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Trunk Appearance Perception Scale

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Purpose

The Trunk Appearance Perception Scale (TAPS) is an instrument for evaluating the self-perception patients with scoliosis have of their trunk deformity.

Link to Instrument

Instrument Details

Acronym TAPS

Area of Assessment

Insight
Negative Affect
Patient Satisfaction
Positive Affect
Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Populations

Musculoskeletal Conditions

Key Descriptions

  • 3 sets of figures that depict the trunk from 3 viewpoints: looking toward the back, looking toward the head with the patient bending over (Adal’s test), and looking toward the front. The last view has two sets of drawings, one for males and one for females.
  • Each drawing is scored from 1 (greatest deformity) to 5 (smallest deformity) and a mean score is obtained by adding the scores for the 3 drawings and dividing by 3.
  • Score ranges from 1-15, with lower scores indicating a greater self-perception of scoliosis deformity while higher scores indicating smaller self-perception of deformity

Number of Items

3

Time to Administer

1-2 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Instrument Reviewers

Tri Pham, Medical Student from UT Southwestern

Body Part

Back

ICF Domain

Body Structure

Measurement Domain

General Health

Musculoskeletal Conditions

back to Populations

Standard Error of Measurement (SEM)

Scoliosis Patients (Bago et al., 2018; n = 109; mean age = 18 years; patients underwent posterior spine fusion and instrumentation with a mean follow-up of 20.8 months)
  • SEM for entire group: 0.238

Minimal Detectable Change (MDC)

Scoliosis Patients (Bago et al., 2018; n = 109; mean age = 18 years; patients underwent posterior spine fusion and instrumentation with a mean follow-up of 20.8 months)
  • MDC for entire group: 0.659

Test/Retest Reliability

Scoliosis Patients

  • Excellent test-retest reliability (ICC = 0.92) (Bago et al., 2010; n = 35)
  • Excellent test-retest reliability (ICC = 0.84) (Thielsch et al., 2018; n = 133)

Internal Consistency

Scoliosis Patients

  • Excellent internal consistency (Cronbach’s alpha = 0.89) (Bago et al., 2010; n = 186; mean age = 17.8 years (6.4); mean magnitude of thoracic curve was 35.6° (± 9.6), main thoracic curve 41.3° (±18.1), and thoracolumbar curve 36° (± 17.8))
  • Excellent internal consistency (Cronbach’s alpha = 0.87) (Matamalas et al., 2014; n = 80; mean age = 20.3 years)
  • Excellent internal consistency (Cronbach’s alpha = 0.86) (Thielsch et al., 2018; n = 255; mean age = 30 years (16.7))

 

Adolescent Idiopathic Scoliosis (Misterska et al., 2013; n = 36 girls; mean age = 13.4 years (1.7))

  • Three evaluations were taken at through different time points during brace wearing. First, second, and third evaluations took place 17.9, 24.5, and 30.1 months into brace usage, respectively. (Misterska et al., 2013; n = 36 girls; mean age = 13.4 years (1.7))
    • Excellent internal consistency at first evaluation (Cronbach’s alpha = 0.84)
    • Adequate internal consistency at second evaluation (Cronbach’s alpha = 0.78)
    • Poor internal consistency at third evaluation (Cronbach’s alpha = 0.50)

 

Mixed Patient Population (Sanchez-Raya et al., 2020; n = 170 patients, 22 controls, 49 kyphosis, and 99 scoliosis; mean age = 16.9 years)

  • Excellent internal consistency (Cronbach’s alpha = 0.8)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Scoliosis Patients (Thielsch et al., 2018)

  • Adequate concurrent validity between TAPS total score and WHO-5 Well-Being Index (r = 0.33)
  • Poor concurrent validity between TAPS total score, Positive and Negative Affect Schedule (r = -0.26), Patient Health Questionnaire (r = -0.26),  Questionnaire on Body Dysmorphic Symptoms (Fragebogen körperdysmorpher Symptome, FKS) (r = -0.24), Perseverative Thinking Questionnaire (r = -0.10), and Big Five Inventory-short subscale ‘neuroticism’ (r = -0.12)

