School Scoliosis Screenings: Family Experiences and Potential Anxiety after Orthopedic Referral

BACKGROUND: Prevalence of adolescent idiopathic scoliosis (AIS) is approximately 2-4% (Reamy & Slakey, 2001). Implementation of mass school screening programs for early detection of AIS has been utilized to prevent curve progression (Luk et al., 2010). Use of school scoliosis screenings (SSS) remains controversial, due to a high rate of false-positive referrals and excessive costs (Fong et al., 2010). Literature frequently alludes to child/parent experiences of anxiety resultant from SSS referrals as a reason to end SSS programs. No systematic study of SSS referral processes associated with anxiety in families has been conducted. AIMS: Knowledge of the level of psychological sequelae, particularly anxiety, subsequent to these referrals will inform SSS referral process overall costs/benefits to families. Enhanced understanding of the family’s experience during the SSS referral process will allow for improvement of the SSS process from a psychological perspective. METHODS: The study consisted of two groups – a patient group of patients from TSRHC (n=27) and a control group (n=27) between ages 9 and 17. One parent per participant also participated. All participants completed the primary outcome measure (State-Trait Anxiety Inventory) at two time points – before and after initial scoliosis evaluation for the patient group, and before and after a controlled wait period for the control group. Parents also completed a questionnaire rating their experience and satisfaction with the SSS referral process. RESULTS/CONCLUSIONS: Children and parents in the patient group experienced significantly elevated levels of state-anxiety upon arrival to the hospital than those in the control group. This supports the subjective concerns of anxiety experienced in families as voiced by researchers evaluating SSS programs. All participants reported a decline in their experience of state-anxiety from the start to end of their appointment, regardless of evaluation outcome. This suggests a certain amount of anticipatory anxiety may be present when arriving to the hospital that declines with comfort with the hospital/staff members. Children and parents in the patient group not diagnosed with AIS experienced a significant decline in state-anxiety from pre to post, when controlling for trait-anxiety. Children and parents in the patient group diagnosed with AIS continued to report significantly elevated levels of anxiety. The control group also remained consistent in their reports of low anxiety from the beginning to end of appointment. Results reveal a high false-positive referral rate at 51.9% referred who were negative for an AIS diagnosis. Only 22% of those referred required treatment at this time. More than half (55.5%) indicated that they did not receive information from the school about scoliosis or the referral/evaluation process. A third (33.3%) of the families who did receive information indicated the information did not adequately address their concerns. This lack of information dissemination may largely explain the presence of anxiety in these families that decreased by the end of their TSRHC appointment with the receipt of more information provided by the medical team. Results suggest that despite the experience of anxiety going into the appointment and despite the outcome of the appointment (diagnosis or not), families report overall satisfaction with SSS and appear to appreciate the value/benefit of the SSS program and the evaluation process. IMPLICATIONS: Results suggests families deem the costs of the referral process (emotional, financial, and time) as worth the benefits of the referral and evaluation process. Though researchers, legislators, and medical professionals were accurate in their perception of anxiety in families, it may not constitute a significant enough burden to consider it a reason for dismissal of SSS programs. A lack of information dissemination may largely explain the presence of anxiety in these families that decreased by the end of their TSRHC appointment with the receipt of more information provided by the medical team. This demonstrates and area of improvement for the SSS programs.