Ceiling effects in the EOSQ-24 may limit its ability to assess treatment outcomes in early-onset scoliosis.

BACKGROUND: The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) is a condition-specific instrument to assess health-related quality of life in children with early-onset scoliosis (EOS). Previous studies have raised concerns regarding ceiling effects, i.e. clustering of scores at the upper limit, which may reduce the ability of the EOSQ-24 to detect clinical improvements.

METHODS: A structured review of published clinical studies reporting EOSQ-24 scores was performed. Data were standardized to a 0-100 scale. For each domain weighted mean scores, standard deviations (SD), and ceiling effect percentages were calculated. A ceiling effect ≥ 15% was considered significant.

RESULTS: Data from 16 studies were included. Significant ceiling effects were observed in the following domains: pulmonary function (28%), physical function (25%), overall satisfaction (22%), transfer (20%), financial burden (22%), daily living (18%), fatigue/energy level (18%), and emotion (16%). Lower ceiling effects were noted in general health, pain/discomfort, parental burden, and child/parent satisfaction domains.

CONCLUSIONS: Eight of EOSQ-24 domains exhibit marked ceiling effects, potentially limiting responsiveness to treatment effects in patients with high baseline function. These findings support consideration of revised scoring strategies or adjunctive measures in EOS outcome assessment. The presence of marked ceiling effect should be noted as a limitation in studies. Objective pulmonary function testing should be implemented in future studies.