1
|
Swaby L, Cui M, Cole A. Discontinuation of brace treatment in adolescent idiopathic scoliosis (AIS): a scoping review. Spine Deform 2024; 12:1217-1228. [PMID: 38693334 PMCID: PMC11343946 DOI: 10.1007/s43390-024-00882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Brace treatment for adolescent idiopathic scoliosis (AIS) is usually prescribed for 20-40° curves in patients with growth potential. The aim is to reduce the risk of curve progression during growth and to avoid the curve reaching a surgical threshold. Having as small a curve as possible at skeletal maturity will reduce the risk of curve progression during adult life. While evidence exists for brace treatment in AIS, there is disagreement on how and when to discontinue bracing. The purpose of this review was to investigate what criteria have been reported for initiating brace cessation and published weaning protocols and to look at estimates of the number of patients that may progress > 5 degrees after the end of growth. METHODS This scoping review summarizes existing knowledge on the best time to stop bracing in AIS patients, how to "wean," and what happens to spinal curves after bracing. Searches were carried out through MEDLINE, EMBASE, and PsycINFO in April 2022. A total of 1936 articles were reduced to 43 by 3 reviewers. Full papers were obtained, and data were extracted. RESULTS Weaning was most commonly determined by Risser 4 (girls) and 5 (boys). Other requirements included 2 years post-menarche and no growth in standing/sitting height for 6 months. Skeletal maturity assessed from hand and wrist radiographs, e.g., Sanders' stage; distal radius and ulnar physes, could determine the optimal weaning time to minimize curve progression. Complete discontinuation was the most common option at skeletal maturity; variations on weaning protocols involved gradual reduction of bracing over 6-12 months. Curve progression after weaning is common. The 12 studies reporting early curve progression after brace weaning found a mean Cobb angle progression of 3.8° (n = 1655). From the seven studies reporting early curve progression by > 5 degrees, there were 236/700 (34%) patients. There is limited information on risk factors to predict early curve progression after finishing brace treatment with larger curves, especially those over 40 degrees possibly having more chance of progression. CONCLUSION Curve progression after bracing cessation is a negative outcome for patients who have tolerated bracing for several years, especially if surgery is required. The literature shows that when to start brace cessation and weaning protocols vary. Approximately 34% of patients progressed by more than 5 degrees at 2-4 years after brace cessation or weaning. Larger curves seem more likely to progress. More research is needed to evaluate the risk factors for curve progression after brace treatment, defining the best time to stop bracing based on the lowest risk of curve progression and whether there is any benefit to weaning.
Collapse
Affiliation(s)
- Lizzie Swaby
- ScHARR, University of Sheffield, Sheffield, S1 4DA, UK.
| | - Mengwei Cui
- ScHARR, University of Sheffield, Sheffield, S1 4DA, UK
| | - Ashley Cole
- Department of Paediatric Orthopaedics, Sheffield Children's Hospital, Sheffield, UK
| |
Collapse
|
2
|
Dolan LA, Weinstein SL, Dobbs MB, Flynn JMJ, Green DW, Halsey MF, Hresko MT, Krengel WF, Mehlman CT, Milbrandt TA, Newton PO, Price N, Sanders JO, Schmitz ML, Schwend RM, Shah SA, Song K, Talwalkar V. BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024; 49:147-156. [PMID: 37994691 PMCID: PMC10841822 DOI: 10.1097/brs.0000000000004879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
STUDY DESIGN Prospective multicenter study data were used for model derivation and externally validated using retrospective cohort data. OBJECTIVE Derive and validate a prognostic model of benefit from bracing for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) demonstrated the superiority of bracing over observation to prevent curve progression to the surgical threshold; 42% of untreated subjects had a good outcome, and 28% progressed to the surgical threshold despite bracing, likely due to poor adherence. To avoid over-treatment and to promote patient goal setting and adherence, bracing decisions (who and how much) should be based on physician and patient discussions informed by individual-level data from high-quality predictive models. MATERIALS AND METHODS Logistic regression was used to predict curve progression to <45° at skeletal maturity (good prognosis) in 269 BrAIST subjects who were observed or braced. Predictors included age, sex, body mass index, Risser stage, Cobb angle, curve pattern, and treatment characteristics (hours of brace wear and in-brace correction). Internal and external validity were evaluated using jackknifed samples of the BrAIST data set and an independent cohort (n=299) through estimates of discrimination and calibration. RESULTS The final model included age, sex, body mass index, Risser stage, Cobb angle, and hours of brace wear per day. The model demonstrated strong discrimination ( c -statistics 0.83-0.87) and calibration in all data sets. Classifying patients as low risk (high probability of a good prognosis) at the probability cut point of 70% resulted in a specificity of 92% and a positive predictive value of 89%. CONCLUSION This externally validated model can be used by clinicians and families to make informed, individualized decisions about when and how much to brace to avoid progression to surgery. If widely adopted, this model could decrease overbracing of AIS, improve adherence, and, most importantly, decrease the likelihood of spinal fusion in this population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kit Song
- Carelon Health Services and the University of California, Los Angeles, CA
| | | |
Collapse
|
3
|
Marchese R, Du Plessis J, Pooke T, McAviney J. The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace ® and the ScoliBalance ® Exercise Approach. J Clin Med 2024; 13:653. [PMID: 38337346 PMCID: PMC10856658 DOI: 10.3390/jcm13030653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/27/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The impact of scoliosis bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE) on trunk muscle endurance in adolescents with idiopathic scoliosis is unknown. ScoliBrace®, a rigid, three-dimensional, over-corrective thoraco-lumbar-sacral orthosis (TLSO), and ScoliBalance®, a PSSE program, were used to treat adolescent idiopathic scoliosis (AIS) patients. A retrospective study of the trunk muscle endurance of 33 AIS patients who received ScoliBrace® and ScoliBalance® was conducted. The patients were treated with ScoliBrace® and an individualized ScoliBalance® program. Trunk extensor muscle endurance (TE) and abdominal muscle endurance (AE) tests were performed at initial assessment and then at averages of 6.6 and 24.4 weeks of treatment. The data were analyzed using the Wilcoxon signed-rank test, Stata version 15.1. The participants were aged 13.24 years (SD = 1.64) with a mean Cobb angle of 38.97° (SD = 9.49°). TE improved significantly (p < 0.001) at both short- and medium-term intervals using ScoliBalance® and ScoliBrace® in the AIS patients. AE also showed significant improvement between baseline and short-term follow-up, with non-significant improvement at medium-term follow-up. Overall, trunk muscle endurance showed improvement in the AIS patients using ScoliBrace® and ScoliBalance®. Future research is required to determine the individual and combined effects of each treatment. However, it seems likely that trunk muscle endurance will not deteriorate in AIS patients with this combined treatment.
Collapse
|
4
|
Charalampidis A, Diarbakerli E, Dufvenberg M, Jalalpour K, Ohlin A, Ahl AA, Möller H, Abbott A, Gerdhem P. Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352492. [PMID: 38285447 PMCID: PMC10825714 DOI: 10.1001/jamanetworkopen.2023.52492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024] Open
Abstract
Importance Moderate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-time bracing. For patients who reject full-time bracing, the effects of alternative, conservative interventions are unknown. Objective To determine whether self-mediated physical activity combined with either nighttime bracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA) in preventing Cobb angle progression in moderate-grade AIS. Design, Setting, and Participants The Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS) randomized clinical trial was conducted from January 10, 2013, through October 23, 2018, in 6 public hospitals across Sweden. Male and female children and adolescents aged 9 to 17 years with an AIS primary curve Cobb angle of 25° to 40°, apex T7 or caudal, and skeletal immaturity based on estimated remaining growth of at least 1 year were included in the study. Dates of analysis were from October 25, 2021, to January 28, 2023. Interventions Interventions included self-mediated physical activity in combination with either NB or SSE or PA (control). Patients with treatment failure were given the option to transition to a full-time brace until skeletal maturity. Main Outcomes and Measures The primary outcome was curve progression of 6° or less (treatment success) or curve progression of more than 6° (treatment failure) seen on 2 consecutive posteroanterior standing radiographs compared with the inclusion radiograph before skeletal maturity. A secondary outcome of curve progression was the number of patients undergoing surgery up until 2 years after the primary outcome. Results The CONTRAIS study included 135 patients (45 in each of the 3 groups) with a mean (SD) age of 12.7 (1.4) years; 111 (82%) were female. Treatment success was seen in 34 of 45 patients (76%) in the NB group and in 24 of 45 patients (53%) in the PA group (odds ratio [OR], 2.7; 95% CI, 1.1-6.6). The number needed to treat to prevent curve progression with NB was 4.5 (95% CI, 2.4-33.5). Treatment success occurred in 26 of 45 patients (58%) in the SSE group (OR for SE vs PA, 1.2; 95% CI, 0.5-2.8). Up to 2 years after the primary outcome time point, 9 patients in each of the 3 groups underwent surgery. Conclusions and Relevance In this randomized clinical trial, treatment with NB prevented curve progression of more than 6° to a significantly higher extent than did PA, while SSE did not; in addition, allowing transition to full-time bracing after treatment failure resulted in similar surgical frequencies independent of initial treatment. These results suggest that NB may be an effective alternative intervention in patients rejecting full-time bracing. Trial Registration ClinicalTrials.gov Identifier: NCT01761305.
Collapse
Affiliation(s)
- Anastasios Charalampidis
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Elias Diarbakerli
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Marlene Dufvenberg
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kourosh Jalalpour
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Acke Ohlin
- Clinical and Molecular Osteoporosis Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | | | - Hans Möller
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Stockholm Center for Spine Surgery, Stockholm, Sweden
| | - Allan Abbott
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Peuchot C, Cassoudesalle H, David R, Jourdan L, Glize B, de Seze M. Could trochanteric pelvic stabilization be removed from the adolescent idiopathic scoliosis brace? A prospective pilot study. Prosthet Orthot Int 2024; 48:55-62. [PMID: 37708334 DOI: 10.1097/pxr.0000000000000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/09/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Idiopathic scoliosis is the most common musculoskeletal deformity in children. There is a dose-response relationship between compliance and improvement in scoliosis. The literature revealed that esthetic considerations have negative consequences on the quality of life (QOL) of patients and consequently on wearing time of the brace. To minimize esthetic problems and then increase QOL and wearing time, we proposed a new relay brace named "corset Collerette" without a pelvic-trochanteric base. METHODS A prospective cohort study was conducted in the rehabilitation department of Bordeaux University Hospital. Patients consulting for adolescent idiopathic scoliosis were registered in a prospective hospital database. The patients expressing unwillingness to wear the usual brace or who had decreased compliance were offered the corset Collerette and were included in a 3-month follow-up. Outcome measures assessed at baseline and at 3 months were Scoliosis Research Society Outcomes Questionnaire (SRS-22) and Brace Questionnaire scales and wearing time. Cobb's angle evolution since the start of bracing was also collected. The primary end point was the QOL assed by the SRS-22 scale at 3 months of follow-up. RESULTS The first 38 patients agreeing to wear the corset Collerette were included in the study. The QOL assessed by the SRS-22 was significantly improved with the corset Collerette ( p < 0.05). There was no significant increase in wearing time and thoracic Cobb's angles between baseline and follow-up ( p > 0.05). CONCLUSION The switch to the corset Collerette allowed an improvement in the QOL of the patients and avoid a decrease in compliance with wearing the brace and maintain the same in-brace Cobb's angles.
