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RehabMeasures Instrument

Bad Sobernheim Stress Questionnaire - Brace

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Purpose

Estimates the psychological stress adolescent scoliosis patients have due to wearing a brace.

Link to Instrument

Instrument Details

Acronym BSSQ-Brace

Area of Assessment

Quality of Life
Stress & Coping

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • Number of items in the instrument: 8 items
  • Minimum and maximum scores: 0 is minimum, 24 is maximum
  • Brief description of item scoring: 0 is high stress and 3 is no stress
    0 - completely true
    1 - nearly true
    2 - hardly true
    3 - not true at all
  • Administration instructions: N/A
  • No manualization of administration or scoring instructions

Number of Items

8

Equipment Required

  • Paper and Pencil

Time to Administer

5-10 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Tiffany Lin, Ashley Maldonado, and Alison Yum

ICF Domain

Body Function

Measurement Domain

Emotion

Musculoskeletal Conditions

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Standard Error of Measurement (SEM)

Chinese Adolescents with Idiopathic Scoliosis: (Xu et al., 2015; n = 86; mean age = 13.5 years; idiopathic scoliosis; wearing a brace > 12 h/d for 3 months; Risser signs I-IV, Cobb angle = 20.8 to 45.8; adolescents)

  • SEM for entire group: 1.14

Minimal Detectable Change (MDC)

Chinese Adolescents with Idiopathic Scoliosis: (Xu et al., 2015)

  • MCD for entire group: 1.49

Cut-Off Scores

German Adolescents with Brace Treatment: (Botens-Helmus, Kelin, & Stephan, 2006; n = 62; mean age = 14.5 (SD = 1.66); adolescent idiopathic scoliosis, average Cobb angle of 40° (SD = 1.66), average Cobb angle in brace 27.7° (SD 20.6); German adolescents)

  • Score of 0-8: “strong” stress

  • Score of 9-16: “medium” stress

  • Score of 17-24: “little” stress

Normative Data

Spanish Adolescents with Idiopathic Scoliosis: (D’Agata, Testor & Rigo, 2010; n = 35; mean age = 13 years (SD = 1.4 years); adolescent idiopathic scoliosis; wearing the Ringo System Chêneau Brace for 14 months on average; mean Cobb angle of the major curve = 35.42 degrees; Spanish adolescents)

  • Average value of BSSQ: 11.7 (SD 4.8)

Polish Adolescents with Idiopathic Scoliosis: (Misterska, G?owacki, & Harasymczuk, 2009; n = 35; median age = 14.8 years old (SD = 1.5 years); idiopathic scoliosis; wearing the Cheneau brace for an average of 16.1 months (SD = 11.7) for 14.9 hours a day (SD = 3.2); mean Cobb’s angle 27.8 degrees (SD = 7.4); Polish, female adolescents)

  • Questionnaires filled for first time: Median score obtained by means of the Polish version of the BSSQ-Brace was 11.3, SD = 4.7, interpreted as medium stress

  • Questionnaires filled for second time: Median score was 10.9 SD = 4.6

  • Median scores on the BSSQ-Brace ranged from 0.9 to 2.5

  • Most patients (82%) experience high or medium stress

  • 17.1% of patients reported little stress caused by wearing the brace

  • 60.0% of patients reported some stress caused by wearing the brace

  • 22.9% of patients reported severe stress from wearing the brace

Chinese Adolescents with Idiopathic Scoliosis: (Xu et al., 2015)

  • Stress levels related to deformity and brace wearing in AIS patients under brace treatment

  • Average = 13.4

  • Little stress level: n = 13

  • Medium stress level: n = 63

  • Strong stress level n = 10

  • SD: 3.6

  • Max: 21

  • Min: 3

Test/Retest Reliability

Spanish Adolescents with Idiopathic Scoliosis: (D’Agata et al., 2010)

  • Excellent test-retest reliability: r = 0.90, n = 32, p < 0.01, n = 32

Polish Adolescents with Idiopathic Scoliosis: (Misterska et al., 2009)

  • Excellent: Cronbach's alpha = 0.82

Chinese Adolescents with Idiopathic Scoliosis: (Xu et al., 2015)

  • Excellent: Cronbach's alpha = 0.80

German Adolescents with Brace Treatment: (Botens-Helmus, et al., 2006, taken at first presentation and 3 days later)

  • Adequate reliability: (ICC = .88)

