gradual deformity correction and rapid recurrence following hardware removal in the skeletally immature. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Vitamin D sufficiency screening in preoperative pediatric orthopaedic patients.

BACKGROUND: Vitamin D is a critical factor in bone metabolism. Vitamin D levels in both children and adults have been reevaluated to assess standards for sufficiency and deficiency. In the adult population, the currently recommended level for Vitamin D sufficiency is greater than 32 ng/mL measured by 25-hydroxyvitamin D assay. Recommended levels for growing children have not been definitively determined; however, scales based on available literature have been used. The purpose of this study was to evaluate Vitamin D sufficiency in pediatric orthopaedic patients admitted to the hospital for surgical procedures which require bone healing. METHODS: Serum 25 hydroxyvitamin D (25 OHD) levels measured by immunochemoluminometric assay were obtained on consecutive pediatric orthopaedic patients admitted electively for long bone osteotomies or spinal fusions over a 10-month period. Seventy patients ranging in age from 2 to 19 years were screened for Vitamin D sufficiency. Vitamin D levels were examined for correlation with age, sex, ethnicity, body mass index (BMI), BMI percentile, orthopaedic diagnosis, and season. RESULTS: Total 90% of the screened patients had 25 OH vitamin D levels below 32 ng/mL. African American children were more likely to have severe Vitamin D deficiency (P=0.013). Vitamin D levels were lower in the winter months (P=0.046). When 20 ng/mL was used as a cutoff, the average age of children below this cutoff was higher than those above (P=0.018). There was no correlation of Vitamin D levels with sex, BMI, BMI percentile, residence in Mexico, and diagnosis. CONCLUSIONS: Total 90% of the children in the screening group were at risk for poor bone healing owing to Vitamin D deficiency or insufficiency. African American children, in particular, should be evaluated for Vitamin D sufficiency before orthopaedic surgeries. Further work must be done to determine the impact of Vitamin D insufficiency on surgical outcomes. LEVEL OF EVIDENCE: Diagnostic study, III.

Hemiepiphysiodesis for the correction of angular deformity about the knee.

BACKGROUND: It is generally accepted that the presence of angular deformity about the knee that persists into the preadolescent years will not correct spontaneously. The goal of this study was to review our experience with hemiepiphysiodesis and physeal stapling for the correction of angular deformity to establish the efficacy of these procedures and to determine their indications and the rate of correction. METHODS: A retrospective review of 48 patients undergoing hemiepiphysiodesis or physeal stapling about the knee was performed. Patients were included if they had at least 2 years of documented follow-up without an osteotomy. RESULTS: The average follow-up was 30.4 months (range, 24-52 months). Genu varum was identified in 33 patients, genu valgum in 14 patients, and a windswept deformity in 1. Of the 52 limbs with genu varum, 35 were secondary to Blount disease. The group with genu varum unrelated to Blount disease presented a change in the mechanical axis from a mean of -32 degrees at surgery to a mean of - 13 degrees. The patients with Blount disease presented a change in the mechanical axis from a mean of -19 degrees at surgery to a mean of -16 degrees. The group with genu valgum presented a change in the mechanical axis from a mean of 20 degrees at surgery to a mean of 2 degrees. CONCLUSIONS: Hemiepiphysiodesis is an effective means for correcting angular deformity about the knee in skeletally immature patients with both genu valgum and genu varum, so long as the genu varum is unrelated to Blount disease. Hemiepiphysiodesis is effective in preventing the progression of deformity in patients with Blount disease. LEVEL OF EVIDENCE: Therapeutic-Level IV.

Pediatric outcomes data collection instrument scores in ambulatory children with cerebral palsy: an analysis by age groups and severity level.

BACKGROUND: The Pediatric Outcomes Data Collection Instrument (PODCI) was developed in 1994 as a patient-based tool for use across a broad age range and wide array of musculoskeletal disorders, including children with cerebral palsy (CP). The purpose of this study was to establish means and SDs of the Parent PODCI measures by age groups and Gross Motor Function Classification System (GMFCS) levels for ambulatory children with CP. METHODS: This instrument was one of several studied in a prospective, multicenter project of ambulatory patients with CP between the aged 4 and 18 years and GMFCS levels I through III. Participants included 338 boys and 221 girls at a mean age of 11.1 years, with 370 diplegic, 162 hemiplegic, and 27 quadriplegic. Both baseline and follow-up data sets of the completed Parent PODCI responses were statistically analyzed. RESULTS: Age was identified as a significant predictor of the PODCI measures of Upper Extremity Function, Transfers and Basic Mobility, Global Function, and Happiness With Physical Condition. Gross Motor Function Classification System levels was a significant predictor of Transfers and Basic Mobility, Sports and Physical Function, and Global Function. Pattern of involvement, sex, and prior orthopaedic surgery were not statistically significant predictors for any of the Parent PODCI measures. Mean and SD scores were calculated for age groups stratified by GMFCS levels. Analysis of the follow-up data set validated the findings derived from the baseline data. Linear regression equations were derived, with age as a continuous variable and GMFCS levels as a categorical variable, to be used for Parent PODCI predicted scores. CONCLUSIONS: The results of this study provide clinicians and researchers with a set of Parent PODCI values for comparison to age- and severity-matched populations of ambulatory patients with CP.

