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Alsiddiky AM, Alharbi KS, Ababtain OA, Alnuwaybit AF, Zamzami MA, Basalah AA, Al-Sabban WH. Brace-related Stress and Quality of Life Parameters between Chêneau and Boston Braces: A Cross-sectional Comparative Study on Adolescent Idiopathic Scoliosis in Saudi Arabia. Orthop Surg 2024. [PMID: 38858814 DOI: 10.1111/os.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Adolescent idiopathic scoliosis (AIS) is the most prevalent spinal deformity affecting healthy children. Although AIS typically lacks symptomatic manifestations, its resultant deformities can affect patients' quality of life (QoL). Evaluating QoL and stress levels is crucial in determining the optimal brace type for AIS patients; however, research comparing the effectiveness of different brace types in this regard is lacking. Therefore, this study aimed to evaluate the impact of Boston versus Chêneau braces on QoL and stress levels in AIS patients. METHODS This cross-sectional study was conducted at a medical institution in Riyadh, Saudi Arabia, involving 52 eligible patients selected through stratified random sampling based on type of brace as the main stratum. The inclusion criteria were idiopathic scoliosis, age ≥ 10 years, bracing for at least 3 months, and no history of cancer. QoL was evaluated according to the revised Scoliosis Research Society 22-item questionnaire (SRS-22r) and stress levels according to the eight-item Bad Sobernheim stress questionnaire (BSSQ-Brace). Independent-sample t-tests were used to compare brace-related QoL and stress level according to participants' sex and brace type. RESULTS Overall, 32 participants were treated with Boston braces (seven men and 25 women), with a median (IQR) age of 11.00 years (10.00-13.00), and 20 participants were treated with Chêneau braces (three men, 17 women), with a median (IQR) age of 12.50 years (10.00-14.25). The total SRS-22 score was not significantly different between the brace groups (p = 0.158). However, patients in the Boston brace group reported significantly higher satisfaction levels (median = 4.00, IQR = 3.50-4.50) than did those in the Chêneau brace group (median = 3.25, IQR = 2.38-4.13, p = 0.013, moderate effect size = 0.345, 95% CI = 0.060 to 0.590). Furthermore, the BSSQ-brace total score was significantly higher in the Boston brace group (median = 9.00, IQR = 8.00-12.00) than in the Chêneau brace group (median = 7.50, IQR = 4.75-10.00, p = 0.007, moderate effect size = 0.376, 95% CI = 0.130 to 0.590), indicating higher stress levels in the Chêneau brace group. CONCLUSION The QoL in AIS patients undergoing brace treatment was comparable across groups. Nonetheless, patients who used Chêneau braces experienced higher stress levels and lower treatment satisfaction rates than did those who used Boston braces. These findings can inform clinical decisions regarding prescription of bracing types and highlight the need for further in-depth research.
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Affiliation(s)
- Abdulmonem M Alsiddiky
- Department of Orthopedic Surgery, College of Medicine, Research Chair of Spinal Deformities, King Saud University, Riyadh, Saudi Arabia
| | | | - Omar A Ababtain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Mazin A Zamzami
- Biochemistry Department, Faculty of Science, Centre of Artificial Intelligence for Precision Medicines, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad A Basalah
- Mechanical Engineering Department, College of Engineering and Islamic Architecture, Umm Al Qura University, Makkah, Saudi Arabia
| | - Wesam H Al-Sabban
- Department of Information Systems, College of Computer and Information Systems, Umm Al-Qura University, Makkah, Saudi Arabia
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Cheung PWH, Chan OKO, Wu H, Lai MKL, Wong LPK, Tang S, Cheung JPY. Immediate vs Gradual Brace Weaning Protocols in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. JAMA Pediatr 2024:2819057. [PMID: 38829664 PMCID: PMC11148786 DOI: 10.1001/jamapediatrics.2024.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/11/2024] [Indexed: 06/05/2024]
Abstract
Importance Lack of evidence and consensus for brace weaning protocol in adolescent idiopathic scoliosis (AIS) results in clinicians prescribing gradual weaning in the hope of avoiding curve deterioration after weaning. However, gradual weaning contributes to prolonged brace wear, which can affect spinal stiffness and health-related quality of life (HRQoL). Objective To determine whether gradual weaning results in better curve magnitude and truncal balance maintenance after brace weaning vs immediate brace removal for patients with AIS. Design, Setting, and Participants This was an open-labeled randomized clinical trial commenced in April 2017 with 24-month follow-up completed in January 2023. Outcome assessors were masked to weaning protocol assigned. The study took place at a