Defining Age-Stratified Baseline Norms for the Scoliosis Research Society (SRS)-22r Questionnaire in U.S. Adults

Survey-based, prospective study.

To establish a baseline range of SRS-22r, analyzing the impact of age and sex within the American population.

The Scoliosis Research Society-22r (SRS-22r) is a widely used PROM for evaluating satisfaction and quality of life in adult spinal deformity. However, normative age-stratified data, especially for adults over 80, remain limited. Establishing population-based SRS-22r values is essential for contextualizing outcomes and guiding treatment strategies.

A total of 658 participants were recruited in January 2025 through the Connect platform (CloudResearch) to complete a RedCap survey containing six demographic questions and the full SRS-22r. We targeted about 100 participants per decade and grouped them into four age cohorts: 18-39, 40-59, 60-79, and 80-89 years. Racial targets reflected U.S. Census distributions.

Of 658 participants, 599 remained after exclusions for prior surgery and incomplete data. Of these, 301 (50.2%) were female with a mean BMI of 26.7±6.2. The mean SRS-22r Total score was 3.9±0.7, with domain scores of Function 4.1±0.8, Pain 3.9±0.8, Self-Image 3.7±0.8, and Mental Health 3.7±0.9. ANOVA showed a U-shaped age effect, with the 18-39 and 80+ groups reporting higher scores across most domains (P<.01). Females had lower scores on all domains (P<.01). BMI correlated negatively with Total (r=-0.24), Self-Image (r=-0.34), and Function (r=-0.23) (all P<.001).

Baseline SRS-22r scores in U.S. adults are strongly shaped by age, sex, and BMI. Scores follow a clear U-shaped pattern, with the youngest and oldest adults reporting the best health, while higher BMI and female sex consistently predict lower scores. These benchmarks provide essential context for interpreting SRS-22r scores in adult spinal deformity.