Relationships among functional outcome measures used for assessing children with ambulatory CP.

In ambulatory children with cerebral palsy (CP), practitioners often examine outcomes using measures related to functions necessary for daily life. The Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Outcomes Data Collection Instrument (PODCI) Parent and Child versions, Gillette Functional Assessment Questionnaire (FAQ) Walking subscale, Functional Independence Measure for Children (WeeFIM), Pediatric Quality of Life Inventory (PedsQL), temporal-spatial gait parameters, and O(2) cost during ambulation were selected for study. Cross-sectional data were collected in a prospective multicenter study of 562 participants with CP (339 males, 223 females), between 4 and 18 years of age (mean age 11y 1mo). There were 240 classified as Gross Motor Function Classification System Level I, 196 as Level II, and 126 as Level III. The tools that had the best interrelationships and underlying constructs predominately measured changes in physical function. These included portions of the FAQ, Parent PODCI, WeeFIM, and GMFM. GMFM Dimensions D and E exhibited a very strong relationship. Temporal-spatial gait parameters and O2 cost measures represented a different construct of physical function. The Child PODCI reports and both the Parent and Child PedsQL reports did not relate well to other measures, suggesting a pattern of answers not related to question content. The Parent PODCI, the FAQ Walking subscale, and GMFM Dimension E were found to be an appropriate minimum set of instruments for assessment of functional outcomes in patients with ambulatory CP.

Body mass index as a prognostic factor in development of infantile Blount disease.

BACKGROUND: Obesity has been associated with infantile Blount disease, yet no specific relationship has been established. The purpose of this study was to determine the relationship between body mass index (BMI) and the development of infantile Blount disease. METHODS: A retrospective study was performed reviewing charts and radiographs of 69 consecutive children between 2 and 4 years old who presented during a 5-year period with the diagnosis of idiopathic genu varum. RESULTS: Forty-nine of these children were noted to have physiological bowing that resolved. Twenty children were diagnosed with infantile Blount disease that required treatment. Logistic regression analysis compared the 2 groups and showed no statistical difference between their age at presentation and age of walking. An independent group Student t test showed a significant statistical difference for body weight, BMI percentile, and weight for height percentile between children with physiological bowlegs and Blount disease. A highly significant difference between the 2 groups was shown in the patient's BMI, proximal tibial metaphyseal-diaphyseal angle, and tibial femoral angle. Based on these data, criteria were established for predicting Blount disease: a tibial metaphyseal-diaphyseal angle greater than or equal to 10 degrees and a BMI greater than or equal to 22. Using these criteria, this prediction method has a sensitivity of 95%, specificity of 100%, true-positive predictive value of 100%, and true-negative predictive value of 98%. CONCLUSIONS: The establishment of a statistically significant relationship between BMI and infantile Blount disease will be helpful to the orthopaedic surgeon in deciding which children would benefit from early treatment of bowlegs. In addition, nutritional counseling can be emphasized for those at risk.

Functional significance of bone density measurements in children with osteogenesis imperfecta.