Collapse
Affiliation(s)
- Charline Peuchot
- Handicap Activity Cognition Health-HACS BPH Inserm U1219, University of Bordeaux, Bordeaux, France
- Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, Bordeaux, France
- Department of Physical Medicine and Rehabilitation, Trois Marres Tampon, Ile de La Réunion, France
| | - Hélène Cassoudesalle
- Handicap Activity Cognition Health-HACS BPH Inserm U1219, University of Bordeaux, Bordeaux, France
- Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, Bordeaux, France
| | - Romain David
- Department of Physical Medicine and Rehabilitation, CHU de Poitiers, Poitiers, France
| | - Louca Jourdan
- Handicap Activity Cognition Health-HACS BPH Inserm U1219, University of Bordeaux, Bordeaux, France
- Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, Bordeaux, France
| | - Bertrand Glize
- Handicap Activity Cognition Health-HACS BPH Inserm U1219, University of Bordeaux, Bordeaux, France
- Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, Bordeaux, France
| | - Mathieu de Seze
- Handicap Activity Cognition Health-HACS BPH Inserm U1219, University of Bordeaux, Bordeaux, France
- Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, Bordeaux, France
| |
Collapse
|
6
|
Zapata KA, Dieckmann RJ, Hresko MT, Sponseller PD, Vitale MG, Glassman SD, Smith BG, Jo CH, Sucato DJ. A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform 2023; 11:861-869. [PMID: 36807105 DOI: 10.1007/s43390-023-00665-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The purpose of this study was to determine the feasibility and efficacy of a United States multi-site randomized control trial (RCT) of the Schroth-based therapy program in Risser 0 patients with mild adolescent idiopathic scoliosis (AIS) curves. METHODS Six sites enrolled 98 Risser 0 patients with single AIS curves between 12° and 24°. Patients were randomized to Exercise:Control group in a 2:1 ratio. Exercise group patients were instructed on the Schroth-based method and a home exercise program of 75 min/week for 1 year. RESULTS Enrollment across 6 institutions averaged 2.2 patients per month over 45 months. Patient attrition was 42% after 1 year (41/98) and 52% after 2 years (51/98). Exercise group patients were significantly younger (11.6 vs 12.5 years) without differences in the baseline Cobb angle (16.2° vs 17.1°). Self-reported exercise adherence averaged 82% at 6 months and 63% at 1 year (n = 35). A significantly lower frequency of patients was braced in the Exercise group after 1 year (26% vs 55%, p = 0.03) but not after 2 years (48% vs 63%, p = 0.31). Curve magnitude changes between groups were not significant after 1 and 2 years. CONCLUSION Performing a multi-site RCT for mild AIS in the United States is challenging with slow enrollment and high attrition. Young patients with small curves have difficulty adhering to the intensive demands of Schroth-based therapy. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Daniel J Sucato
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| |
Collapse
|
7
|
The natural history of curve behavior after brace removal in adolescent idiopathic scoliosis: a literature review. Spine Deform 2023; 11:567-578. [PMID: 36715866 PMCID: PMC10147768 DOI: 10.1007/s43390-022-00638-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/26/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Brace treatment is the most common nonoperative treatment to prevent curve progression in adolescent idiopathic scoliosis (AIS). The goal of this review and analysis is to characterize curve behavior after completion of brace treatment and to identify factors that may facilitate the estimation of long-term curve progression. METHOD A review of the English language literature was completed using the MEDLINE (PUBMED) database of publications after 1990 until September 2020. Studies were included if they detailed a minimum of 1 year post-brace removal follow-up of AIS patients. Data retrieved from the articles included Cobb angle measurements of the major curves at "in-brace," weaning, and follow-up visit(s) for all patients described and for subset populations. RESULTS From 75 articles, 18 relevant studies describing a follow-up period of 1-25 years following brace removal were included in the analyses. The reviewed literature demonstrates that curves continue to progress after brace treatment is completed with three main phases of progression: (i) immediate (upon brace removal) where a mean curve progression of 7° occurs; (ii) short term (within five years of brace removal) where a relatively high progression rate is evident (0.8°/year); and (iii) long term (more than five years after brace removal) where the progression rate slows (0.2°/year). The magnitude and rate of curve progression is mainly dependent on the degree of curve at weaning as curves weaned at < 25° progress substantially less than curves weaned at ≥ 25° at 25 years. CONCLUSION Curves continue to progress after brace removal and the rate and magnitude of progression are associated with the curve size at weaning, with larger curves typically exhibiting more rapid and severe progression. This analysis provides physicians and patients the ability to estimate long-term curve size based on the curve size at the time of weaning. LEVEL OF EVIDENCE IV.
Collapse
|
8
|
Design and position control of a robotic brace dedicated to the treatment of scoliosis. ROBOTICA 2023. [DOI: 10.1017/s0263574722001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
This paper’s content focuses on designing and prototyping a robotic brace dedicated to treating scoliosis. Scoliosis is an abnormal spinal curvature affecting 1–3% of children and constitutes a major therapeutic problem. In moderate cases of deformity, passive brace treatment is performed. However, this approach can lead to important patient discomfort. So, we propose a robotic solution providing greater mobility and the possibility of adapting the procedure to each patient. The robotic brace we built and tested is composed of three specific rings adapted to the patient’s torso. Each independent module of two consecutive rings is movable through a Stewart–Gough platform-type mechanism. As the robotic brace is lightweight, it brings better portability and improves the patient’s comfort.
The first part of the paper shows the state of the art of bracing techniques: from passive to active orthoses. Next, the mechatronics of the device is detailed, and the robot’s kinematic models are developed. The motion control principle is given. In the last part, motion tests were administered with a healthy human to validate the brace architecture choice and its position and motion control strategies.
Collapse
|
9
|
Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthet Orthot Int 2022; 46:383-391. [PMID: 35320151 DOI: 10.1097/pxr.0000000000000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement.
Collapse
|
10
|
Lee SB, Chae HW, Kwon JW, Sung S, Lee HM, Moon SH, Lee BH. Is There an Association Between Psychiatric Disorders and Adolescent Idiopathic Scoliosis? A Large-database Study. Clin Orthop Relat Res 2021; 479:1805-1812. [PMID: 33780404 PMCID: PMC8277277 DOI: 10.1097/corr.0000000000001716] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children with adolescent idiopathic scoliosis (AIS) have reduced quality of life related to poor self-image, perhaps because of cosmetic concerns. However, there has not been a large-database epidemiologic study on the association between psychiatric disorders and scoliosis. QUESTIONS/PURPOSES Using the Korean National Health Insurance database, we asked: (1) How common are psychiatric disorders among children with AIS? (2) After controlling for gender, age, insurance type, and residential district, are psychiatric disorders more common among children with AIS than among age-matched controls? METHODS A retrospective analysis was conducted using sample datasets from the Health Insurance Review and Assessment Service from 2012 to 2016, which is a 10% randomly extracted sample of total inpatients and outpatients each year. The mean number of total patients in each dataset was 1,047,603 ± 34,534. The mean number of children with AIS was 7409 ± 158 for each year. The age criteria was 10 to 19 years for the matching. Mood disorders, anxiety disorders, and behavioral disorders were selected as disorders possibly associated with AIS. We identified children with AIS who had any of the disorders above, and we obtained the prevalence of these disorders based on diagnostic codes. As an exploratory analysis, clinically meaningful variables were selected among the available codes in the dataset, and a univariable logistic regression test was performed for each variable. A multivariable logistic regression test with advanced variables was performed to identify the adjusted odds ratios of psychiatric disorders in children with AIS. RESULTS The median (range) prevalence of psychiatric disorders in children with AIS from 2012 to 2016 was 7% (6% to 7%). Compared with children who did not have AIS, and after controlling for gender, age, insurance type, and residential district, children with AIS were more likely to have psychiatric disorders in all 5 years. The adjusted ORs of psychiatric disorders in children with AIS compared with children who did not have AIS ranged from 1.47 to 1.74 (2012: OR 1.60 [95% CI 1.46 to 1.75]; p < 0.001; 2013: OR 1.73 [95% CI 1.58 to 1.89]; p < 0.001; 2014: OR 1.74 [95% CI 1.59 to 1.91]; p < 0.001; 2015: OR 1.71 [95% CI 1.56 to 1.88]; p < 0.001; 2016: OR 1.47 [95% CI 1.33 to 1.62]; p < 0.001). CONCLUSION Considering the higher prevalence of psychiatric disorders in children with AIS compared with children who did not have AIS, children with AIS and their parents should be counseled about the increased risk of deteriorating mental health of the patients, and surgeons should provide early referral to pediatric psychiatrists. Further studies should investigate the effect of the factors related to AIS, such as curve type, Cobb angle, and treatment modality. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
Affiliation(s)
- Soo-Bin Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Bundang Jesaeng Hospital, Gyeonggi-do, Republic of Korea
| | - Hyun-Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Sahyun Sung
- Department of Orthopedic Surgery, Ewha Woman’s University Seoul Hospital, Seoul, Republic of Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
11
|
Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace: Comparative Effectiveness Analysis of BrAIST and ISICO Cohorts. Spine (Phila Pa 1976) 2020; 45:1193-1199. [PMID: 32205704 DOI: 10.1097/brs.0000000000003506] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Comparative effectiveness study OBJECTIVE.: To evaluate factors leading to higher percentage of brace failures in a cohort of North American patients with adolescent idiopathic scoliosis relative to their peers in Italy. SUMMARY OF BACKGROUND DATA Studies of bracing in United States have shown worse outcomes than studies from European centers, possibly due to sample characteristics or treatment approaches. METHODS Sample: Braced patients, aged 10 to 15, Risser <3, Cobb 20°- to 40°, observed to Cobb ≥40° and/or ≥Risser 4 selected from prospective databases. Comparators: Bracing per Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) (TLSO) and Italian Scientific Spine Institute (ISICO) protocol (SPoRT braces with or without SEAS exercises). Baseline characteristics (sex, age, BMI, Risser, Cobb, curve type) and average hours of brace wear/day. Differences in programs (e.g., SEAS, type of brace, weaning protocol) were captured by a variable named "SITE." OUTCOME Treatment failure (Cobb ≥40 before Risser 4). STATISTICS Comparison of baseline characteristics, analyses of risk factors, treatment components, and outcomes within and between cohorts using logistic regression. RESULTS A total of 157 BrAIST and 81 ISICO subjects were included. Cohorts were similar at baseline but differed significantly in terms of average hours of brace wear: 18.31 in the ISICO versus 11.76 in the BrAIST cohort. Twelve percent of the ISICO and 39% of the BrAIST cohort had failed treatment. Age, Risser, Cobb, and a thoracic apex predicted failure in both groups. SITE was related to failure (odds ratio [OR] = 0.19), indicating lower odds of failure with ISICO versus BrAIST approach. With both SITE and wear time in the model, SITE loose significance. In the final model, the adjusted odds of failure were higher in boys (OR = 3.34), and those with lowest BMI (OR = 9.83); the odds increased with the Cobb angle (OR = 1.23), and decreased with age (OR = 0.41) and hours of wear (OR = 0.86). CONCLUSION Treatment at the ISICO resulted in a lower failure rate, primarily explained by longer average hours of brace wear. LEVEL OF EVIDENCE 3.
