The prediction model of social alienation trajectory in adolescent idiopathic scoliosis patients based on social ecosystem theory: a prospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Social alienation adversely impairs the physical and mental health and the long-term prognosis of adolescents with idiopathic scoliosis (AIS). However, the dynamic patterns of social alienation after diagnosis and a systematic prediction framework based on social ecosystem theory (SET) remain unavailable, limiting early clinical screening and intervention. The objective of the study was to identify distinct developmental trajectories of social alienation in AIS patients within SET framework, and to develop and validate a nomogram for predicting adverse trajectories at diagnosis. Methods A total of 276 consecutive AIS patients were enrolled at the Spine Surgery Center of the Affiliated Taizhou People’s Hospital of Nanjing Medical University between May 2024 and April 2025, and completed one-year follow-up. Growth mixture modeling (GMM) was used to delineate social alienation trajectories. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). A web-based dynamic nomogram was developed for clinical application. Results GMM identified three distinct trajectories: "stable low-risk" (C1), "moderately increasing risk" (C2), and "persistently high-risk" (C3). Based on three trajectories, we designated the C1 as the “low-risk resilient group” (C1’) and merged C2 and C3 into the “medium-high-risk alienated group” (C2’). Multivariate analysis identified seven independent predictors of C2’: age (OR = 8.210), combine other health conditions (OR = 8.149), economic discrimination (OR = 1.650), positive self-esteem (OR = 0.838), negative self-esteem (OR = 1.249), intra-family support (OR = 0.862), and extra-family support (OR = 0.899). The nomogram demonstrated excellent discrimination (AUC = 0.913, 95% CI: 0.878–0.948) and calibration, and DCA showed excellent clinical utility. Conclusions AIS patients exhibit heterogeneous social alienation trajectories during the first year after diagnosis. Our nomogram accurately identifies medium-high-risk patients, offering a practical tool for early risk stratification and targeted psychosocial interventions. Clinical trial number Not applicable.
Source: Scientific Reports
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W7223279037