Construct Validity

Convergent Validity

Scoliosis Patients

  • Adequate convergent validity between TAPS total score and largest curve (r = -0.55) (Bago et al., 2010; n = 186)
  • Excellent convergent validity between TAPS total score and thoracolumbar/lumbar curve (r = -0.65) (Bago et al., 2010; n = 186)
  • Adequate convergent validity between TAPS total score with upper thoracic curve (r = -0.49) and main thoracic curve (r = -0.44) (Bago et al., 2010; n = 186)
  • Adequate convergent validity between TAPS total score and Scoliosis Research Society Questionnaire (SRS-22) (r = 0.52) (Bago et al., 2010; n = 186)
  • Adequate convergent validity between TAPS total score with SRS-22 subscales ‘pain’ (r = 0.37), ‘image’ (r = 0.54), and ‘mental health’ (r = 0.30) (Bago et al., 2010; n = 186) (Matamalas et al., 2014)
  • Excellent convergent validity between TAPS total score with Spinal Appearance Questionnaire – Appearance (r = 0.80) (Matamalas et al., 2014)
  • Adequate convergent validity between TAPS total score with  Quality of Life Profile for Spinal Deformities (r = -0.35), SRS-22 subscale ‘self-image’ (r = 0.46), SRS-22 subscale ‘function’ (r = 0.50)m SRS-22 subscale ‘pain’ (r = 0.42), and Spinal Appearance Questionnaire – Excitations (r = -0.36) (Matamalas et al., 2014)
  • Excellent convergent validity between TAPS total score and Cobb angle (r = -0.62) (Matamalas et al., 2014)
  • Adequate convergent validity between TAPS total score and waist height angle (r = -0.32) (Matamalas et al., 2016; n = 77 patients; mean age = 20.3 years (8.6)
  • Poor convergent validity between TAPS total score and right waste angle, left waist angle, right/left waist angle difference, and waistline distance ratio (r = -0.06 to -0.10) (Matamalas et al., 2016)
  • Adequate convergent validity between TAPS total score and coracoid height difference (r = 0.323), outer shoulder height difference (r = 0.413), and acromion angle (r = 0.337) (Terheyden et al., 2018; n = 40; mean age = 15.9 years)
  • Adequate convergent validity between TAPS total score with SRS-22r (r = 0.48) (Thielsch et al., 2018)
  • Poor to adequate convergent validity between TAPS total score with SRS-22r subscales ‘function,’ ‘pain,’ ‘self-image,’ ‘mental health,’ and ‘satisfaction’ (r = 0.26 – 0.50) (Thielsch et al., 2018)
  • Adequate convergent validity between TAPS total score with job-related worries (r = -0.33), overall stress (r = -0.51), VAS pain (r = -0.33), and Cobb angle (r = -0.51) (Thielsch et al., 2018)
  • Poor convergent validity between TAPS total score with social life-related worries (r = -0.27) (Thielsch et al., 2018)
  • Adequate convergent validity between TAPS total score with age (r = -0.59) (Thielsch et al., 2018)

  • Spearman correlation coefficients between the TAPS figures and the different SRS-22 (Scoliosis Research Society-22) scales

    TAPS

    SRS pain

    SRS function

    SRS image

    SRS mental health

    SRS sum

    1

    0.30

    0.26

    0.51

    0.28

    0.47

    2

    0.34

    0.23

    0.43

    0.33

    0.47

    3

    0.46

    0.21

    0.50

    0.24

    0.45

    Mean Sum

    0.37

    0.26

    0.54

    0.30

    0.52

    P</=0.05 for all coefficients

     

    Spearman correlation coefficients between each TAPS figure and the magnitudes of the curves

     

    Upper Thoracic

    Main Thoracic

    Thoracolumbar/lumbar

    Largest curve

    TAP1

    -0.32

    -0.42**

    -0.65**

    -0.51

    TAP2

    -0.26

    -0.38**

    -0.50**

    -0.47**

    TAP3

    -0.47

    -0.41**

    -0.58**

    -0.49**

    Mean Sum

    -0.49*

    -0.44**

    -0.65**

    -0.55**

    * p = 0.05 ** p < 0.01

     