territory-wide tertiary scoliosis clinic serving the largest number of referrals in the local population. Patients with AIS ready to wean off of brace wear were eligible (402 were screened; 33 were excluded [15 for <18 hours/day of brace-wear compliance before weaning, 11 were treated with Milwaukee brace, and 7 declined to participate]; and 369 were included), and those who were treated with a custom molded thoracolumbosacral orthosis and had reached skeletal maturity were consecutively recruited. Interventions Patients were randomized to gradual weaning protocol (n = 176) with an additional 6 months of nighttime wear before completely stopping or immediate weaning protocol (n = 193) with immediate brace removal at recruitment. Main Outcomes and Measures Changes in major curve Cobb angle and truncal balance from the time of weaning to 6-month, 12-month, and 24-month follow-up. HRQoL was also assessed using the refined Scoliosis Research Society 22-item and EuroQol 5-dimension questionnaires. Results A total of 369 patients (mean [SD] age, 14.9 [1.1] years; 304 [83.4%] girls) were randomized with 284 (77.0%) completing 24-month longitudinal follow-up. Immediate and gradual weaning groups had no significant differences in change of major Cobb angle at postweaning 6-month (difference, -0.6°; 95% CI, -1.4 to 0.2; P = .17), 12-month (difference, -0.3°; 95% CI, -1.2 to 0.6; P = .47), and 24-month (difference, -0.3°; 95% CI, -1.2 to 0.7; P = .60) follow-up. The number of curve progression, nonprogression, and rebound cases were comparable (χ22 = 2.123; P = .35). Postweaning changes in truncal balance and HRQoL demonstrated no significant differences between groups. Conclusions Gradual weaning did not demonstrate superiority to immediate weaning with predefined criteria of Cobb angle and truncal balance maintenance and HRQoL after brace weaning. Gradual and immediate weaning achieved very similar maintenance of brace outcomes in AIS. We therefore recommend the consideration of immediate brace weaning, which aims to benefit patients with earlier time for increased exercises and activity level. Trial Registration ClinicalTrials.gov Identifier: NCT03329716.
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Affiliation(s)
- Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Oi Kiu Olivia Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Marcus Kin Long Lai
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lester Po Kwan Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shiyu Tang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Fernandes IP, Gomes MVP, Andrade RM, Schmidt AV, Ribeiro AP, Magalhães MO. Translation, cross-cultural adaptation and clinimetric properties of the Brazilian Portuguese version of the Brace Questionnaire. Spine Deform 2024:10.1007/s43390-024-00883-2. [PMID: 38689179 DOI: 10.1007/s43390-024-00883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To perform a cross-cultural adaptation and validation of the Brazilian-Portuguese versions of the Brace Questionnaire in adolescent idiopathic scoliosis. METHODS A forward-backward translation process was employed to produce a Brazilian Portuguese version of the Brace Questionnaire, followed by comprehensive cross-cultural adaptation stages. The measurements of internal consistency and test-retest reliability were assessed by Cronbach's a and intraclass correlation coefficient (ICC), respectively. The Pearson's correlation coefficient was used to analyze the concurrent validity by comparison with the Scoliosis Research Society-22r questionnaire. RESULTS A total of 84 scoliosis patients (age 13.4 ± 2.0 years, thoracic Cobb angle 33.3° ± 13.8°, and lumbar Cobb angle 29.8° ± 14.3°) were included. The Brace Questionnaire showed excellent internal consistency (Cronbach α = 0.93) and moderate reliability (ICC = 0.86). The correlations between the Brace Questionnaire and Scoliosis Research Society-22 were r = 0.66; p = 0.011. In addition, it was found that the Brazilian version of the Brace Questionnaire does not have ceiling and floor effects. CONCLUSIONS The Brazilian-Portuguese adaptation of the brace questionnaire shows excellent reliability and can be a valid tool for psychometric assessment in adolescent idiopathic scoliosis.
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Affiliation(s)
- Isabela Pedrosa Fernandes
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, Brazil
| | - Marcella Veronnica Pereira Gomes
- Post Graduation Program in Human Movement Sciences, Universidade Federal do Pará (UFPA), R. Augusto Corrêa, 01, Belém, PA, 66075-110, Brazil
| | | | | | - Ana Paula Ribeiro
- Laboratório de Biomecânica e Reabilitação Musculoesquelética, Health Science Post-Graduate Department, University Santo Amaro, São Paulo, Brazil
| | - Mauricio Oliveira Magalhães
- Post Graduation Program in Human Movement Sciences, Universidade Federal do Pará (UFPA), R. Augusto Corrêa, 01, Belém, PA, 66075-110, Brazil.