Collapse
|
12
|
Donzelli S, Zaina F, Negrini S. Predicting scoliosis progression: a challenge for researchers and clinicians. EClinicalMedicine 2020; 18:100244. [PMID: 31993579 PMCID: PMC6978184 DOI: 10.1016/j.eclinm.2019.100244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sabrina Donzelli
- ISICO – Italian Scientific Spine Institute, Milan, Italy
- Corresponding author.
| | - Fabio Zaina
- ISICO – Italian Scientific Spine Institute, Milan, Italy
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan “La Statale”, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|
13
|
Almansour H, Pepke W, Bruckner T, Diebo BG, Akbar M. Three-Dimensional Analysis of Initial Brace Correction in the Setting of Adolescent Idiopathic Scoliosis. J Clin Med 2019; 8:jcm8111804. [PMID: 31661811 PMCID: PMC6912396 DOI: 10.3390/jcm8111804] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/29/2019] [Accepted: 10/25/2019] [Indexed: 11/24/2022] Open
Abstract
The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers.
Collapse
Affiliation(s)
- Haidara Almansour
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| | - Wojciech Pepke
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69118 Heidelberg, Germany.
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, NY 11203, USA.
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| |
Collapse
|
14
|
Andrusiewicz M, Harasymczuk P, Janusz P, Biecek P, Żbikowska A, Kotwicka M, Kotwicki T. TIMP2 Polymorphisms Association With Curve Initiation and Progression of Thoracic Idiopathic Scoliosis in the Caucasian Females. J Orthop Res 2019; 37:2217-2225. [PMID: 31119800 DOI: 10.1002/jor.24380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/17/2019] [Indexed: 02/04/2023]
Abstract
Idiopathic scoliosis (IS) etiology remains unclear, but strong genetic background is suggested. Previously reported TIMP2 study indicates an association of genic rs8179090 with IS progression in a Han Chinese population. However, there has been a lack of investigation into intragenic TIMP2 polymorphisms in IS patients. We recruited 100 Caucasian females with IS and 100 controls. Patients were subdivided accordingly to: progression rate, curve severity, joint mobility, and curve pattern. Allele-specific-polymerase chain reaction based on fluorescence resonance energy transfer was applied to evaluate nine TIMP2 polymorphisms. Distribution of genotype and allele frequency in only one polymorphism (rs11658743) differed in case-control study. Four of the polymorphisms (rs2277700, rs11077401, rs2376999, and rs4789934) showed non-equal distributions either in genotype or/and allele distributions in the patients of different progression rates. The rs11077401 was related to curve severity patients distinction and the rs8179090 distinguished patients with different joint mobility level. Two polymorphisms either differed statistically in case of curve patterns subgrouping (rs8068674 and rs8179090) or showed a slight tendency toward significance in the recessive model of allele distributions (rs9916809 and rs8179090). The remaining two polymorphisms (rs2377005, rs11658743) showed no association with either clinical or radiographic IS characteristics. The influence of the G allele of the rs8179090 on the clinical course of IS has not yet been confirmed. We identified four TIMP2 polymorphisms (rs11077401, rs2376999, rs2277700, and rs4789934) that were associated with a higher risk of the progressive IS form. Further genetic association studies based on suggested clinical criteria would be necessary to validate TIMP2 polymorphisms associated with the curve progression. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2217-2225, 2019.
Collapse
Affiliation(s)
- Mirosław Andrusiewicz
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806, Poznań, Poland
| | - Piotr Harasymczuk
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Janusz
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznań, Poland
| | - Przemysław Biecek
- Department of Medical Statistics, University of Warsaw, Warsaw, Poland
| | - Aleksandra Żbikowska
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806, Poznań, Poland
| | - Małgorzata Kotwicka
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806, Poznań, Poland
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
15
|
Aulisa AG, Guzzanti V, Falciglia F, Giordano M, Galli M, Aulisa L. Brace treatment of Idiopathic Scoliosis is effective for a curve over 40 degrees, but is the evaluation of Cobb angle the only parameter for the indication of treatment? Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.04782-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Xu L, Yang X, Wang Y, Wu Z, Xia C, Qiu Y, Zhu Z. Brace Treatment in Adolescent Idiopathic Scoliosis Patients with Curve Between 40° and 45°: Effectiveness and Related Factors. World Neurosurg 2019; 126:e901-e906. [PMID: 30872192 DOI: 10.1016/j.wneu.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate effectiveness of brace treatment in patients with adolescent idiopathic scoliosis with curve between 40° and 45° and to determine predictive factors associated with bracing outcome. METHODS Bracing was used to treat 90 patients with curve >40 degrees. Factors including Risser sign, age, sex, curve pattern, curve magnitude, and initial curve correction were compared between patients with curve improvement and patients with curve progression. Logistic regression analysis was used to determine the independent predictors of curve progression. RESULTS Curve was improved in 34 (37.8%) patients and stabilized in 12 (13.3%) patients. Remarkable curve progression >50 degrees was observed in 44 (48.9%) patients. Intergroup comparison showed significant differences between the 2 groups in terms of age (12.3 ± 1.4 years vs. 13.2 ± 1.6 years, P = 0.01), initial curve correction (2.2% ± 5.4% vs. 19.7% ± 12.2%, P < 0.001), and curve pattern (P = 0.03). Logistic regression analysis showed that initial curve correction of <10% (odds ratio = 12.82, P < 0.001) and Risser grade of 0 (odds ratio = 1.46, P = 0.04) were significant indicators of curve progression. CONCLUSIONS Bracing may produce a favorable outcome in certain patients with curve between 40° and 45°. It should be cautiously used in this situation, as there was a higher probability of bracing failure. It is important to differentiate patients at high risk of curve progression at an early stage to avoid overtreatment.
Collapse
Affiliation(s)
- Leilei Xu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xianfeng Yang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuwen Wang
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhichong Wu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chao Xia
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
| |
Collapse
|
17
|
NIU XINJIAN, YANG CHIFU, TIAN BOWEN, LI XIANG, ZHENG SHUTAO, CONG DACHENG, HAN JUNWEI, AGRAWAL SUNILK. INVESTIGATION OF ROBOTIC BRACES OF PATIENTS WITH IDIOPATHIC SCOLIOSIS (IS) — REVIEW OF THE LITERATURE AND DESCRIPTION OF A NOVEL BRACE. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519418400389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Idiopathic scoliosis (IS) is a complex three-dimensional (3D) deformity. The non-operative treatments for IS have been developed for a long time. According to current studies, hard braces are more effective than soft braces for the treatment of scoliosis. Though current braces are proved to be effective for the treatment of IS, there are several shortcomings needed to be overcome: (i) Braces cannot realize precise control over a specific vertebra. (ii) Braces affect cardiopulmonary efficiency (braces limit maximal exercise performance). (iii) The brace is not modulated based on user’s needs. (iv) Braces, including motions during eating, tying shoes, sitting, and standing. (v) Braces apply forces on skin, which causes pain, skin breakdown, and abnormal deformation of bone. In order to solve these boring problems of the current braces, this paper proposed a new intelligent robotic spine brace based on the principle of human biomechanics, three point pressure treatment theory and parallel mechanism theory. This novel brace can offer 3D active dynamic adjustable corrective forces for the treatment of IS and some experiments are employed for verifying the effect of the proposed brace.
Collapse
Affiliation(s)
- XINJIAN NIU
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin 150001, P. R. China
| | - CHIFU YANG
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin 150001, P. R. China
| | - BOWEN TIAN
- Department of Economic and Trade, School of Business Administration, Zhongnan University of Economics and Law, Wuhan 430000, P. R. China
| | - XIANG LI
- Department of Mechatronics Engineering, Harbin Institute of Technology, Harbin 150001, P. R. China
| | - SHUTAO ZHENG
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin 150001, P. R. China
| | - DACHENG CONG
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin 150001, P. R. China
| | - JUNWEI HAN
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin 150001, P. R. China
| | - SUNIL K. AGRAWAL
- Robotics and Rehabilitation (ROAR) Laboratory, Department of Mechanical Engineering, Columbia University, New York 10027, USA
| |
Collapse
|
18
|
Piantoni L, Tello CA, Remondino RG, Bersusky ES, Menéndez C, Ponce C, Quintana S, Hekier F, Francheri Wilson IA, Galaretto E, Noël MA. Quality of life and patient satisfaction in bracing treatment of adolescent idiopathic scoliosis. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:26. [PMID: 30564635 PMCID: PMC6295031 DOI: 10.1186/s13013-018-0172-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bracing is used as a valid non-surgical treatment for adolescent idiopathic scoliosis (AIS) to avoid progression of the deformity and thereby surgery. The effect of bracing treatment on quality of life of patients with AIS has been a topic of interest in the international literature. The aim of this study was to evaluate the quality of life and patient satisfaction during bracing treatment for AIS of a pediatric hospital. MATERIAL AND METHOD We assessed a total of 43 non-consecutive female patients (mean age at questionnaire, 13 years and 1 month and 10 years and 8 months to 14 years and 5 months; mean period of usage of brace, 1 year and 7 months), with adolescent idiopathic scoliosis (AIS), older than 10 years of age until skeletal maturity, with a Risser sign less than 3 and scoliosis between 20 and 45°, treated with thoracolumbosacral orthosis (TLSO) for a period longer than 6 months, and without other comorbidities or previous surgeries, were evaluated. The patients were administered a previously validated to Spanish questionnaire on quality of life (Brace Questionnaire (BrQ); Grivas TB et al.). BrQ is a validated tool and is considered a disease-specific instrument; its score ranges from 20 to 100 points, and higher BrQ scores are associated with better quality of life. RESULTS The patients reported using the brace for a mean of 17.6 h daily and for a mean period of 1 year and 7 months at the time of the study. Overall, 72% of the study population reported to be in some way psychologically affected by the brace wearing, 56% felt their basic motor activities were affected, 54% felt socialization with their environment was affected, 46% considered their quality of life deteriorated due to pain, and 40% reported conflicts in the school environment. CONCLUSION Patients with AIS treated with bracing reported a negative impact (53.5% overall) on quality of life and treatment satisfaction in terms of psychological, motor, social, and school environment aspects. An interdisciplinary approach would be important for the integrated psychosocial care of these patients.