Turkish Adolescents with Idiopathic Scoliosis (Yilmaz, Kuru, & Yavuzer, 2012; n = 38; mean age = 13.47 years (2.93 years); idiopathic scoliosis; mean Cobb angle = 39.05 (11.17 degrees); Turkish adolescents)

  • Excellent: test-retest reliability

Analysis of the scores, collected twice one week apart:

  • First collection r = 0.647 (p = 0.003)

  • Second collection r = 0.978 (p = 0.001)

Internal Consistency

Spanish Adolescents with Idiopathic Scoliosis: (D’Agata et al., 2010)

  • Good: Cronbach's alpha = 0.81

Polish Adolescents with Idiopathic Scoliosis: (Misterska et al., 2009)

  • Excellent: Cronbach's alpha 0.80

Chinese adolescents with Idiopathic Scoliosis (Xu et al., 2015)

  • Excellent: Cronbach's alpha = 0.80

German Adolescent with Brace Treatment: (Botens-Helmus et al., 2006)

  • Excellent: Cronbach’s alpha = 0.97

*Scores higher than .90 may indicate redundancy in the scale questions

Turkish Adolescents with Idiopathic Scoliosis (Yilmaz et al., 2012)

  • Excellent: Cronbach's alpha = 0.88

Construct Validity

Spanish Adolescents with Idiopathic Scoliosis: (D’Agata et al., 2010)

  • Excellent convergent validity of BSSQ(brace).es and SRS-22 (r = 0.656, p < 0.01)

  • Adequate convergent validity of BSSQ(brace).es and SRS-22 scale: Function (r = 0.43, p = 0.05)

  • Adequate convergent validity of BSSQ(brace).es and SRS-22 scale: Pain subscale (r = 0.37, p = 0.05)

  • Excellent convergent validity of BSSQ(brace).es and SRS-22 scale: Self Image (r = 0.60, p = 0.01)

  • Adequate convergent validity of BSSQ(brace).es and SRS-22 scale: Satisfaction (r = 0.45, p = 0.05)

Chinese Adolescents with Idiopathic Scoliosis: (Xu et al., 2015)

  • Adequate convergent validity of the relationship between BSSQ-Brace and SRS-22: r = 0.48

  • Adequate convergent validity of function: r = 0.33

  • Poor convergent validity of pain: r = 0.29

  • Adequate convergent validity of self-image: r = 0.37

  • Adequate convergent validity of mental health: r = 0.32

Floor/Ceiling Effects

Spanish Adolescents with Idiopathic Scoliosis: (D’Agata et al., 2010)

  • Excellent no floor or ceiling effects

Polish Adolescents with Idiopathic Scoliosis: (Misterska et al., 2009)

  • Excellent no ceiling effect

  • Adequate floor effect occurred in the second filling of the questionnaire and only applied to one patient representing 2.9% of patients

Chinese Adolescents with Idiopathic Scoliosis: (Xu et al., 2015)

  • Adequate ceiling and floor effects of < 5% which indicated that items measured the extent of the problem properly

German Adolescents with Brace Treatment: (Botens-Helmus, et al., 2006)

  • Excellent no ceiling effects

 

Bibliography

Botens-Helmus, C., Klein, R., & Stephan, C. (2006). The reliability of the Bad Sobernheim Stress Questionnaire (BSSQbrace) in adolescents with scoliosis during brace treatment. Scoliosis, 1, 22.

D’Agata, E., Testor, C. P., & Rigo, M. (2010). Spanish validation of Bad Sobernheim Stress Questionnaire (BSSQ (brace).es) for adolescents with braces. Scoliosis, 5, 15.

Misterska, E., G?owacki, M., & Harasymczuk, J. (2009). Polish adaptation of Bad Sobernheim Stress Questionnaire-Brace and Bad Sobernheim Stress Questionnaire-Deformity. European Spine Journal, 18(12), 1911.

Xu, X., Wang, F., Yang, M., Huang, Q., Chang, Y., Wei, X., Bai, Y., & Li, M. (2015). Chinese adaptation of the Bad Sobernheim Stress Questionnaire for patients with adolescent idiopathic scoliosis under brace treatment. Medicine, 94(31).

Yilmaz, H. G., Kuru, T., & Yavuzer, G. (2012). Turkish adaptation and reliability of Bad Sobernheim Stress Questionnaire in adolescents with idiopathic scoliosis using spinal brace. Turkiye Fiziksel Tip Ve Rehabilitasyon Dergisi-Turkish Journal of Physical Medicine and Rehabilitation, 58(3), 225–228.