    Adolescent Idiopathic Scoliosis (Misterska et al., 2013; n = 36 girls; mean age = 13.4 years (1.7))

  • Adequate convergent validity between Cobb angle and TAPS total score (rs = -0.46), TAPS Figure 1 (rs = -0.46), and TAPS Figure 2 (rs = -0.44) (Misterska et al., 2013)
  • Adequate convergent validity between angle of trunk rotation measured with Perdriolli’s inclinometer with TAPS Figure 2 (rs = -0.43) (Misterska et al., 2013)
  • Adequate convergent validity between TAPS Figure 3 at 3rd evaluation with SRS-22 subscale Function/activity (rs = 0.34) (Misterska et al., 2013)

  • Associations between Trunk Appearance Perception Scale, Scoliosis Research Society-22 and Bad Sobberheim Stress Questionnaires results in the course of brace treatment

    Trunk Appearance Perception Scale

    Scoliosis Research Society-22

    		        

    Bad Sobberheim Stress Questionnaires

    Function/activity

    Pain

    Self-image

    Mental health

    Satisfaction with treatment

    Total score

    Bad Sobberheim Stress Questionnaire-Deformity

    Bad Sobberheim Stress Questionnaire-Deformity

    1st assessment

    Figure 1

    rs = −0.09

    rs = −0.07

    rs = 0.16

    rs = −0.01

    rs = 0.07

    rs = 0.01

    rs = −0.08

    rs = −0.18

    Figure 2

    rs = 0.01

    rs = −0.20

    rs = 0.05

    rs = 0.07

    rs = 0.06

    rs = 0.02

    rs = 0.09

    rs = 0.04

    Figure 3

    rs = 0.05

    rs = −0.06

    rs = 0.15

    rs = 0.17

    rs = 0.15

    rs = 0.13

    rs = 0.12

    rs = −0.01

    Total score

    rs = −0.06

    rs = −0.16

    rs = 0.09

    rs = 0.01

    rs = 0.20

    rs = −0.01

    rs = 0.04

    rs = −0.08

    2nd assessment

    Figure 1

    rs = −0.07

    rs = −0.08

    rs = 0.15

    rs = −0.03

    rs = −0.24

    rs = 0.04

    rs = 0.02

    rs = −0.03

    Figure 2

    rs = −0.06

    rs = −0.03

    rs = 0.07

    rs = −0.26

    rs = −0.10

    rs = −0.12

    rs = 0.08

    rs = 0.08

    Figure 3

    rs = 0.06

    rs = 0.29

    rs = 0.24

    rs = 0.07

    rs = −0.14

    rs = 0.27

    rs = 0.30

    rs = 0.27

    Total score

    rs = 0.02

    rs = 0.19

    rs = 0.21

    rs = −0.04

    rs = −0.15

    rs = 0.16

    rs = 0.20

    rs = 0.26

    3rd assessment

    Figure 1

    rs = 0.07

    rs = 0.19

    rs = 0.09

    rs = −0.17

    rs = 0.10

    rs = −0.09

    rs = −0.01

    rs = −0.16

    Figure 2

    rs = 0.22

    rs = −0.07

    rs = 0.09

    rs = 0.12

    rs = 0.14

    rs = 0.09

    rs = 0.12

    rs = −0.03

    Figure 3

    rs = 0.34*

    rs = 0.16

    rs = 0.14

    rs = 0.27

    rs = 0.23

    rs = 0.30

    rs = 0.17

    rs = 0.01

    Total score

    rs = 0.30

    rs = 0.08

    rs = 0.22

    rs = 0.25

    rs = 0.31

    rs = 0.27

    rs = 0.24

    rs = −0.05

    * p < 0.05

    Divergent Validity

    Scoliosis Patients (Thielsch et al., 2018)

  • Adequate divergent validity between TAPS total score and BMI (r = -0.35)

Floor/Ceiling Effects

Scoliosis Patients (Bago t al., 2010; n = 186)

