Effect of Group Exercising and Adjusting the Brace at Shorter Intervals on Cobb Angle and Quality of Life of Patients With Idiopathic Scoliosis

The Superiority of Schroth Exercise Combined Brace Treatment for Mild-to-Moderate Adolescent Idiopathic Scoliosis: A Systematic Review and Network Meta-Analysis

OBJECTIVE

The current study aimed to assess and rank the comparative efficacy of different nonoperative treatments on Cobb angle, angle of trunk rotation, and quality of life for mild-to-moderate adolescent idiopathic scoliosis.

METHODS

A comprehensive search of databases, including Medline, The Cochrane Library, PubMed, EMBASE, and Web of Science spanning all previous years up to January 1, 2024. The included studies were evaluated for literature quality according to Cochrane Handbook criteria, and a network meta-analysis was performed using STATA 14.0 statistical software.

RESULTS

Twenty randomized controlled trials met all inclusion criteria and were analyzed. Schroth exercise and scoliosis-specific exercise combined with brace treatments had a significant positive effect on Cobb angle and quality of life. For angle of trunk rotation, Schroth exercise and Schroth exercise combined with brace treatments prove more effective compared to the control group. On surface-under-the-cumulative-ranking-curve analysis, Schroth exercise combined with brace treatment had the highest likelihood for reducing Cobb angle (P-score = 0.899), angle of trunk rotation (0.82), and improving quality of life (0.828).

CONCLUSIONS

Although most conservative treatments had benefits for mild-to-moderate adolescent idiopathic scoliosis, the most optimal programs were those that included (1) at least 10 weeks of approximately 60-minute Schroth exercise sessions twice a week and (2) wearing the brace for 23 hours every day throughout the treatment period.

A new scoliosis brace padding method based on trunk asymmetry for scoliosis treatment

BACKGROUND

Pressure pads are used with scoliosis braces to adjust the magnitude and location of corrective forces that mechanically support the torso to correct the spine deformity. In the conventional brace (C.B.) design approaches, the location and shape of pads are determined based on the visual assessment of the clinician. The accuracy of this approach could be improved because it is limited to the clinician's expertise. The present study aimed to develop a new brace (N.B.) padding method based on trunk asymmetry for adolescents with idiopathic scoliosis and compare the efficacy of the developed method with C.B. in improving the Cobb angle and body posture symmetricity.

METHODS

The trunk surface geometry was scanned using a 3-dimensional scanner. The best plane of symmetry was determined, and the original trunk was reflected in the plane of symmetry, creating the reflected trunk. The difference between the reflected and original trunks was computed and color-coded using deviation contour maps. The boundary of deformed regions, with a minimum of 6-mm deviation contour maps, was identified as the trim lines for brace pads. Eight participants were recruited and divided into conventional and new padding groups. The variation of Cobb angle and torso asymmetry parameters, including the trunk rotation and back surface rotation, as well as the brace satisfaction and trunk appearance perception of the 2 groups, were compared after 3 months of treatment.

RESULTS

Cobb angle improved equally in the N.B. and C.B. groups. However, back surface rotation improved in the N.B. group (+49.6%) and worsened in the C.B. group (-6.8%). The mean trunk rotation was improved by 30% in the N.B. and further exacerbated by -2.2% in the C.B. group. The brace satisfaction and trunk appearance perception scores were higher in the N.B. than in the C.B. group, however not statistically significant.

CONCLUSIONS

The present study showed that the proposed brace padding system improved the trunk appearance without negatively affecting the Cobb angle correction.