Collapse
Affiliation(s)
- Lucas Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| | - Carlos A. Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| | - Rodrigo G. Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| | - Ernesto S. Bersusky
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| | - Celica Menéndez
- Departamento de Salud Mental, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Corina Ponce
- Departamento de Salud Mental, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Susana Quintana
- Departamento de Servicio Social, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Felisa Hekier
- Departamento de Servicio Social, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Ida A. Francheri Wilson
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| | - Mariano A. Noël
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM, CABA, Buenos Aires, Argentina
| |
Collapse
|
19
|
Ha AS, Beauchamp EC. Editorial on " Screening for adolescent idiopathic scoliosis: US preventive services task force recommendation statement". JOURNAL OF SPINE SURGERY 2018; 4:812-816. [PMID: 30714016 DOI: 10.21037/jss.2018.10.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alex S Ha
- New-York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | | |
Collapse
|
20
|
Wibmer C, Trotsenko P, Gilg MM, Leithner A, Sperl M, Saraph V. Observational retrospective study on socio-economic and quality of life outcomes in 41 patients with adolescent idiopathic scoliosis 5 years after bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:611-618. [PMID: 30145658 DOI: 10.1007/s00586-018-5746-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE We analysed socio-economic- and health-related quality of life (primary outcome) and radiological outcome (secondary outcome) 5 years after full time rigid bracing (FTRB) plus physiotherapeutic scoliosis-specific exercises (PSSE) in adolescent idiopathic scoliosis. METHODS We included 41 patients (38 female and 3 male) treated with FTRB (Chênau brace) and PSSE (Schroth) between 2001 and 2010. The study protocol included a clinical and radiological examination, the completion of the SRS-24 questionnaire and acquisition of data on socio-economic factors (educational and employment status) and physical activity. Descriptive statistics were used to analyse the data; differences between patients with mild (< 30°) and severe curves (30°-50°) regarding hrQoL outcomes were analysed using the Mann-Whitney U Test. RESULTS Primary outcomes showed full employment (higher education, 39%, and full-time work, 61%) and the majority of the patients (79.9%) performing moderate sports two to four times per week. The SRS-24 questionnaire produced a total mean score (MS) of 4.0 (79.9%). Patients with mild curves had a significantly better total score (MS 4.1 vs. MS 3.8, p = 0.020) and were more satisfied with the treatment (MS 4.3 vs MS 3.9, p = 0.020). As to the secondary outcomes, from start of bracing to follow-up (a mean of 6.7 years after brace weaning), the average Cobb angle changed from 28.6° to 25.6° (range 4°-48°); in 51.2% the curve angles could be maintained after weaning. CONCLUSIONS Compared with the literature, our results showed similar curve development and hrQoL (pain, self-image and function) and better results regarding satisfaction with treatment. In comparison with the average population, there were no disadvantages as to occupation, education and sports. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Christine Wibmer
- Department of Orthopedic Surgery and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Pawel Trotsenko
- Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Magdalena M Gilg
- Department of Orthopedic Surgery and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedic Surgery and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Matthias Sperl
- Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Vinay Saraph
- Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| |
Collapse
|
21
|
Negrini S, Donzelli S, Negrini A, Parzini S, Romano M, Zaina F. Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial. Ann Phys Rehabil Med 2018; 62:69-76. [PMID: 30145241 DOI: 10.1016/j.rehab.2018.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In an ideal experimental setting, 2 randomized controlled trials recently showed the efficacy of physiotherapeutic scoliosis-specific exercises (PSSEs) for adolescents with idiopathic scoliosis (AIS). Now large observational studies are needed to check the generalizability of these results to everyday clinical life. OBJECTIVE To explore the effectiveness of PSSEs for avoiding bracing or progression of AIS in everyday clinics. METHODS This was a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients. Inclusion criteria were AIS, age≥10 years old at first evaluation, Risser sign 0-2, and 11-20°Cobbangle. Exclusion criteria were consultations only and brace prescription at baseline. Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle>29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design. RESULTS We included 293 eligible subjects after propensity score matching (SEAS, n=145; UP, n=95; controls, n=53). The risk of success was increased 1.7-fold (P=0.007) and 1.5-fold (P=0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2-3.7) and 1.8 (95% CI 1.5-2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis. CONCLUSIONS SEAS reduced the bracing rate in AIS and was more effective than UP. PSSEs are additional tools that can be included in the therapeutic toolbox for AIS treatment.
Collapse
Affiliation(s)
- Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia, 25121 Brescia, Italy; IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy
| | - Alessandra Negrini
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy
| | - Silvana Parzini
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy
| |
Collapse
|
22
|
Brace Treatment for Adolescent Idiopathic Scoliosis. J Clin Med 2018; 7:jcm7060136. [PMID: 29867010 PMCID: PMC6024899 DOI: 10.3390/jcm7060136] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
In the past, numerous non-operative treatments for adolescent idiopathic scoliosis (AIS), including exercise, physical therapy, electrical stimulation, and brace treatment, have been tried to delay or prevent the curve progression. Of these, brace treatment is the only option that is widely accepted and has demonstrated the efficacy to alter the natural history of AIS. Recently, the importance of brace treatment for AIS has been increasing since the efficacy was objectively established by the BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) study in 2013. This editorial article summarizes the current status of brace treatment in patients with AIS and discusses future prospects on the basis of our clinical experiences.
Collapse
|
23
|
Ridderbusch K, S. Spiro A, Kunkel P, Grolle B, Stücker R, Rupprecht M. Strategies for Treating Scoliosis in Early Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:371-376. [PMID: 29932047 PMCID: PMC6039715 DOI: 10.3238/arztebl.2018.0371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 04/26/2017] [Accepted: 03/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scoliosis in early childhood is defined as abnormal curvature of the spine of any etiology that arises before age 10. The affected children are at high risk of developing restrictive pulmonary dysfunction. The treatment presents major challenges because of the complexity and high morbidity of the disease. METHODS This article is based on pertinent articles retrieved by a selective literature search, and on the results of a retrospective study by the authors. RESULTS In addition to conservative treatment methods including physiotherapy, casts, and corsets, progressive scoliosis usually requires early surgical intervention. In recent years, many different so-called non-fusion techniques have been developed for the surgical treatment of early childhood scoliosis. The goal of this new strategy is to avoid early fusion procedures and to enable further growth of the rib cage, lungs, and spine in addition to correcting the scoliosis. The authors also present their own intermediate-term results with a novel growth-preserving spinal operation that exploits magnet technology. CONCLUSION Because of the low prevalence and heterogeneous etiology of early childhood scoliosis, the literature to date contains no randomized controlled therapeutic trials concerning this small group of high-risk patients. For the treatment to succeed, it is essential for specialists from all of the involved medical disciplines to work closely together. Conservative measures such as physiotherapy, casts, and corsets can delay the (frequent) need for surgery or even make surgery unneces - sary, particularly in the idiopathic types of early childhood scoliosis. The new non-fusion techniques enable continued growth of the spine, rib cage, and lung in addition to correcting the scoliosis.
Collapse
Affiliation(s)
- Karsten Ridderbusch
- Department of Pediatric Orthopedics, Altona Children‘s Hospital, Hamburg
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Alexander S. Spiro
- Department of Pediatric Orthopedics, Altona Children‘s Hospital, Hamburg
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Philip Kunkel
- Department of Pediatric Neurosurgery, Altona Children‘s Hospital, Hamburg
| | - Benjamin Grolle
- Department of Pediatrics, Altona Children‘s Hospital, Hamburg
| | - Ralf Stücker
- Department of Pediatric Orthopedics, Altona Children‘s Hospital, Hamburg
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Martin Rupprecht
- Department of Pediatric Orthopedics, Altona Children‘s Hospital, Hamburg
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| |
Collapse
|
24
|
Whether Orthotic Management and Exercise are Equally Effective to the Patients With Adolescent Idiopathic Scoliosis in Mainland China?: A Randomized Controlled Trial Study. Spine (Phila Pa 1976) 2018; 43:E494-E503. [PMID: 28885287 DOI: 10.1097/brs.0000000000002412] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective randomized controlled trial. OBJECTIVE The aim of this study was to investigate the effectiveness of orthotic management versus exercise on spinal curvature, body symmetry, and quality of life. SUMMARY OF BACKGROUND DATA A number of well-designed studies comparing conservative treatment of adolescent idiopathic scoliosis (AIS) have been conducted and the evidence becomes stronger. However, there is a lack of the information on the effectiveness of orthotic management versus exercise. METHODS The inclusion criteria recommended by the Scoliosis Research Society (SRS) and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) were used during enrollment. Eligible patients were randomly assigned to either bracing group or exercise group. Patients in the bracing group were prescribed with a rigid thoracolumbosacral orthosis and requested to wear 23 h/day, while patients in the exercise group were treated with the protocol of the Scientific Exercise Approach to Scoliosis. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, and quality of life (QoL) were collected every 6 months. RESULTS Twenty-four patients in the bracing group and 29 patients in the exercise group participated in this study. For the intergroup comparison, the bracing group showed better results about the correction of spinal curvature (Cobb angle at the first 12 months of intervention, P = 0.039), scores concerning QoL, especially function (P < 0.001), mental health (P < 0.001), and total score (P < 0.001), were higher than that of the exercise group. The results of body symmetry evaluation did not differ significantly between the two groups. For the intragroup comparison, parameters of spinal curvature (baseline vs. 12-month, P < 0.03 in the exercise group and P < 0.001 in the bracing group), QoL (baseline vs. 12-month, P < 0.001), and TAPS (baseline vs. 12-month, P < 0.033) significantly improved over the studied period. Shoulder balance (baseline vs. 12-month, P < 0.005) showed significant improvement only in the bracing group. CONCLUSION Both interventions of bracing and exercise showed significant treatment effectiveness on the patients with AIS. Bracing was superior to capture corrections in parameters of spinal curvature and body symmetry, while the QoL, especially in aspect of the functional and psychological status, was significantly better in the exercise group. LEVEL OF EVIDENCE 1.
Collapse
|
25
|
Mao SH, Sun X, Shi BL, Qiu Y, Qian BP, Cheng JCY. Association between braced curve behavior by pubertal growth peak and bracing effectiveness in female idiopathic scoliosis: a longitudinal cohort study. BMC Musculoskelet Disord 2018; 19:88. [PMID: 29580223 PMCID: PMC5870088 DOI: 10.1186/s12891-018-1987-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-pubertal idiopathic scoliosis (IS) is associated with high risk of bracing ineffectiveness. Integrated multidimensional maturity assessments are useful but complex to predict the high-risk occurrence of curve progression. This study is designed to provide a simple screening method for brace effectiveness by determining whether or not the braced curve behavior at growth spurt, being defined as variations in Cobb angle velocity (AV) at peak height velocity (PHV), can be a new factor predictive of brace outcome prescribed before PHV. METHODS This is a retrospective study of a series of 35 IS girls with simplified skeletal maturity score no more than 3 at initiation of bracing treatment and followed up through the growth spurt until brace weaning or surgery. Serial Cobb angle and maturity indicators involving height velocity, Risser sign, triradiate cartilage, simplified skeletal maturity score and distal radius and ulna classification were assessed and patients were stratified into either a positive or negative category based on a positive or negative value of AV at PHV. Comparisons were made between the positive and negative AV groups, as well as the failed and successful bracing groups, using independent sample T test and crosstab analysis. Logistic regression analysis was used to identify the predictive factors of failed brace treatment. RESULTS Brace treatment prescribed before PHV was found to have an overall failure rate of 57.1% and a surgical rate of 45.7%. Negative AV at PHV accounting for 54.3% of the recruited patients were associated with lower brace failure rate (36.8% vs. 81.2%, p = 0.016) and surgical rate (21.1% vs. 75.0%, p = 0.002). Patients in the failed bracing group showed higher ratio of thoracic curve (80.0% vs. 26.7%,p = 0.002) and higher AV at growth peak (2.3 ± 9.1 vs. -6.5 ± 11.4°/yrs., p = 0.016). The logistic regression analysis revealed that positive AV at PHV (OR = 9.268, 95% CI = 1.279-67.137, p = 0.028) and thoracic curve type (OR = 13.391, 95% CI = 2.006-89.412, p = 0.007) were strong predictive factors of ineffective brace treatment initiated before PHV. CONCLUSIONS Sustained curve correction following bracing despite early onset and rapid pubertal growth was strongly predictive of effective brace control of scoliosis.