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Vergillos-Luna M, Alhada T, Oborocianu I, Miladi L, Monticone M, Rampal V, Saint-Pol AL, Bertoncelli CM, Boissière L, Solla F. Bipolar Fusionless Versus Standard Fusion Surgery in Neuromuscular Scoliosis: A Two-center Comparative Study. Clin Spine Surg 2023; 36:444-450. [PMID: 37348070 DOI: 10.1097/bsd.0000000000001472] [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: 01/19/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN Nonrandomized controlled cohort. OBJECTIVE To compare early results between bipolar fusionless construct (BFC) and single posterior fusion (SPF) surgery in neuromuscular scoliosis (NMS). BACKGROUND Surgical treatments for NMS have traditionally been characterized by high complication rates. A mini-invasive BFC was developed to reduce these risks while maintaining adequate curve reduction. There is, however, a current lack of studies comparing clinical and radiologic perioperative outcomes between both techniques. METHODS All patients surgically treated for NMS with to-pelvis construct between 2011 and 2021 at 2 centers were included and divided into 2 groups according to the surgical technique (BFC or SPF). Gender, age, main deformity region, etiology, preoperative and postoperative main curve magnitude and pelvic obliquity, surgery time, estimated blood loss and transfusion rates, length of hospital stay, the magnitude of main curve and pelvic obliquity correction, and early complications were compared. Quantitative data were compared through ANOVA or Mann-Whitney test. Analysis of qualitative outcomes was performed through Fisher exact test and logistic regressions. Kruskal-Wallis test was used to compare complications between groups. RESULTS Eighty-nine NMS patients were included: 48 in the SPF group and 41 in the BFC group. Surgery time (203 vs. 241 min), rate (32 vs. 52%) and severity of complications, unplanned returns to the operating room (15 vs. 39%), estimated blood loss (179 vs. 364 cc), and transfusion rates (27 vs. 73%) were lower in the BFC group ( P <0.05). There were no significant differences in age, maturity stage, preoperative curve magnitude, preoperative pelvic obliquity and postoperative curve, and pelvic obliquity correction between groups. CONCLUSIONS BFC may be a safer and less invasive option for NMS surgical treatment, resulting in similar curve corrections while significantly decreasing the number and severity of complications as well as intraoperative blood loss when compared with SPF. LEVEL OF EVIDENCE Level -lll.
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Affiliation(s)
| | - Toulla Alhada
- Spine Surgery Unit, CHU Bordeaux-Pellegrin, Bordeaux, France
| | - Ioana Oborocianu
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
| | - Lotfi Miladi
- Pediatrics Orthopedics Department, Necker Hospital, Paris, France
| | - Marco Monticone
- Department of Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
| | - Virginie Rampal
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
| | | | - Carlo M Bertoncelli
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
| | - Louis Boissière
- Spine Surgery Unit, CHU Bordeaux-Pellegrin, Bordeaux, France
| | - Federico Solla
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
- Department of Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
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Chu K, Kuang X, Cheung PWH, Li S, Zhang T, Cheung JPY. Predicting Progression in Adolescent Idiopathic Scoliosis at the First Visit by Integrating 2D Imaging and 1D Clinical Information. Global Spine J 2023:21925682231211273. [PMID: 37903546 DOI: 10.1177/21925682231211273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES The prediction of curve progression in patients with adolescent idiopathic scoliosis (AIS) remains an unresolved area in orthopedic surgery. To make a rapid meaningful prediction, easily accessible multi-dimensional data at the patient's first consultation should be used. Current studies use clinical growth parameters and numerical values extracted from radiographs to compile a predictive model, leaving out the radiographs themselves. Such practice inevitably wastes a lot of information. Thus, this study aims to create a neural network that can predict AIS progression among patients with curves indicated for bracing by integrating both one-dimensional (1D) clinical and two-dimensional (2D) radiological data collected at the patient's first visit in a fully automated manner. METHODS 513 idiopathic scoliosis patients indicated for and managed with bracing orthosis were recruited. After exclusion, 463 patients were included in deep learning analysis. Processed first-visit growth parameters and posteroanterior radiographs are used as training inputs and the curve progression outcomes obtained in follow ups are used as binary training outputs. The CapsuleNet architecture was modified and trained accordingly to make a prediction. RESULTS The final model achieved 90% sensitivity with an overall accuracy of 73.9% in the prediction of AIS in-brace curve progression by using first-visit multi-dimensional data, outperforming conventional convolutional neural networks. CONCLUSIONS This first-ever multidimensional-input model shows promise in serving as a screening tool for AIS in-brace curve progression. The incorporation of such a model into routine AIS diagnostic pipeline can assist orthopedics clinicians in personalizing the most appropriate management for each patient.
