Validity, reliability, and responsiveness of SRS-7 as an outcomes assessment instrument for operatively treated patients with adult spinal deformity

Amit Jain, Virginie Lafage, Michael P. Kelly, Hamid Hassanzadeh, Brian J Neuman, Daniel Sciubba, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames, Justin K. Scheer, Douglas Burton, Munish C. Gupta, Robert Hart, Richard A. Hostin, Khaled M. Kebaish

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Study Design. A retrospective analysis. Objective. The aim of our study was to compare the normality, concurrent validity, internal consistency, responsiveness, and dimensionality of an item response theory-derived seven-question instrument (SRS-7), against the Scoliosis Research Society- 22r (SRS-22r) questionnaire in operatively treated patients with adult spinal deformity (ASD). Summary of Background Data. Compared with SRS-22r, SRS-7 (which has been validated in operatively treated patients with adolescent idiopathic scoliosis) has advantages of being short, unidimensional, and linear. Methods. A prospective database of ASD patients was queried for patients 18 years or older who were operatively treated, and who answered pre- and postoperative (at 2-year follow-up) SRS- 22r questions (n=276). Corresponding SRS-7 scores were calculated using answers to SRS-22r items 1, 4, 6, 10, 18, 19, and 20. Significance was set at a P value less than 0.01. Results. SRS-7 and SRS-22r were normally distributed preoperatively but not postoperatively. SRS-7 and SRS-22r scores had high correlation both preoperatively (r=0.76, P<0.01) and postoperatively (r=0.83, P<0.01). The internal consistency reliability Cronbach a values were 0.61 (SRS-7) and 0.83 (SRS- 22r) preoperatively and 0.91 (SRS-7) and 0.95 (SRS-22r) postoperatively. SRS-7 was found to be more responsive than SRS- 22r with measures of effect size: Cohen d=1.21 versus 1.13, Hedge g=1.21 versus 1.13, and effect size correlation r=0.52 versus 0.49. Iterative principal factor analysis of pre- and postoperative scores showed the presence of one dominant latent factor in SRS-7 (unidimensionality) and four latent factors in SRS-22r (multidimensionality). Conclusion. SRS-7 is a valid, reliable, responsive, and unidimensional instrument, which can be used as a short-form alternative to the SRS-22r for assessing global changes in patient-reported outcomes over time in patients with ASD.

Original languageEnglish (US)
Pages (from-to)1463-1468
Number of pages6
Issue number18
StatePublished - Sep 15 2016


  • Scoliosis Research Society questionnaire
  • adult spinal deformity
  • patient-reported outcomes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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