Chinese validation of the quality of life profile for spinal deformities (QLPSD)

We aimed to translate and validate the Quality of Life Profile for Spine Deformities (QLPSD), an age-specific tool assessing the individuals' health-related quality of life (HRQoL), into a Chinese version for adolescent individuals with adolescent idiopathic scoliosis (AIS). The Chinese version was translated from the original Spanish QLPSD following widely accepted guidelines and evaluated by both individuals with AIS and experts. 172 Chinese-speaking individuals between 9 and 18 years of age with Cobb angles between 20° and 40° were included. Internal consistency, test-retest reliability, and floor and ceiling effects were all analyzed. Convergent validity was evaluated by correlating the measures in the Chinese QLPSD with those in the 22-item Scoliosis Research Society Questionnaire (SRS-22). Known-groups construct validity was assessed by comparing the QLPSD scores of two groups of individuals divided by their Cobb angles. The internal consistency (total Cronbach's alpha = 0.917) and the test-retest reliability (total intra-class correlation coefficient = 0.896) were both satisfactory. The Chinese QLPSD correlated well with the SRS-22 in the total score and in relevant subscales (r = -0.572, p < 0.01). The questionnaire was able to differentiate between individuals with different Cobb angles. No floor or ceiling effects were shown in the total score, neither were there ceiling effects in the subscales, but floor effects were observed in four of the five subscales, between 20.0% and 45.7%. The Chinese version of the QLPSD shows adequate transcultural adaptation, reliability, and validity, and is useful as a clinical evaluation tool for the HRQoL of adolescent Chinese-speaking individuals with AIS.

Predictive Factors on Initial in-brace Correction in Idiopathic Scoliosis: A Systematic Review

STUDY DESIGN

Systematic literature review.

OBJECTIVE

The aim of this study was to systematically review the literature and provide an overview of reported predictive factors on initial in-brace correction in patients with idiopathic scoliosis (IS).

SUMMARY OF BACKGROUND DATA

Brace therapy is the best proven non-surgical treatment for IS. There is strong evidence that lack of initial in-brace correction is associated with brace treatment failure. To improve initial in-brace corrections and subsequently long-term brace treatment success, knowledge about factors influencing initial in-brace correction is a prerequisite.

METHODS

A systematic literature search was performed in Pubmed, Embase, Web-of-Science, Scopus, Cinahl, and Cochrane in November 2020. Studies which reported factors influencing initial in-brace correction in IS patients treated with brace therapy were considered eligible for inclusion.

RESULTS

Of the 4562 potentially eligible articles identified, 28 studies fulfilled the inclusion criteria and were included in this systematic review. Nine studies (32%) were classified as high quality studies and the remaining 19 studies (68%) as low quality. Thirty-four different reported factors were collected from the included studies. Strong evidence was found for increased curve flexibility as favorable predictive factor for initial in-brace correction. Moderate evidence was found for thoracolumbar or lumbar curve pattern as favourable predictive factor, and double major curve pattern as unfavourable predictive factor for initial in-brace correction. Also moderate evidence was found that there is no significant difference on initial in-brace correction between computer-aided design and manufacturing systems (CAD/CAM) braces with or without finite element models (FEM) simulation, and braces fabricated using the conventional plaster-cast.

CONCLUSION

The results of this systematic review indicate that increased curve flexibility is strongly associated with increased initial in-brace correction.Level of Evidence: 1.

Success Rate of Brace Treatment for Juvenile-Onset Idiopathic Scoliosis up to Skeletal Maturity

BACKGROUND

Natural history studies have reported that the progression rate of juvenile idiopathic scoliosis (JIS) curves larger than 20° is high and tends to progress. The aim of this study was to investigate the outcome of bracing on JIS and to determine the prognostic factors on the success rate of brace treatment.

METHODS

From March 1985 to February 2015, the clinical data of all JIS patients with referral age from 4 to 10 years who received brace treatment were reviewed. Those patients with a prebrace Cobb angle >20° and a Risser sign of 0 to 2 were included and followed up a minimum of 2 years after discontinuation of the brace or time of spinal fusion. The Cobb angle was recorded at the time of diagnosis, before initiation of bracing, weaning time, brace discontinuation, and final follow-up.

RESULTS

From 297 patients with JIS, a total of 75 cases (18 boys, 57 girls) with an average curve magnitude of 31.9° at the time of diagnosis met the inclusion criteria of the study. For successfully treated patients, the average best in-brace correction was 55% for Lenke I curves, 59% for Lenke II curves, 41% for Lenke III curves, and 62% for Lenke V curves. For a total of 27 patients (36%), the brace treatment failed. Of these, 21 patients (78%) reached spinal fusion, and curves of 6 patients (22%) increased to ≥50°. The progression rate was highest in patients with Lenke type III curves (67%), and also in those with a curve magnitude of ≥46° (94%).

