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Investigating the potential psychological impact of early screening and long-term monitoring for adolescent idiopathic scoliosis among patients and caregivers

Department of Orthopaedics & Traumatology

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Dr K Kwan Applications accepted all year round Funded PhD Project (Students Worldwide)

About the Project

Scoliosis is a three-dimensional deformity of the spine. The commonest form, adolescent idiopathic scoliosis (AIS) develops in puberty and may progress during adolescence. School screening for AIS allows early detection of spinal curvatures and non-surgical treatment with spinal bracing has been proven to control curve progression. However, school screening and subsequent repeated monitoring in adolescence remain controversial in many countries. One of the key concerns is the potential psycho-social impact of early AIS detection has on patients and their caregivers. Although healthcare professionals have been aware of the psychological effects AIS patients and their caregivers may suffer, research available on this subject is scarce. Some of the negative psychological impact may also be a result of the misconceptions surrounding the diagnosis which can manifest as low uptake rates to screening and poor compliance to treatment. Previous research has demonstrated that AIS is an independent risk factor for development of depression, and feelings of isolation, denial and distress have been reported by at least 40% of patients and their guardians in the early stages of treatment. Other studies have also established the potential to review and revise chronic illness management models effectively after surveying the needs of patients. The Family Asthma Management System Scale was developed to assess asthma knowledge and management practices of asthmatic children and their caregivers while a questionnaire was developed to assess patient knowledge and misconceptions of osteoarthritis. Hence, in this study we will determine the psycho-social impact of early screening and long-term monitoring for AIS. We will prospectively study patients newly referred to a tertiary clinic through the school screening program, based on their scoliosis severity coupled with idiosyncratic psychological characteristics, social behaviour, and family circumstances, to dissect the psychosocial domains which may be impacted. Patients and their caregivers will be given questionnaires at four different time points during their two-year follow-up to build a prospective regression model with baseline measures predicting the impact of AIS screening on the patients’ psychological well-being and health behaviours. Parental anxiety and change in upbringing behaviour will be examined as moderators of the children’s mental state. In addition to examining the aforementioned psychosocial variables, we will also conduct psychometric testing on a new scale – Scoliosis Misconception Scale, aka SMS, to assess patient understanding about etiology, symptoms, effect and treatment of AIS. Lists of items will be derived according to our local health professionals’ clinical observations and only the most relevant items will be selected through exploratory factor analysis. A systematic scoring method will be established to ensure the validity and reliability of the scale. The results of this study will provide direct evidence on the psychosocial effects for patient who underwent school screening for AIS. Findings will facilitate targeted approaches to address specific psycho-social impact of scoliosis and its treatment, heighten compliance to long-term monitoring and prevention of scoliosis progression, and help clinicians tailor the patient-provider experience to improve the current clinical care model.

Dr Kenny Kwan is a Clinical Assistant Professor and Honorary Associate Consultant at the Department of Orthopaedics and Traumatology, Queen Mary Hospital and The University of Hong Kong. He obtained his undergraduate medical degree at the University of Oxford Medical School in 2002. He became a fellow of the Royal College of Surgeons of England in 2011. His research interests are in magnetically controlled growing rods in early onset scoliosis, non-neurologic complications after surgical correction of adult spinal deformity and intraoperative changes in intraocular pressure in prone spine surgery. Dr. Kwan obtained several prized and awards: Li Po Chun Charitable Trust Fund – Visiting Fellowship to Division of Spine Surgery, Washington University School of Medicine in St Louis, USA AOSpine East Asia Fellowship – National Centre for Spinal Disorders, Budapest, Hungary in 2014. He obtained HKOA Spine Chapter Travelling Fellowship – North American Spine Society Annual Meeting, New Orleans.

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