Collapse
Affiliation(s)
- Sai-Hu Mao
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Xu Sun
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Ben-Long Shi
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Yong Qiu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China. .,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China.
| | - Jack C Y Cheng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| |
Collapse
|
26
|
Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:3. [PMID: 29435499 PMCID: PMC5795289 DOI: 10.1186/s13013-017-0145-8] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). METHODS Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. RESULTS The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. CONCLUSION The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.
Collapse
Affiliation(s)
- Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia Viale Europa 11, Brescia, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Angelo Gabriele Aulisa
- U.O.C. of Orthopedics and Traumatology, Children’s Hospital Bambino Gesù, Institute of Scientific Research, 00165 Rome, Italy
| | - Dariusz Czaprowski
- Center of Body Posture, Olsztyn, Poland
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
| | - Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Department of Surgery, Edmonton, Canada
| | | | - Helmut Diers
- Department of Orthopedics and Trauma Surgery, University Medical Center, Mainz, Germany
| | - Theodoros B. Grivas
- Department of Orthopaedics and Traumatology, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | - Andrea Lebel
- Scoliosis Physiotherapy & Posture Centre, 231 McLeod Street, Ottawa, Ontario K2P0Z8 Canada
| | - Cindy Marti
- Schroth-Barcelona Institute, LLC, Spinal Dynamics of Wisconsin, SC., Barcelona, Spain
| | - Toru Maruyama
- Saitama Prefectural Rehabilitation Center, Saitama, Japan
| | - Joe O’Brien
- National Scoliosis Foundation, Stoughton, MA USA
| | - Nigel Price
- Section of Spine Surgery, Children’s Mercy Hospitals and Clinics, UMKC Orthopedics, Kansas City, MO USA
| | - Eric Parent
- Department of Physical Therapy, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Manuel Rigo
- Salvá SLP (E. Salvá Institute), Vía Augusta 185, 08021 Barcelona, Spain
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Luke Stikeleather
- National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA 22124 USA
| | - James Wynne
- Boston Orthotics & Prosthetics, Boston, MA USA
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| |
Collapse
|
27
|
Abstract
BACKGROUND Clinical evidence regarding the ability of braces to decrease the risk of curve progression to surgical threshold in patients with adolescent idiopathic scoliosis (AIS) continues to strengthen. Unfortunately, there is still a great deal of uncertainty regarding the impact of brace wear on psychosocial well-being or the impact of psychological well-being on brace wear adherence. The purpose of this study is to evaluate psychosocial well-being, in particular body image and quality of life (QOL), and brace wear adherence in female AIS patients undergoing brace treatment. METHODS The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) was a multicenter, controlled trial using randomized and preference assignments into an observation or brace treatment group. BrAIST patients were skeletally immature adolescents diagnosed with AIS having moderate curve sizes (20 to 40 degrees). Patients in the bracing group were instructed to wear a thoracolumbosacral orthosis, at least 18 h/d. Scores on the Spinal Appearance Questionnaire and the PedsQL4.0 Generic Scales from 167 female BrAIST patients who were randomized to brace treatment (n=58) and patients who chose brace treatment (n=109) were analyzed. RESULTS At baseline and at 12 months, no differences were found between the least-adherent brace wear group (<6 h/d) and most-adherent brace wear group (≥12 h/d) patients in terms of major curve, body image, and QOL. In the most-adherent group, poorer body image scores were significantly correlated with poorer QOL scores at baseline, at 6 months, and at 12 months but not at 18 months. In general, body image scores and QOL scores were not significantly correlated in the least-adherent group. When comparing patients that had a ≥6 degree increase of their major curve between baseline and 12 months to patients that did not, there were no significant differences in body image or QOL scores. CONCLUSIONS For females adolescents with AIS, body image and QOL do not have a significant impact on brace wear adherence and are subsequently not significantly impacted by brace wear. LEVEL OF EVIDENCE Level II-therapeutic (prospective comparative study).
Collapse
|
28
|
Health-Related Quality of Life and Care Giver Burden Following Spinal Fusion in Children With Cerebral Palsy. Spine (Phila Pa 1976) 2017; 42:E733-E739. [PMID: 27792122 DOI: 10.1097/brs.0000000000001940] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective longitudinal cohort. OBJECTIVE The objective of this study was to evaluate changes in caregivers' perceptions of health-related quality of life (HRQOL) and caregiver burden in children with severe cerebral palsy (CP) following spinal fusion. SUMMARY OF BACKGROUND DATA Progressive scoliosis is common in nonambulatory children with CP; the utility of spine fusion has been long debated and prospective evaluations of patient reported outcomes are limited. METHODS Children 3 to 21 years old, gross motor classification system (GMFCS) IV-V CP, scheduled for spine fusion were enrolled consecutively from September 2011 to March 2014. Caregivers completed the CPCHILD and ACEND pre-operatively and at 6 weeks, 3, 6, 12, and 24 months postoperatively. Changes in CPCHILD and ACEND scores from preoperative to 1 and 2 years after surgery were assessed using paired t tests. Correlations between preoperative Cobb angle and CPCHILD and ACEND scores were evaluated using Pearson's correlation analysis. RESULTS Twenty-six GMFCS IV-V CP patients with severe scoliosis treated with spine fusion were included. Mean age was 14 years, 50% male, and 46% had instrumentation to the pelvis. Average preoperative Cobb angle was 68.9° (SD 25.68) with an average improvement of 76%. The CPCHILD score increased by 9.8 points above baseline [95% confidence interval (95% CI): 3.4-16.2] at 1 year postoperatively (P = 0.005). However, at 2 years, the CPCHILD score regressed to baseline (P = 0.40). ACEND scores did not change from baseline scores at 1-year (P = 0.09) and 2-year (P = 0.72) follow-up, reflecting that caregiver burden is little changed by spine fusion. There was no correlation between preoperative Cobb angle and CPCHILD score (P = 0.52) or ACEND score (P = 0.56) at 1-year or 2-year follow-up (P = 0.69, P = 0.90). Children with Cobb angle ≤75° experienced more improvement 1 year after surgery than children with Cobb angle >75°. CONCLUSION HRQOL improves 1 year following spine fusion but regresses to baseline after 2 years. Caregiver burden was unchanged following spine fusion. LEVEL OF EVIDENCE 2.
Collapse
|
29
|
Donzelli S, Zaina F, Martinez G, Di Felice F, Negrini A, Negrini S. Adolescents with idiopathic scoliosis and their parents have a positive attitude towards the Thermobrace monitor: results from a survey. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:12. [PMID: 28405634 PMCID: PMC5385080 DOI: 10.1186/s13013-017-0119-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/28/2017] [Indexed: 12/20/2022]
Abstract
Background A temperature monitor is used to objectively measure brace wear time in adolescent idiopathic scoliosis. The reliability of this device have been demonstrated, and some specialists introduced the use of a compliance monitor as a standard of care in everyday clinical practice, as we did since 2010 with the Thermobrace (TB). The attitude towards these objective monitors has never been investigated. The present study aims to investigate the attitude of parents and patients towards the use of temperature sensors for measuring brace wear compliance. Methods Three hundred one consecutive girls and 63 boys and their parents have been interviewed. The inclusion criteria were as follows: brace wear full-time prescription at first visit and at least one visit with download and discussion of TB data. Usefulness, acceptability, reliability, and feeling related to data download were the investigated domains. Patients were invited by the administrative staff to complete anonymously the questionnaire. The European Commission was informed about the present survey and approved it (ICT-37-2015-1). Descriptive statistic was used to present the results. Results Among the 364 invited patients and parents, 336 adhered by completing it (rate of responders was 93.2%). The mean age was 14.65 (SD 2.36), the mean Cobb angle was 34.18 (SD 13.57), and the average brace wear prescription was 21.76 h per day (SD 2.53). We did not ask parents about their age, profession, nor other personal data. Globally, the interviewed patients and parents showed a very positive attitude towards the TB monitor: the mean rate of parents stating a completely or at least partially positive attitude towards this electronic device was 94.0% while among patients, it was 85.6%. Conclusions This is the first study investigating the attitude of parents and patients towards a brace wear compliance monitor. People who experienced this objective monitoring are aware of the advantages related to it and support its usefulness not only for clinicians but also for patients and parents to respect the hours prescribed without any affection on the children and parents or the patient-physician relationship. The present results should encourage the spread of these tools in daily clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s13013-017-0119-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Fabio Zaina
- ISICO, Via R Bellarmino 13/1, 20141, Milan, Italy
| | | | | | | | | |
Collapse
|
30
|
Wong AL, Wilson M, Girnary S, Nojoomi M, Acharya S, Paul SM. The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review. J Hand Ther 2017; 30:447-456. [PMID: 28400179 PMCID: PMC5632567 DOI: 10.1016/j.jht.2017.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/14/2017] [Accepted: 02/28/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review INTRODUCTION: There exist numerous combinations of orthoses and motion protocols for the treatment of proximal extensor tendon injuries. PURPOSE The purpose of this study was to determine the optimal combination of motion protocol and orthotic treatment for the rehabilitation of proximal extensor tendon injuries (zones IV-VIII). METHODS A systematic review of English language randomized clinical trials and cohort studies investigating extensor tendon rehabilitation from 1960 to 2016 was conducted in MEDLINE, Embase, Cochrane, CINAHL, PEDro, and OTseeker. Outcomes of total active motion, grip strength, return to work, patient attrition, and patient-reported outcomes were compared. RESULTS Eleven studies of predominantly average quality (1, low; 8, average; and 2, high) were included in the final review. Results were difficult to compare due to differences in reporting. Early total active motion and final grip strength were greater with dynamic extension orthoses (191°-214°; 35-38 kg/89% contralateral side) and relative motion orthoses (205°-236°; 85%-95% contralateral side) compared to static orthoses (79°-202°; 23-34 kg/59% contralateral side). Four studies excluded patients who did not follow up, and loss to follow-up was 12%-33% in the other studies. Patient-reported outcomes were not comparable, as they were only included in 3 studies, and each used a different assessment tool. CONCLUSION Average quality evidence supports the use of early active motion (EAM) as the superior motion protocol, but optimal orthosis to deliver EAM could not be determined. Prospective research should focus on patient-reported outcomes and the design of orthoses that facilitate the use of the EAM. LEVEL OF EVIDENCE 2a.