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Affiliation(s)
- Kenneth Chu
- Digital Health Laboratory, Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Xihe Kuang
- Digital Health Laboratory, Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Conova Medical Technology Limited, Hong Kong SAR, China
| | - Prudence W H Cheung
- Digital Health Laboratory, Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Sofia Li
- Digital Health Laboratory, Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Teng Zhang
- Digital Health Laboratory, Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Conova Medical Technology Limited, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Digital Health Laboratory, Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Liu S, Ho LY, Hassan Beygi B, Wong MS. Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels: A Systematic Review. JBJS Rev 2023; 11:01874474-202310000-00010. [PMID: 38079521 DOI: 10.2106/jbjs.rvw.23.00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Wearing spinal orthosis for 16 to 23 hours a day during the teenage years could be challenging and stressful for patients with adolescent idiopathic scoliosis (AIS). The investigation of clinical outcomes under various orthosis-wearing compliances can provide helpful insight into orthotic treatment dosage. This systematic review aims to investigate actual orthosis-wearing compliance and evaluate the effectiveness of orthotic treatment in controlling scoliotic curvature and preventing surgery for patients with AIS under various levels of orthosis-wearing compliance. METHODS A literature search of 7 electronic databases, namely PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL Complete, Web of Science, and Embase, was conducted on May 19, 2023. Participant characteristics, orthotic treatment protocols, compliance information, outcome measures, and key findings were extracted. The Newcastle-Ottawa Scales were used to evaluate the quality of included cohort and case-control studies. RESULTS This study systematically reviewed 17 of 1,799 identified studies, including 1,981 subjects. The actual compliance was inconsistent and ranged from 7.0 to 18.8 hours daily. The proportion of compliant subjects in each study varied from 16.0% to 78.6% due to the heterogeneity of calculation period, measurement methods, and orthosis prescription time. Thirteen studies were investigated to determine the effectiveness of orthotic treatment in controlling curve deformity under different compliance groups, and 2 studies compared the compliance under different treatment outcomes. The rate of curve progression, defined as surpassing the measurement error threshold of 5° or 6° after orthotic treatment, varied from 1.8% to 91.7% across the studies. Ten studies defined the treatment failure, surgery, or surgery indication as Cobb angle progressing to a certain degree (e.g., 40°, 45°, or 50°) and reported failure/surgery/surgery indication rates ranging from 0.0% to 91.7% among different compliance level groups. CONCLUSION This review found that the actual compliance with orthotic treatment was generally lower than the prescribed wearing time and exhibited wide variation among different studies. The electronic compliance monitors show promise in regular orthotic treatment practice. More importantly, the group with higher and consistent compliance has significantly less curve progression and lower surgery or failure rate than the group with lower and inconsistent compliance. Further studies are proposed to investigate the minimal orthosis-wearing compliance in patients with AIS treated with different types of orthoses. LEVEL OF EVIDENCE Level III, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shan Liu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Cheung PWH, Cheung JPY. Can the proximal humeral ossification system (PHOS) effectively guide brace weaning in patients with adolescent idiopathic scoliosis? 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 2023; 32:2185-2195. [PMID: 37100964 DOI: 10.1007/s00586-023-07693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE The proximal humeral epiphyses can be conveniently viewed in routine spine radiographs. This study aimed to investigate whether the proximal humeral epiphyseal ossification system (PHOS) can be used to determine the timing of brace weaning in adolescent idiopathic scoliosis (AIS), as assessed by the rate of curve progression after brace weaning. METHODS A total of 107 patients with AIS who had weaned brace-wear at Risser Stage ≥ 4, no bodily growth and post-menarche ≥ 2 years between 7/2014 and 2/2016 were studied. Increase in major curve Cobb angle > 5° between weaning and 2-year follow-up was considered curve progression. Skeletal maturity was assessed using the PHOS, distal radius and ulna (DRU) classification, Risser and Sanders staging. Curve progression rate per maturity grading at weaning was examined. RESULTS After brace-wear weaning, 12.1% of the patients experienced curve progression. Curve progression rate for weaning at PHOS Stage 5 was 0% for curves < 40°, and 20.0% for curves ≥ 40°. No curve progression occurred when weaning at PHOS Stage 5 with radius grade of 10 for curves ≥ 40°. Factors associated with curve progression were: Months post-menarche (p = 0.021), weaning Cobb angle (p = 0.002), curves < 40° versus ≥ 40° (p = 0.009), radius (p = 0.006) and ulna (p = 0.025) grades, and Sanders stages (p = 0.025), but not PHOS stages (p = 0.454). CONCLUSION PHOS can be a useful maturity indicator for brace-wear weaning in AIS, with PHOS Stage 5 having no post-weaning curve progression in curves < 40°. For large curves ≥ 40°, PHOS Stage 5 is also effective in indicating the timing of weaning together with radius grade ≥ 10.
