The design of the study followed the validation process of trans-cultural adaptation. The research is aimed at validating the German BSSQ (mit Korsett) into Spanish (Additional File 1), as there are no questionnaires addressing to adolescents with bracing in this language. Vasiliadis E, Grivas TB, Gkoltsiou V (2006) and Botens-Helmus C, Klein R, Stephan C (2006) prepared two specific questionnaires for brace treated patients: Brace Questionnaire values the HRQL in adolescents with scoliosis during a brace treatment Bad Sobernheim Stress Questionnaire (BSSQ (mit Korsett)) measures the Stress produced by brace in adolescent with Idiopathic Scoliosis. Д«riefly, these are the reasons which have led to assessing HRQOL and stress in brace treated patients. Receiving an individual and/or family psychological treatment,. Having a mother who takes a positive attitude towards her own daughter's scoliosis

Living in an ordinary family rather than living in a single parent family However, researchers reveal that there are some protective factors for treatment outcomes in adolescents with bracing, such as: Psychological stress is a cause of concern for professionals as it can negatively correlate with no compliance treatment. Above all in female adolescents, bracing generally correlates with a poor Body Image at a time when it is normally changing and evolving into an adult identity. So, bracing is considered a further stressor for adolescents who are just living in a 'storm-and-stress' period, characterized by accentuated conflicts with parents, mood disruptions and risk behaviors. Specifically, since the object of this study is the Adolescent population with Idiopathic Scoliosis (IS), stress response can be roused by spinal deformity and increased by brace treatment. According to the authors, there are eight coping strategies and they belong to two groups: Problem solving strategies (such as, Seeking Social Support) and Emotion-focused strategies (such as Escape-Avoidance) Lazarus and Folkman (1984) call 'coping strategies' the individual's cognitive and behavioral efforts which aim to minimize, reduce, tolerate and dominate environmental demands. In this last theory, through a cognitive appraisal, the person has an active role in evaluating situations as exceeding his resources.

stress as a relationship between the person and the environment. stress as a stimulus caused by the environment ДЈ. stress as a physiological, mainly hormonal, response to environmental demands Дў. At the moment, there are different definitions of stress, mainly divided into three categories:ДЎ. The concept of 'stress' has been re-defined and changed over time. Stress deteriorates quality of life, which has been defined as a multidimensional concept, and Stress is one of its component.

The topic of stress has been studied in different situations involving diseases and it is closely related to the HRQOL concept. ConclusionsД«SSQ (brace).es is reliable and valid and can be used with Spanish adolescents to assess the stress level caused by the brace. By undertaking an Exploratory Principal Components Analysis, a latent structure was found based on two Components which explicate the variance at 60.8%. It demonstrated convergent validity with SRS-22 since the Pearson correlation coefficient was 0.656 (p < 0.01). ResultsД«SSQ(brace).es is reliable because of its satisfactory internal consistency (Cronbach's alpha coefficient was 0.809, p < 0.001) and temporal stability (test-retest method with a Pearson correlation coefficient of 0.902 (p < 0.01)). The statistical analysis calculated the reliability (test-retest reliability and internal consistency) and the validity (convergent and construct validity) of the BSSQ (brace).es. The materials used were a socio-demographics data questionnaire, the SRS-22 and the Spanish version of BSSQ(brace).es. The methodology used adheres to literature on trans-cultural adaptation by doing a translation and a back translation it involved 35 adolescents, ages ranging between 10 and 16, with Adolescent Idiopathic Scoliosis (AIS) and wearing the same kind of brace (Rigo System ChГЄneau Brace). As a result of scientific and medical professionals gaining interest in Stress and Health Related Quality of Life (HRQL), the aim of our research is, thus, to validate into Spanish the German questionnaire Bad Sobernheim Stress Questionnaire (BSSQ) (mit Korsett), for adolescents wearing braces.

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