Collapse
Affiliation(s)
- Alison L Wong
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States,Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Canada
| | - Madeline Wilson
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Sakina Girnary
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Matthew Nojoomi
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Soumyadipta Acharya
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Scott M Paul
- Rehabilitation Medicine Department, NIH Clinical Center, Bethesda, United States,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, United States,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, United States
| |
Collapse
|
31
|
Negrini S, Minozzi S, Bettany-Saltikov J, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Zaina F. Braces for Idiopathic Scoliosis in Adolescents. Spine (Phila Pa 1976) 2016; 41:1813-1825. [PMID: 27584672 DOI: 10.1097/brs.0000000000001887] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A Cochrane systematic review. OBJECTIVE To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, psychological, and cosmetic issues. SUMMARY OF BACKGROUND DATA Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. Although adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. METHODS We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015. We also checked reference lists and hand searched grey literature. Randomized controlled trials (RCTs) and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. We used standard methodological procedures expected by the Cochrane Collaboration. RESULTS We included seven studies. Five were planned as RCTs, two as prospective controlled clinical trials. One RCT failed completely, another was continued as an observational study. There was very low quality evidence from one small RCT that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation. CONCLUSION Two studies showed that bracing did not change QoL during treatment, and QoL, back pain psychological and cosmetic issues in the long term (16 years.) All articles showed that bracing prevented curve progression. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children. LEVEL OF EVIDENCE 1.
Collapse
Affiliation(s)
- Stefano Negrini
- Physical and Rehabilitation Medicine, University of Brescia, IRCCS Fondazione Don Gnocchi Milan, Brescia, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Theodoros B Grivas
- Department of Trauma and Orthopedics, Tzanio General Hospital of Piraeus, Piraeus, Greece
| | - Tomasz Kotwicki
- Department of Pediatric Orthopedics and Traumatology, University of Medical Sciences, Poznan, Poland
| | - Toru Maruyama
- Department of Orthopedic Surgery, Saitama Medical University, Kawagoe, Japan
| | | | - Fabio Zaina
- ISICO, Italian Scientific Spine Institute, Milan, Italy
| |
Collapse
|
32
|
Korbel K, Stoliński Ł, Kozinoga M, Kotwicki T. Retrospective analysis of idiopathic scoliosis medical records coming from one out-patient clinic for compatibility with Scoliosis Research Society criteria for brace treatment studies. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:37. [PMID: 27785476 PMCID: PMC5073407 DOI: 10.1186/s13013-016-0097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background First author attempted to analyse medical records of patients with idiopathic scoliosis for compliance with the Scoliosis Research Society brace studies criteria. A retrospective analysis of medical records of 2705 girls treated from 1989 to 2002 was carried out. Methods Age, Cobb, Risser and menarchal status were analyzed for compliance with the Scoliosis Research Society brace studies criteria: a) age ≥10 years, b) Risser 0–2, c) 25–40° Cobb angle, d) no earlier treatment, e) patients before first menses or not more than one year from first menses. Results It has been found that 183 girls out of 2705 were ≥10 years old and in the range 25–40° Cobb angle. One hundred two out of 2705 patients revealed eligible for brace effectiveness study according to SRS 2005 criteria. 120 out of 2705 patients revealed eligible for brace brace effectiveness study according to SRS-SOSORT 2014 criteria. Conclusion The excluded patients revealed too old or with too significant Cobb angles. This indicates the changing criteria for scoliosis brace treatment over the time. Direct comparison of current results of brace treatment with historical series of cases turns out to be very difficult.
Collapse
Affiliation(s)
| | | | - Mateusz Kozinoga
- Rehasport Clinic, Górecka 30, Poznan, 60-476 Poland ; Spine Disorders and Pediatric Orthopaedics Department, University of Medical Sciences, Górecka 30, Poznan, 60-476 Poland
| | - Tomasz Kotwicki
- Spine Disorders and Pediatric Orthopaedics Department, University of Medical Sciences, Górecka 30, Poznan, 60-476 Poland
| |
Collapse
|
33
|
Holdefer RN, Skinner SA. Commentary : The value of intraoperative neurophysiological monitoring: evidence, equipoise and outcomes. J Clin Monit Comput 2016; 31:657-664. [PMID: 27481235 DOI: 10.1007/s10877-016-9910-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/19/2016] [Indexed: 02/08/2023]
Abstract
The use of intraoperative neurophysiological monitoring (IONM) has grown despite an absence of randomized controlled trials that might unequivocally demonstrate improved outcomes. At issue is how to demonstrate value when other evidence indicates patient harms (opportunity cost) if IONM is withheld for the sake of randomization. In this article we review other non-randomized methods to assess the effects of IONM on post-operative outcomes. We also examine how clinical equipoise may resolve whether (or not) an anticipated controlled study is ethical. We conclude that the value of IONM in a particular surgical setting should be determined by a benefits/harms analysis based on all the available evidence.
Collapse
Affiliation(s)
- R N Holdefer
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359740, Seattle, WA, 98104-2499, USA
| | - S A Skinner
- Intraoperative Monitoring, Department of Neurophysiology, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA.
| |
Collapse
|
34
|
Pellios S, Kenanidis E, Potoupnis M, Tsiridis E, Sayegh FE, Kirkos J, Kapetanos GA. Curve progression 25 years after bracing for adolescent idiopathic scoliosis: long term comparative results between two matched groups of 18 versus 23 hours daily bracing. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:3. [PMID: 27299156 PMCID: PMC4900243 DOI: 10.1186/s13013-016-0065-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/10/2016] [Indexed: 11/14/2022]
Abstract
Background Scoliotic curves do not necessarily stop progressing at skeletal maturity. The factors that influence curve behavior following bracing are not fully determined. Our objectives were to evaluate the loss of the scoliotic curve correction in a cohort of patients treated with bracing during adolescence and to compare the outcomes of 18 versus 23 h of bracing at a mean of 25 years post brace removal. Methods Seventy-seven patients, who were successfully treated for Adolescent Idiopathic Scoliosis with Βoston brace, were re-evaluated 25 years after the end of their treatment. Patients were further divided in 2 matched groups; those wearing the brace for 23 h and those not wearing the brace at school-time, limiting the application of the brace to 18 h. The mean scoliotic curve was compared between groups before, during, just after bracing and 25 years post bracing. Validated in patients’ native language forms of Short Form 36 and Oswestry Disability Index questionnaires were used to compare the quality of life between groups 25 years post bracing. Results The mean age of the cohort was 40.4 (±3.2) years. They underwent long term follow up at a mean of 25.16 (±2.69) years after brace removal. The mean cohort scoliotic curve increased by 3.9 (±6.69) at 25 years since brace removal. There was however no significant difference in the mean Cobb angle of the cohort between pre brace and long term follow up period (p = 0.307). The 18 and 23 h application groups were comparable according to demographics and several bracing and scoliotic curve parameters. There was no significant difference in the mean curve magnitude between 18 and 23 h application groups at brace removal (p = 0.512) and at 25 years follow-up (p = 0.878). There was also no significant difference in the mean score of Quality of Life questionnaires between groups at long term follow up. Conclusion Scoliotic curves do not necessarily stop progressing after bracing. Bracing is effective treatment method with good long term results in appropriate patients. Since compliance was not objectively measured, we don’t feel confident to give any indication about everyday dosage.
Collapse
Affiliation(s)
- Stavros Pellios
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Fares E Sayegh
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - John Kirkos
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - George A Kapetanos
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| |
Collapse
|
35
|
Abstract
STUDY DESIGN The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) included skeletally immature high-risk patients with adolescent idiopathic scoliosis (AIS) with moderate curve sizes (20°- 40°). BrAIST was a multicenter, controlled trial using both randomized and preference treatment arms into either an observation group or a brace treatment group. OBJECTIVE The aim of this study was to analyze and compare body image and quality-of-life (QOL) in female AIS patients who were observed or treated with a brace. SUMMARY OF BACKGROUND DATA Brace treatment is an effective means for controlling progressive scoliosis and preventing the need for surgery, but there is no consensus regarding the effect of brace treatment on body image or on QOL in adolescents with AIS. METHODS Data from female BrAIST patients in the randomized (n = 132) or preference (n = 187) arms and were observed (n = 120) or brace treated (n = 199) were analyzed. Patients completed the Spinal Appearance Questionnaire (SAQ) and the Pediatric Quality of Life Inventory (PedsQOL) 4.0 Generic Scales at baseline and 6 month follow-up visits up to 2 years. Items on the SAQ measured three body image constructs (self, ideal, and overall). The PedsQOL measured health, activities, feelings, social factors, and school. RESULTS . In general, there were no significant differences within or between study arms or treatments regarding body image or QOL through 2 years of follow-up. Poorer body image was significantly correlated with poorer QOL during the first 2 years of follow-up regardless of study arm or treatment. Patients who crossed-over to a different treatment and patients with largest Cobb angles ≥ 40 degrees had significantly poorer body image, in particular self-body image, compared with those that did not. CONCLUSION This study does not support findings from previous research indicating that wearing a brace has a negative impact on or is negatively impacted by body image or QOL. LEVEL OF EVIDENCE 2.
Collapse
|
36
|
Weinstein SL, Dolan LA. The Evidence Base for the Prognosis and Treatment of Adolescent Idiopathic Scoliosis: The 2015 Orthopaedic Research and Education Foundation Clinical Research Award. J Bone Joint Surg Am 2015; 97:1899-903. [PMID: 26582623 PMCID: PMC6951844 DOI: 10.2106/jbjs.o.00330] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Stuart L. Weinstein
- Department of Orthopaedic Surgery, University of Iowa, University Hospital, 01026 JPP, Iowa City, IA 52245. E-mail address for S.L. Weinstein:
| | - Lori A. Dolan
- Department of Orthopaedic Surgery, University of Iowa, University Hospital, 01026 JPP, Iowa City, IA 52245. E-mail address for S.L. Weinstein:
| |
Collapse
|
37
|
Abstract
PURPOSE Brace compliance measurement in adolescent idiopathic scoliosis (AIS) has been the subject of a few recent studies. Various sensors have been developed to measure compliance. We have developed a temperature-based data logger-the Cricket-specifically for scoliosis braces, with associated custom software, that is embedded directly in the brace. The purpose of this study was to analyze patterns of brace wear and patient compliance among children with AIS using the Cricket. METHODS Fifty-five AIS patients prescribed various brace-time regimens were monitored using the Cricket. All subjects were treated with the Wilmington brace. The compliance rate for each group was determined. RESULTS Overall compliance among subjects was 69.9 ± 31.5 %. Only 14.5 % met or exceeded prescribed brace time. This is consistent with previous compliance monitoring results. CONCLUSION The results of this study objectively show the difference between prescribed and actual brace wear time and reaffirm the Cricket sensor as an accurate and comfortable brace-monitoring device.