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Affiliation(s)
- Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5thFloor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5thFloor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
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Vigouroux M, Newman G, Amja K, Hovey RB. "He told me my pain was in my head": mitigating testimonial injustice through peer support. FRONTIERS IN PAIN RESEARCH 2023; 4:1125963. [PMID: 37283705 PMCID: PMC10239879 DOI: 10.3389/fpain.2023.1125963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Women with disabilities are exposed to sexism and ableism, earn less income, and work in exceptionally challenging conditions compared to women without disabilities and men with or without disabilities. Adolescent girls living with scoliosis may begin experiencing this compounding bias during their encounters with healthcare from the moment they start noticing differences in their bodies. Being significantly more likely than boys to progress to a curve angle where painful treatment such as bracing or spinal fusion surgery is required, adolescent girls living with scoliosis are therefore more likely to experience chronic pain. The long-term impact of pain and pain-related stigma includes lower educational attainments, decreased vocational functionality, and social impairments in adults after having experienced chronic pain in adolescence. Approach In this article, the authors will explore the effects and mechanisms of gender-specific peer support in disrupting this trajectory to adverse outcomes. Through individual interviews consisting of open-ended questions, the researchers gathered narrative data from Curvy Girls members, a community-based peer support group for girls and young women living with scoliosis. The data was analyzed using an applied philosophical hermeneutics approach, with intersectionality and testimonial injustice as their framework. Findings They found that the study participants had their pain narratives reinterpreted by the adults in their lives, including their parents and healthcare practitioners, leading them to question and doubt their own experiences. Discussion These negative outcomes were mitigated through the peer support they received and offered from Curvy Girls. Participants reported having gained confidence and a sense of belonging after they joined this group, allowing them to better cope with their condition more effectively in different facets of their lives.
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Affiliation(s)
- Marie Vigouroux
- Department of Integrated Studies in Education, Faculty of Education, McGill University, Montreal, QC, Canada
- Institute for Gender, Sexuality and Feminist Studies, Faculty of Arts, McGill University, Montreal, QC, Canada
| | | | - Kristina Amja
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Richard Bruce Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
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An JK, Berman D, Schulz J. Back pain in adolescent idiopathic scoliosis: A comprehensive review. J Child Orthop 2023; 17:126-140. [PMID: 37034188 PMCID: PMC10080242 DOI: 10.1177/18632521221149058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/10/2022] [Indexed: 04/11/2023] Open
Abstract
Purpose Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects millions of children worldwide. A variety of treatment algorithms exist for patients based on radiographic parameters such as the Cobb angle and the Risser stage. However, there has been a growing focus on nonradiographic outcomes such as back pain, which can cause functional disability and reduced quality of life for patients. In spite of this, back pain in AIS is poorly characterized in the literature. We aimed to summarize various factors that may influence back pain in AIS and the impact of different treatment methods on pain reduction. Methods A comprehensive systematic review was undertaken using the PubMed and Cochrane database. Keywords that were utilized and combined with "Adolescent Idiopathic Scoliosis" included, "back pain," "treatment," "biomechanics," "biochemistry," "epidemiology," and "biopsychosocial." The literature was subsequently evaluated and deemed relevant or not relevant for inclusion. Results A total of 93 articles were ultimately included in this review. A variety of contradictory literature was present for all sections related to epidemiology, underlying biomechanics and biochemistry, biopsychosocial factors, and treatment methodologies. Conclusion Back pain in AIS is common but remains difficult to predict and treat. The literature pertaining to causative factors and treatment options is heterogeneous and inconclusive. Longer-term prospective studies combining biopsychosocial intervention in conjunction with existing curve correction techniques would be meaningful.