  • Adequate floor and ceiling effects for total score (1.6% and 3.8%, respectively)
  • Adequate floor and ceiling effects for 1st set of images (8.1% and 7.0%, respectively)
  • Adequate floor and ceiling effects for 2nd set of images (1.6% and 17.7%, respectively)
  • Adequate floor and ceiling effects for 3rd set of images (5.4% and 9.1%, respectively)

Responsiveness

Adolescent Idiopathic Scoliosis

  • Between 1st and 2nd evaluation: effect size of 0.343. Between 1st and 3rd evaluation: effect size of 0.527. Between 2nd and 3rd evaluation: effect size of <0.3 (Misterska et al., 2013)
  • Pre- and post-Isolated Percutaneous Thoracoplasty change from 2.57 to 3.66 (p = 0.014) (Yang et al., 2013; n = 7 girls; mean age = 20.24 years)

 

Scoliosis Patients (Bago et al., 2018; n = 109; mean age = 18 years; patients underwent posterior spine fusion and instrumentation with a mean follow-up of 20.8 months)

  • Internal responsiveness: effect size of 1.96 with a standardized response mean of 1.73.
  • External responsiveness: significant correlation was bfound between magnitude of largest curve percentage of correction and TAPS (r = 0.14)

Bibliography

Bago, J., Sanchez-Raya, J., Perez-Grueso, F. J. S., & Climent, J. M. (2010). The Trunk Appearance Perception Scale (TAPS): a new tool to evaluate subjective impression of trunk deformity in patients with idiopathic scoliosis. Scoliosis, 5(1), 6.

Misterska, E., Glowacki, M., Latuszewska, J., & Adamczyk, K. (2013). Perception of stress level, trunk appearance, body function and mental health in females with adolescent idiopathic scoliosis treated conservatively: a longitudinal analysis. Quality of Life Research, 22(7), 1633-1645.

Matamalas, A., Bagó, J., D'Agata, E., & Pellisé, F. (2014). Body image in idiopathic scoliosis: a comparison study of psychometric properties between four patient-reported outcome instruments. Health and quality of life outcomes, 12(1), 81.

Yang, J. H., Bhandarkar, A. W., Kasat, N. S., Suh, S. W., Hong, J. Y., Modi, H. N., & Hwang, J. H. (2013). Isolated percutaneous thoracoplasty procedure for skeletally mature adolescent idiopathic scoliosis patients, with rib deformity as their only concern: Short-term outcomes. Spine, 38(1), 37-43.

Matamalas, A., Bagó, J., & Pellisé, F. (2016). Validity and reliability of photographic measures to evaluate waistline asymmetry in idiopathic scoliosis. European Spine Journal, 25(10), 3170-3179.

Terheyden, J. H., Wetterkamp, M., Gosheger, G., Lange, T., Schulze Bövingloh, A., & Schulte, T. L. (2018). Rasterstereography versus radiography for assessing shoulder balance in idiopathic scoliosis: A validation study relative to patients' self-image. Journal of back and musculoskeletal rehabilitation, 31(6), 1049–1057. https://doi.org/10.3233/BMR-170867

Bago, J., Matamalas, A., Sánchez-Raya, J., Pellise, F., & Pérez-Grueso, F. J. (2018). Responsiveness of Image Perception Outcome Scales After Surgical Treatment of Idiopathic Scoliosis: A Comparison Between the Trunk Appearance Perception Scale (TAPS) and Scoliosis Research Society–22 (SRS-22) Questionnaire. Spine deformity, 6(4), 417-423.

Thielsch, M. T., Wetterkamp, M., Boertz, P., Gosheger, G., & Schulte, T. L. (2018). Reliability and validity of the Spinal Appearance Questionnaire (SAQ) and the Trunk Appearance Perception Scale (TAPS). Journal of orthopaedic surgery and research, 13(1), 274.

Sanchez-Raya, J., Matamalas, A., Figueras, C., & Bago, J. (2020). Validity of a one-item drawing-based instrument to assess trunk deformity perception in kyphotic deformities. Spine Deformity, 1-8.

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