Collapse
|
38
|
Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015; 1:15030. [PMID: 27188385 DOI: 10.1038/nrdp.2015.30] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
Collapse
Affiliation(s)
- Jack C Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Aina J Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew B Dobbs
- Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Theodoros B Grivas
- Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Keith D Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Alain Moreau
- Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada.,Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Ian A Stokes
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Stuart L Weinstein
- Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust - Queen's Medical Centre Campus, Nottingham, UK
| |
Collapse
|
39
|
Negrini S, Minozzi S, Bettany‐Saltikov J, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Zaina F. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2015; 2015:CD006850. [PMID: 26086959 PMCID: PMC10616811 DOI: 10.1002/14651858.cd006850.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. While adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. OBJECTIVES To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, and psychological and cosmetic issues. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015 for relevant clinical trials. We also checked the reference lists of relevant articles and conducted an extensive handsearch of grey literature. SELECTION CRITERIA Randomized controlled trials (RCTs) and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included seven studies (662 participants). Five were planned as RCTs and two as prospective controlled trials. One RCT failed completely, another was continued as an observational study, reporting also the results of the participants that had been randomized.There was very low quality evidence from one small RCT (111 participants) that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation (mean difference (MD) -2.10, 95% confidence interval (CI) -7.69 to 3.49). There was very low quality evidence from a subgroup of 77 adolescents from one prospective cohort study showing that QoL, back pain, psychological, and cosmetic issues did not differ significantly between rigid bracing and observation in the long term (16 years).Results of the secondary outcomes showed that there was low quality evidence that rigid bracing compared with observation significantly increased the success rate in 20° to 40° curves at two years' follow-up (one RCT, 116 participants; risk ratio (RR) 1.79, 95% CI 1.29 to 2.50). There was low quality evidence that elastic bracing increased the success rate in 15° to 30° curves at three years' follow-up (one RCT, 47 participants; RR 1.88, 95% CI 1.11 to 3.20).There is very low quality evidence from two prospective cohort studies with a control group that rigid bracing increases the success rate (curves not evolving to 50° or above) at two years' follow-up (one study, 242 participants; RR 1.50, 95% CI 1.19 to 1.89) and at three years' follow-up (one study, 240 participants; RR 1.75, 95% CI 1.42 to 2.16). There was very low quality evidence from a prospective cohort study (57 participants) that very rigid bracing increased the success rate (no progression of 5° or more, fusion, or waiting list for fusion) in adolescents with high degree curves (above 45°) (one study, 57 adolescents; RR 1.79, 95% CI 1.04 to 3.07 in the intention-to-treat (ITT) analysis).There was low quality evidence from one RCT that a rigid brace was more successful than an elastic brace at curbing curve progression when measured in Cobb degrees in low degree curves (20° to 30°), with no significant differences between the two groups in the subjective perception of daily difficulties associated with wearing the brace (43 girls; risk of success at four years' follow-up: RR 1.40, 1.03 to 1.89). Finally, there was very low quality evidence from one RCT (12 participants) that a rigid brace with a pad pressure control system is no better than a standard brace in reducing the risk of progression.Only one prospective cohort study (236 participants) assessed adverse events: neither the percentage of adolescents with any adverse event (RR 1.27, 95% CI 0.96 to 1.67) nor the percentage of adolescents reporting back pain, the most common adverse event, were different between the groups (RR 0.72, 95% CI 0.47 to 1.10). AUTHORS' CONCLUSIONS Due to the important clinical differences among the studies, it was not possible to perform a meta-analysis. Two studies showed that bracing did not change QoL during treatment (low quality), and QoL, back pain, and psychological and cosmetic issues in the long term (16 years) (very low quality). All included papers consistently showed that bracing prevented curve progression (secondary outcome). However, due to the strength of evidence (from low to very low quality), further research is very likely to have an impact on our confidence in the estimate of effect. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children. This challenge may prevent us from seeing increases in the quality of the evidence over time. Other designs need to be implemented and included in future reviews, including 'expertise-based' trials, prospective controlled cohort studies, prospective studies conducted according to pre-defined criteria such as the Scoliosis Research Society (SRS) and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria. Future studies should increase their focus on participant outcomes, adverse effects, methods to increase compliance, and usefulness of physiotherapeutic scoliosis specific exercises added to bracing.
Collapse
Affiliation(s)
- Stefano Negrini
- University of Brescia ‐ IRCCS Fondazione Don Gnocchi MilanPhysical and Rehabilitation MedicineViale EuropaBresciaItaly25121
| | - Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia di Santa Costanza, 53RomeItaly00198
| | - Josette Bettany‐Saltikov
- University of TeessideSchool of Health and Social CareVictoria RoadMiddlesbroughClevelandUKTS13BA
| | | | - Theodoros B. Grivas
- "Tzanio" General Hospital of PiraeusDepartment of Trauma and OrthopaedicsPiraeusAtticaGreece18536
| | - Tomasz Kotwicki
- University of Medical SciencesDepartment of Pediatric Orthopedics and Traumatologyul. 28 Czerwca 1956 nr 135PoznanPoland61‐545
| | - Toru Maruyama
- Saitama Medical UniversityDepartment of Orthopaedic Surgery1981 KamodaKawagoeSaitamaJapan350‐8550
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute)Via Roberto Bellarmino 13/1MilanItaly20141
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute)Via Roberto Bellarmino 13/1MilanItaly20141
| | | |
Collapse
|
40
|
Kuroki H, Inomata N, Hamanaka H, Higa K, Chosa E, Tajima N. Efficacy of the Osaka Medical College (OMC) brace in the treatment of adolescent idiopathic scoliosis following Scoliosis Research Society brace studies criteria. SCOLIOSIS 2015; 10:12. [PMID: 25932040 PMCID: PMC4415349 DOI: 10.1186/s13013-015-0036-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/19/2015] [Indexed: 11/10/2022]
Abstract
Background The efficacy of brace treatment for patients with adolescent idiopathic scoliosis (AIS) remains controversial. To make comparisons among studies more valid and reliable, the Scoliosis Research Society (SRS) has standardized criteria for brace studies in patients with AIS. The purpose of this study was to evaluate the efficacy of the Osaka Medical College (OMC) brace for AIS in accordance with the modified standardized criteria proposed by the SRS committee on bracing and non-operative management. Methods From 1999 through 2010, 31 consecutive patients with AIS who were newly prescribed the OMC brace and met the modified SRS criteria were studied. The study included 2 boys and 29 girls with a mean age of 12 years and 0 month. Patients were instructed to wear the brace for a minimum of 20 hours per day at the beginning of brace treatment. The mean duration of brace treatment was 4 years and 8 months. We examined the initial brace correction rate and the clinical outcomes of main curves evaluated by curve progression and surgical rate, and the compliance evaluated by the instruction adherence rate for all cases. The clinical course of the brace treatment was considered progression if ≥6° curvature increase occurred and improvement if ≥6° curvature decrease occurred according to SRS judgment criteria. Results The average initial brace correction rate was 46.8%. In 10 cases the curve progressed, 6 cases the curve improved, and 15 cases the curve remained unchanged (success rate: 67.7%). The mean instruction adherence rate, that was defined the percentage of the visits that patients declared they mostly followed our instruction to total visits, was 53.7%. The success rate was statistically higher in the patient group whose instruction adherence rate was greater than 50% (88.2%) as compared with in those 50% or less (42.8%). Conclusions OMC brace treatment for AIS patients could alter the natural history and significantly decreased the progression of curves to the threshold for surgical intervention. Better instruction adherence of brace wear associated with greater success.
Collapse
Affiliation(s)
- Hiroshi Kuroki
- Department of Orthopaedic Surgery, National Hospital Organization Miyazaki Higashi Hospital, 4374-1 Tayoshi Ooaza, Miyazaki, 880-0911 Japan
| | - Naoki Inomata
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Hideaki Hamanaka
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Kiyoshi Higa
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Naoya Tajima
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Miyazaki, Japan
| |
Collapse
|
41
|
Kuroki H, Inomata N, Hamanaka H, Higa K, Chosa E, Tajima N. Predictive factors of Osaka Medical College (OMC) brace treatment in patients with adolescent idiopathic scoliosis. SCOLIOSIS 2015; 10:11. [PMID: 25873992 PMCID: PMC4395903 DOI: 10.1186/s13013-015-0038-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/31/2015] [Indexed: 11/10/2022]
Abstract
Background Factors influencing clinical course of brace treatment apply to adolescent idiopathic scoliosis (AIS) patients remain unclear. By making clear them, we may select suitable patients for brace treatment and alleviate overtreatment. The purpose of this study was to explore predictive factors of Osaka Medical College (OMC) brace treatment for AIS patients in accordance with the modified standardized criteria proposed by the Scoliosis Research Society (SRS) committee on bracing and non-operative management. Methods From 1999 through 2010, 31 consecutive patients with AIS who were newly prescribed the OMC brace and met the modified SRS criteria were studied. The study included 2 boys and 29 girls with a mean age of 12 years and 0 month. We investigated the clinical course and evaluated the impacts of compliance, initial brace correction rate, curve flexibility, curve pattern, Cobb angle, chronological age, and Risser stage to clinical outcomes. The clinical course of the brace treatment was considered progression if ≥6° curvature increase occurred and improvement if ≥6° curvature decrease occurred according to SRS judgment criteria. Results The curve progressed in 10 cases, the curve improved in 6 cases, and the curve remained unchanged in 15 cases (success rate: 67.7%). The success rate was statistically higher in the patient group whose instruction adherence rate was greater than 50% as compared with in those 50% or less. Initial brace correction rate, curve flexibility, curve pattern, the magnitude of Cobb angle, chronological age, and Risser stage did not have any significant effect for clinical courses. However, success rate was insignificantly higher in the cases whose Cobb angle in brace was smaller than that in hanging position. Conclusions OMC brace treatment could alter the natural history of AIS, however, that was significantly affected by compliance of brace wear.
Collapse
Affiliation(s)
- Hiroshi Kuroki
- Department of Orthopaedic Surgery, National Hospital Organization Miyazaki Higashi Hospital, 4374-1 Tayoshi Ooaza, Miyazaki, 880-0911 Japan
| | - Naoki Inomata
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Hideaki Hamanaka
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Kiyoshi Higa
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Naoya Tajima
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Miyazaki, Japan
| |
Collapse
|
42
|
Negrini S, Hresko TM, O’Brien JP, Price N. Recommendations for research studies on treatment of idiopathic scoliosis: Consensus 2014 between SOSORT and SRS non-operative management committee. SCOLIOSIS 2015; 10:8. [PMID: 25780381 PMCID: PMC4360938 DOI: 10.1186/s13013-014-0025-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 01/29/2023]
Abstract
The two main societies clinically dealing with idiopathic scoliosis are the Scoliosis Research Society (SRS), founded in 1966, and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT), started in 2004. Inside the SRS, the Non-Operative Management Committee (SRS-NOC) has the same clinical interest of SOSORT, that is the Orthopaedic and Rehabilitation (or Non-Operative, or conservative) Management of idiopathic scoliosis patients. The aim of this paper is to present the results of a Consensus among the best experts of non-operative treatment of Idiopathic Scoliosis, as represented by SOSORT and SRS, on the recommendation for research studies on treatment of Idiopathic Scoliosis. The goal of the consensus statement is to establish a framework for research with clearly delineated inclusion criteria, methodologies, and outcome measures so that future meta- analysis or comparative studies could occur. A Delphi method was used to generate a consensus to develop a set of recommendations for clinical studies on treatment of Idiopathic Scoliosis. It included the development of a reference scheme, which was judged during two Delphi Rounds; after this first phase, it was decided to develop the recommendations and 4 other Delphi Rounds followed. The process finished with a Consensus Meeting, that was held during the SOSORT Meeting in Wiesbaden, 8-10 May 2014, moderated by the Presidents of SOSORT (JP O'Brien) and SRS (SD Glassman) and by the Chairs of the involved Committees (SOSORT Consensus Committee: S Negrini; SRS Non-Operative Committee: MT Hresko). The Boards of the SRS and SOSORT formally accepted the final recommendations. The 18 Recommendations focused: Research needs (3), Clinically significant outcomes (4), Radiographic outcomes (3), Other key outcomes (Quality of Life, adherence to treatment) (2), Standardization of methods of non-operative research (6).
