Redefining Mental Health Assessment in Adolescent Idiopathic Scoliosis using PROMIS Psychological Well-Being Measures.

STUDY DESIGN: Prospective. OBJECTIVE: To evaluate the construct validity of PROMIS Positive Affect (PA), Life Satisfaction (LS), and Meaning & Purpose (MP) measures compared to the SRS-22 in AIS patients and determine whether these measures capture distinct aspects of mental health not adequately assessed by traditional instruments. SUMMARY OF BACKGROUND DATA: Traditional AIS mental health assessment focuses on psychopathology, but optimal well-being requires positive psychological functioning too. PROMIS PA, LS, and MP measures need validation in AIS populations and may capture patients who can benefit from interventions prior to AIS treatment to optimize outcomes. METHODS: This prospective cohort study enrolled 93 AIS patients (mean age 13.8±1.8 years, 78.5% female) at a single institution. Patients completed PROMIS PA, LS, MP, Anxiety, and Depression measures alongside the SRS-22 questionnaire at baseline. Construct validity was assessed using Spearman correlations. Agreement between PROMIS measures (threshold t-score <45 for LS, MP, and PA and >55 for depression and anxiety) and SRS-22 Mental Health domain (threshold <3.5) for detecting suboptimal well-being was evaluated using Cohen's kappa (κ) and logistic regression. RESULTS: PROMIS measures demonstrated moderate-to-strong correlation with SRS-22 Mental Health (|ρ| = 0.53-0.79) but weak correlation with other SRS-22 domains. Between 14-40% of patients with suboptimal PROMIS well-being scores had SRS-22 Mental Health scores indicating low depression risk. Agreement between measures was moderate (κ=0.47-0.77), with no measure significantly more likely to identify suboptimal mental health compared to the SRS-22. Among bracing patients, those with curves ≤30° had MP scores 10.9 (95% CI: 2.2-19.7) points higher than those with curves >50° (P=0.039). CONCLUSION: PROMIS well-being measures demonstrate acceptable construct validity in AIS patients while capturing unique variance not assessed by the SRS-22, identifying vulnerable patients with suboptimal positive functioning despite low psychopathology risk. LEVEL OF EVIDENCE: 2.

Duke Scholars

Author Cynthia Lea Green Biostatistics & Bioinformatics, Division of Biostatistics

Author Robert Lark Orthopaedic Surgery

Author Anthony Agostino Catanzano Jr. Orthopaedic Surgery