BACKGROUND: The treatment of osteogenesis imperfecta has been directed at improvement of bone mineral density, yet the importance of bone mineral density in predicting functional and clinical outcome in this patient population has not been demonstrated. We used a validated functional outcome measure to identify the relationship between bone mineral density and physical function in children with osteogenesis imperfecta, and we also evaluated the relationship of bone mineral density to the rate of surgery and fracture in patients with osteogenesis imperfecta. METHODS: Twenty patients (age range, four to seventeen years) with osteogenesis imperfecta who had undergone bone mineral densitometry as measured by dual x-ray absorptiometry of the lumbar spine, wrist, and proximal aspect of the femur between November 1999 and April 2001 were retrospectively analyzed. Functional outcome was measured with use of the Pediatric Outcomes Data Collection Instrument. These questionnaires were completed by the parents of all twenty patients and, in addition, by fifteen patients in the study who were between the ages of eleven and eighteen years. Fracture and surgery rates were calculated on the basis of the number of documented fractures and surgical procedures that the patient had had from the time of the initial presentation until the time of the latest follow-up visit. RESULTS: There were significant relationships between the bone mineral density of the lumbar spine and the scores obtained on the parent-completed questionnaires with regard to upper-extremity functioning (r = 0.57, p < 0.01), transfers and basic mobility (r = 0.55, p = 0.01), sports and physical functioning (r = 0.55, p = 0.01), and global functioning (r = 0.60, p < 0.004). There were also significant relationships between the bone mineral density of the wrist and the scores obtained on the child-completed questionnaires with regard to upper-extremity functioning (r = 0.82, p < 0.01), sports and physical functioning (r = 0.76, p < 0.01), and global functioning (r = 0.83, p = 0.001). There were significant negative relationships between the bone mineral density of the lumbar spine and the rate of fractures (r = -0.69, p < 0.001) and the bone mineral density of the lumbar spine and the rate of surgery (r = -0.60, p < 0.01). CONCLUSIONS: There is a relationship between bone mineral density and the functional outcome, rate of fracture, and rate of surgery in patients with osteogenesis imperfecta. Bone mineral density appears to be an indicator of disease severity and may be predictive of long-term functional outcome. To establish specific guidelines for treatment, more data on normative bone-mineral density in children with osteogenesis imperfecta will be needed.

The Pediatric Outcomes Data Collection Instrument (PODCI) and functional assessment of patients with unilateral upper extremity deficiencies.

The Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to quantify functional abilities of a group of unilateral upper extremity deficiency (U-UED) patients and compare them with "normal" control children. Sixty-four consecutive patients with U-UED were assessed. Parents and adolescent (ages 11-21) patients responded. Underlying diagnosis, amputation level, and type of prosthesis were recorded. Scores were compared for congenital versus traumatic etiologies for patients with various amputation levels, and for patients using prostheses versus those not using prostheses. In both parent and patient responses, PODCI scores were significantly lower than "normal" for upper extremity function and sports. Scores were similar for congenital and acquired amputees. Responses from adolescent patients showed progressively decreasing scores for upper extremity, transfers, sports, and global function with progressively proximal amputation levels. Patients using prostheses with different terminal devices did not significantly differ. Parent responses for prosthesis wearers showed lower comfort/pain scores (ie, increased pain) than non-prosthesis wearers, but no significant differences in function, including upper extremity function.

The Pediatric Outcomes Data Collection Instrument (PODCI) and functional assessment in patients with adolescent or juvenile idiopathic scoliosis and congenital scoliosis or kyphosis.

STUDY DESIGN: An initial examination of functional assessment scores in scoliosis and kyphosis populations. OBJECTIVE: Examination of scores from the Pediatric Outcomes Data Collection Instrument for patients with idiopathic scoliosis, congenital scoliosis, and congenital kyphosis, comparing scores with those of children without orthopedic disabilities. SUMMARY OF BACKGROUND DATA: Little information has been presented regarding performance of scoliosis patients on the Pediatric Outcomes Data Collection Instrument. METHODS: A total of 102 patients with adolescent idiopathic scoliosis, 47 with congenital scoliosis without kyphosis, and 9 with congenital kyphosis completed the Pediatric Outcomes Data Collection Instrument. Responses were compared with those from a "normal" population. Subgroup analyses were performed for patients with adolescent idiopathic scoliosis. A P value <0.05 was considered statistically significant. RESULTS: Scores in Transfers, Sports, Comfort, and Happiness were significantly lower than "normal" in adolescent idiopathic scoliosis. In congenital scoliosis without kyphosis, scores in all categories except Happiness were significantly lower than "normal." All category scores were significantly lower than "normal" in congenital kyphosis. In adolescent idiopathic scoliosis, age and curve location did not influence Comfort scores. Comfort scores were significantly lower than "normal" for all curve locations and for all ranges of Cobb angle. Happiness scores were significantly lower in adolescent idiopathic scoliosis patients with Cobb angles >50 degrees who had not received surgery when compared with either patients who had received surgery or patients with Cobb angles <50 degrees. CONCLUSION: These findings provide some normative values for the Pediatric Outcomes Data Collection Instrument for three specific diagnoses. Patients with adolescent idiopathic scoliosis, congenital scoliosis, and congenital kyphosis gave responses significantly different from "normal" children. Pain appeared to be a common finding with these diagnoses.