Collapse
Affiliation(s)
- Stefano Negrini
- />Clinical and Experimental Sciences Department, University of Brescia, Viale Europa 32, 25123 Brescia, Italy
- />IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Timothy M Hresko
- />Department of Orthoapedic Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, USA
| | | | - Nigel Price
- />Children’s Mercy Hospital, University of Missouri Kansas City, Kansas, USA
| | - SOSORT Boards
- />Clinical and Experimental Sciences Department, University of Brescia, Viale Europa 32, 25123 Brescia, Italy
- />IRCCS Fondazione Don Gnocchi, Milan, Italy
- />Department of Orthoapedic Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, USA
- />National Scoliosis Foundation, Stoughton, MA USA
- />Children’s Mercy Hospital, University of Missouri Kansas City, Kansas, USA
| | - SRS Non-Operative Committee
- />Clinical and Experimental Sciences Department, University of Brescia, Viale Europa 32, 25123 Brescia, Italy
- />IRCCS Fondazione Don Gnocchi, Milan, Italy
- />Department of Orthoapedic Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, USA
- />National Scoliosis Foundation, Stoughton, MA USA
- />Children’s Mercy Hospital, University of Missouri Kansas City, Kansas, USA
| |
Collapse
|
43
|
Ugras A. Brace treatment is effective for scoliosis. Orthopedics 2015; 38:6-7. [PMID: 25611404 DOI: 10.3928/01477447-20150105-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
44
|
Jevsevar DS. The Role of Evidence-Based Medicine in Clinical Practice Policy. JBJS Rev 2014; 2:01874474-201409000-00002. [DOI: 10.2106/jbjs.rvw.m.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
45
|
Abstract
School nurses have provided routine health screenings of school-age children for decades. During the 1970s, recommendations for school scoliosis screening, which were based upon poor access to health care, led state boards of education to mandate that school nurses screen for scoliosis. The history of mandated scoliosis screening in U.S. schools is reviewed, and current school nurse practices for scoliosis screening are presented. Elevated referral rates for repeat scoliosis examination following school scoliosis screenings have led to questions of efficacy. Further controversy exists regarding school nurses screening for scoliosis due to a lack of evidence indicating a decreased need for scoliosis surgery. This article contains evidence-based recommendations for discontinuing school scoliosis screening to help school nurses refocus their efforts on complex health needs and preventive health issues more likely to impact the majority of their students.
Collapse
|
46
|
Negrini S, Donzelli S, Lusini M, Minnella S, Zaina F. The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study. BMC Musculoskelet Disord 2014; 15:263. [PMID: 25095800 PMCID: PMC4132192 DOI: 10.1186/1471-2474-15-263] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/16/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Recently an RCT confirmed brace efficacy in adolescent idiopathic scoliosis (AIS) patients. Previously, a Cochrane review suggested also producing studies according to the Scoliosis Research Society (SRS) criteria on the effectiveness of bracing for AIS. Even if the SRS criteria propose a prospective design, until now only one out of 6 published studies was prospective. Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria for AIS conservative treatment. METHODS STUDY DESIGN/SETTING prospective cohort study nested in a clinical database of all outpatients of a clinic specialized in scoliosis conservative treatment. PATIENT SAMPLE seventy-three patients (60 females), age 12 years 10 months ±17 months, 34.4±4.4 Cobb degrees, who satisfied SRS criteria were included out of 3,883 patients at first evaluation. OUTCOME MEASURES Cobb angle at the end of treatment according to SRS criteria : (unchanged; worsened 6° or more, over 45° and surgically treated, and rate of improvement of 6° or more).Braces were prescribed for 18-23 hours/day according to curves magnitude and actual international guidelines. Weaning was gradual after Risser 3. All patients performed exercises and were managed according to SOSORT criteria. Results in all patients were analyzed according to intent-to-treat at the end of the treatment. Funding and Conflict of Interest: no. RESULTS Overall 34 patients (52.3%) improved. Seven patients (9.6%) worsened, of which 1 patient progressed beyond 45° and was fused. Referred compliance was assessed during a mean period of 3 years 4 months ±20 months; the median adherence was 99.1% (range 22.2-109.2%). Employing intent-to-treat analysis, there were failures in 11 patients (15.1%). At start, these patients had statistically significant low BMI and kyphosis, high thoracic rotation and higher Cobb angles. Drop-outs showed reduced compliance and years of treatment; their average scoliosis at discontinuation was low: 22.7° (range 16-35°) at Risser 1.3 ± 1. CONCLUSIONS Bracing in patients with AIS who satisfy SRS criteria is effective. Combining bracing with exercise according to SOSORT criteria shows better results than the current literature.
Collapse
Affiliation(s)
- Stefano Negrini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11 Brescia, Italy
- IRCCS Don Gnocchi Foundation, Milan, Italy
| | | | - Monia Lusini
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | | | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| |
Collapse
|
47
|
Abstract
BACKGROUND The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. METHODS We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). RESULTS The trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score-adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P<0.001). CONCLUSIONS Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST ClinicalTrials.gov number, NCT00448448.).
Collapse
Affiliation(s)
- Stuart L Weinstein
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA.
| | | | | | | |
Collapse
|
48
|
Lange JE, Steen H, Gunderson R, Brox JI. Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis. SCOLIOSIS 2011; 6:18. [PMID: 21880123 PMCID: PMC3189160 DOI: 10.1186/1748-7161-6-18] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/31/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is recommended that research in patients with idiopathic scoliosis should focus on short- and long-term patient-centred outcome. The aim of the present study was to evaluate outcome in patients with late-onset juvenile or adolescent idiopathic scoliosis 16 years or more after Boston brace treatment. METHODS 272 (78%) of 360 patients, 251 (92%) women, responded to follow-up examination at a mean of 24.7 (range 16 - 32) years after Boston brace treatment. Fifty-eight (21%) patients had late-onset juvenile and 214 had adolescent idiopathic scoliosis. All patients had clinical and radiological examination and answered a standardised questionnaire including work status, demographics, General Function Score (GFS) (100 - worst possible) and Oswestry Disability Index (ODI) (100 - worst possible), EuroQol (EQ-5D) (1 - best possible), EQ-VAS (100 - best possible), and Scoliosis Research Society - 22 (SRS - 22) (5 - best possible). RESULTS The mean age at follow-up was 40.4 (31-48) years. The prebrace major curve was in average 33.2 (20 - 57)°. At weaning and at the last follow-up the corresponding values were 28.3 (1 - 58)° and 32.5 (7 - 80)°, respectively. Curve development was similar in patients with late-onset juvenile and adolescent start. The prebrace curve increased > 5° in 31% and decreased > 5° in 26%. Twenty-five patients had surgery. Those who did not attend follow-up (n = 88) had a lower mean curve at weaning: 25.4 (6-53)°. Work status was 76% full-time and 10% part-time. Eighty-seven percent had delivered a baby, 50% had pain in pregnancy. The mean (SD) GFS was 7.4 (10.8), ODI 9.3 (11.0), EQ-5D 0.82 (0.2), EQ-VAS 77.6 (17.8), SRS-22: pain 4.1 (0.8), mental health 4.1 (0.6), self-image 3.7 (0.7), function 4.0 (0.6), satisfaction with treatment 3.7 (1.0). Surgical patients had significantly reduced scores for SRS-physical function and self-image, and patients with curves ≥ 45° had reduced self-image. CONCLUSION Long-term results were satisfactory in most braced patients and similar in late-onset juvenile and idiopathic adolescent scoliosis.
Collapse
Affiliation(s)
- Johan Emil Lange
- Orthopaedic and Radiological Department, Rikshospitalet, Oslo University Hospital, Norway
| | - Harald Steen
- Orthopaedic and Radiological Department, Rikshospitalet, Oslo University Hospital, Norway
| | - Ragnhild Gunderson
- Orthopaedic and Radiological Department, Rikshospitalet, Oslo University Hospital, Norway
| | - Jens Ivar Brox
- Orthopaedic and Radiological Department, Rikshospitalet, Oslo University Hospital, Norway
| |
Collapse
|
49
|
Lange JE, Steen H, Brox JI. Long-term results after Boston brace treatment in adolescent idiopathic scoliosis. SCOLIOSIS 2009; 4:17. [PMID: 19709435 PMCID: PMC2743640 DOI: 10.1186/1748-7161-4-17] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 08/26/2009] [Indexed: 11/25/2022]
Abstract
Background Few studies have evaluated long-term outcome after bracing using validated health related quality of life outcome measures. The aim of the present study was to evaluate the long-term outcome in adolescent idiopathic scoliosis (AIS) 12 years or more after treatment with the Boston brace. Methods 109 (80%) of 135 patients (7 men) with AIS treated with the Boston brace at a mean of 19.2 (range 12–28) years previously responded to long-term follow-up examination. All patients (n = 109) answered a standardised questionnaire including demographics, work status, treatment, Global Back Disability Question, Oswestry Disability Index (ODI) (100-worst possible), General Function Score (GFS) (100 – worst possible), EuroQol (EQ-5D) (1 – best possible), EQ-VAS (100 – best possible)) and Scoliosis Research Society -22 (SRS – 22) (5 – best possible). Clinical and radiological examination was obtained in 86 patients. Results The magnitude of the primary prebrace major curve was in average 33.4° (range 20 – 52). At weaning and at the last follow-up the corresponding values were 28.3° (9–56) and 34.2° (8 – 87), respectively. The mean age at follow-up was 35 (27 – 46) years. Work status was: full time (80%), on sick-leave (3%), on rehabilitation (4%), disability pension (4%), homemaker (7%), students (2%), 7% had changed their job because of back pain. 88% had had delivered a baby, 55% of them had pain in pregnancy. Global back status was excellent or good in 81%. The mean (standard deviation) ODI was 6.4 (9.8), GFS 5.4 (10.5), EQ-5D 0.84 (0.2), SRS-22: pain 4.2 (0.8), mental health 4.2 (0.7), self-image 3.9 (0.7), function 4.1 (0.6), satisfaction with treatment 3.7 (1.0). 28% had taken physiotherapy for back pain the last year and 12% had visited a doctor. Conclusion Long-term results were satisfactory in most patients with AIS treated with the Boston brace.
Collapse
Affiliation(s)
- Johan Emil Lange
- Orthopaedic Department, Rikshospitalet, Oslo University Hospital, Norway
| | | | | |
Collapse
|