The SRS-22r Outcome Questionnaire
Short answer. The SRS-22r is a 22-item questionnaire from the Scoliosis Research Society. It measures function, pain, self-image, mental health, and satisfaction with treatment. Each item is scored from 1 (worst) to 5 (best), and each domain score is the average of its items. In adult deformity surgery, a change of about 0.4 points is commonly treated as clinically meaningful, with some important caveats.
What does the SRS-22r measure?
| Domain | Items | Internal consistency (Cronbach's α) |
|---|---|---|
| Function/activity | 5 | 0.83 |
| Pain | 5 | 0.87 |
| Self-image/appearance | 5 | 0.80 |
| Mental health | 5 | 0.90 |
| Satisfaction with management | 2 | 0.73 |
The subscore (or total) is usually calculated from the first four domains, without satisfaction. Population-based normative data exist for adolescents and adults. The SRS-22r is also part of the core outcome set for spinal deformity.
How is it scored?
Each domain score is the mean of the items answered, on a 1–5 scale. Ceiling effects of 20–44% have been reported, which limits sensitivity in patients who are only mildly affected.
What is a clinically meaningful change?
In 1,321 adults having deformity surgery, Crawford and colleagues (2015) concluded that the minimal clinically important difference (MCID) can be estimated at 0.4. That corresponds to a one-step change on two of the five items in a domain. Other reports give different values:
- A systematic review: 0.43–0.94
- A 2024 ROC-based analysis in operated adult deformity patients: 0.64
Values for adolescent idiopathic scoliosis differ substantially by domain.
Caveat: Kelly and colleagues (2018) found that the minimum detectable measurement difference exceeds 0.4 for the Pain domain (0.6) and the Self-Image domain (0.5). On those domains, a 0.4 change may fall within measurement noise. Detectable differences also vary with age and baseline disability.
How is the SRS-22r used in adult deformity research?
In the NIH-funded ASLS trial, surgery improved the SRS-22 score by 0.7 points more than non-operative care in the as-treated analysis. About 86% of operative patients reached the MCID, compared with about 39% of non-operative patients. Across deformity types, self-image is the most impaired domain before surgery and improves the most afterward. Patient satisfaction correlates more strongly with self-image improvement (r = 0.64) than with radiographic correction.
Where can I get the questionnaire?
The official SRS-22r forms, translations, and scoring instructions are hosted by the Scoliosis Research Society at srs.org/Research/Patient-Outcome-Questionnaires. Do not reproduce the questionnaire items on diebo.com. Link to SRS instead, and follow SRS terms for research use.
Using it in clinical care
Sources
- Crawford, C. H., et al. "The Minimum Clinically Important Difference in SRS-22R Total Score, Appearance, Activity and Pain Domains After Surgical Treatment of Adult Spinal Deformity." Spine, 2015. †
- Kelly, M. P., et al. "Minimum Detectable Measurement Difference for Health-Related Quality of Life Measures Varies With Age and Disability in Adult Spinal Deformity." Spine, 2018. †
- Lai, S. M., et al. "Identification of Scoliosis Research Society-22r Health-Related Quality of Life Questionnaire Domains Using Factor Analysis Methodology." Spine, 2010. †
- Kelly, Michael P., et al. "Operative Versus Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis." Journal of Bone and Joint Surgery (Am), 2019. †