CONCLUSIONS

Brace treatment is an effective strategy for controlling the curve progression and avoiding spinal fusion in JIS.

LEVEL OF EVIDENCE

4.

Sticking to It: A Scoping Review of Adherence to Exercise Therapy Interventions in Children and Adolescents With Musculoskeletal Conditions

OBJECTIVE

To identify and categorize barriers, facilitators, and strategies to boost exercise therapy adherence in youth with musculoskeletal conditions to inform research and clinical practice.

STUDY DESIGN

Scoping review.

LITERATURE SEARCH

We searched MEDLINE, CINAHL, SPORTDiscus, Scopus, PEDro, and ProQuest from inception to October 1, 2019.

STUDY SELECTION CRITERIA

Studies written in English, with original data featuring an adherence barrier, facilitator, or boosting strategy for exercise therapy in youth (age, 19 years or younger) with musculoskeletal conditions, were included.

DATA SYNTHESIS

Arksey and O'Malley's framework and the PRISMA Extension for Scoping Reviews guided data synthesis. Study quality was assessed with the Mixed Methods Appraisal Tool. Descriptive consolidation included study and sample characteristics, exercise therapy details, and adherence measurement specifics. Inductive thematic analysis of adherence barriers, facilitators, and boosting strategies followed Braun and Clarke's 6-step guide.

RESULTS

Of 5705 potentially relevant records, 41 studies, representing 2020 participants (64% girls; age range, 2-19 years) with 12 different musculoskeletal conditions and multiple exercise therapy interventions, were included. Despite poor reporting of adherence concepts, time constraints, physical environment (eg, location), and negative exercise experiences were commonly identified barriers. Social support and positive exercise experiences were frequently identified facilitators. Reinforcement, exercise program modification, and education were recurring boosting strategies, despite being infrequent barriers or facilitators.

CONCLUSION

A diversity of barriers to and facilitators of exercise therapy for youth with musculoskeletal conditions were identified. Efforts to link adherence-boosting strategies to an individual's needs should be considered. Making exercise enjoyable, social, and convenient may be important to maximizing adherence in this population. J Orthop Sports Phys Ther 2020;50(9):503-515. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9715.

Could the Clinical Effectiveness Be Improved Under the Integration of Orthotic Intervention and Scoliosis-Specific Exercise in Managing Adolescent Idiopathic Scoliosis?: A Randomized Controlled Trial Study

OBJECTIVE

The aim of the study was to compare the effectiveness of the integration of orthotic intervention and scoliosis-specific exercise with orthotic intervention only via assessing the spinal deformity, back muscle endurance, and pulmonary function of the patients with adolescent idiopathic scoliosis.

DESIGN

It is a prospective randomized controlled study. Patients who fulfilled the SRS criteria for orthotic intervention were randomly assigned to the orthosis combined with exercise group (combined orthotic and exercise intervention) or the orthotic intervention group (orthotic intervention only). All the subjects were prescribed with a rigid thoracolumbosacral orthosis and scoliosis-specific exercise program was provided to the subjects in the orthosis combined with exercise group. Cobb angle, back muscle endurance, and pulmonary function of subjects were measured at baseline, 1-mo, and 6-mo follow-up visits.

RESULTS

After 6 mos of intervention, the subjects in the orthosis combined with exercise group showed better Cobb angle correction than those in the orthotic intervention group. The back muscle endurance and pulmonary function decreased in the subjects of the orthotic intervention group, whereas some improvement happened in the subjects of the orthosis combined with exercise group. Between-group statistical significance was detected at the 6-mo follow-up among back muscle endurance time and parameters of pulmonary function.

CONCLUSIONS

In this study, orthotic intervention combined with scoliosis-specific exercise offered better Cobb angle correction and improvement of the respiratory parameters and back muscle endurance of the patients with adolescent idiopathic scoliosis as compared with orthotic intervention only.