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Affiliation(s)
- Juhyung K An
- College of Medicine, SUNY Downstate
Health Sciences University, Brooklyn, NY, USA
| | - Daniel Berman
- Department of Orthopedic Surgery,
Montefiore Medical Center, Bronx, NY, USA
- Daniel Berman, Apt 18L, 353 East 83rd
Street, New York, NY 10028, USA.
| | - Jacob Schulz
- Department of Orthopedic Surgery,
Montefiore Medical Center, Bronx, NY, USA
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Ragborg LC, Dragsted C, Ohrt-Nissen S, Andersen T, Gehrchen M, Dahl B. Health-related quality of life in patients 40 years after diagnosis of an idiopathic scoliosis. Bone Joint J 2023; 105-B:166-171. [PMID: 36722050 DOI: 10.1302/0301-620x.105b2.bjj-2022-0897.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. METHODS We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. RESULTS The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. CONCLUSION In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis.Cite this article: Bone Joint J 2023;105-B(2):166-171.
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Affiliation(s)
- Lærke C Ragborg
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Casper Dragsted
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Andersen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin Gehrchen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Benny Dahl
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Dureigne F, Chagnas MO, Roren A, Couzi E, Lefèvre-Colau MM, Moreau S, Nicol V, Rannou F, Daste C, Nguyen C. Barriers and facilitators to bracing in adults with painful degenerative scoliosis: a single-centred mixed-method feasibility study. BMC Musculoskelet Disord 2023; 24:32. [PMID: 36647098 PMCID: PMC9841704 DOI: 10.1186/s12891-022-06111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Conservative treatments including bracing and exercise therapy are prescribed on the first-line in adults with degenerative scoliosis. However, adherence to conservative treatments is low. We aimed to assess barriers and facilitators to bracing in adults with painful degenerative scoliosis. METHODS We conducted a single-centred mixed-method pilot and feasibility study. All patients scheduled for a multidisciplinary custom-made bracing consultation, from July 2019 to January 2020, in a French tertiary care centre, were screened. Patients were eligible if they had painful adult degenerative scoliosis and a prescription for a rigid custom-made lumbar-sacral orthosis. The primary outcome was barriers and facilitators to bracing assessed by a qualitative approach using semi-structured interviews. Secondary outcomes were back pain, spine-specific activity limitations, symptoms of depression and satisfaction with bracing post-intervention assessed by a quantitative approach. RESULTS Overall, 56 patients were screened and 14 (25%) were included. Mean age was 68.2 (12.3) years. Mean follow-up was 9.8 (2.0) months. Barriers to bracing were increased limitations in some activities, discomfort in hot weather and burden of aesthetic appearance. Facilitators to bracing were reduced pain, improved activities of daily living, suitable weight and improved spinal alignment. Participants self-implemented solutions to enhance adherence. The mean reduction from baseline in pain intensity was 1.7 (2.3) of 10 points, and 6 of 13 patients (46%) had pain intensity < 4 of 10 points. CONCLUSION Bracing is a feasible intervention for people with painful adult degenerative scoliosis. Patients self-implemented their own solutions to enhance adherence.
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Affiliation(s)
- Flora Dureigne
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Marie-Ombeline Chagnas
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Alexandra Roren
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.7429.80000000121866389INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne, ECaMO Team, 75004 Paris, France ,Fédération pour la Recherche sur le Handicap et l Autonomie, 75013 Paris, France
| | - Emmanuel Couzi
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Marie-Martine Lefèvre-Colau
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.7429.80000000121866389INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne, ECaMO Team, 75004 Paris, France ,Fédération pour la Recherche sur le Handicap et l Autonomie, 75013 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France
| | - Sylvain Moreau
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Vanina Nicol
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - François Rannou
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France ,grid.7429.80000000121866389INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - Camille Daste
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France ,grid.7429.80000000121866389INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne, METHODS Team, 75004 Paris, France
| | - Christelle Nguyen
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France ,grid.7429.80000000121866389INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
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Rojc M, Sršen KG, Mohar J, Vidmar G. Slovenian version of the scoliosis research society instrument-22 revised (SRS-22r) in adolescents and adults: Psychometric properties and some implications. J Pediatr Rehabil Med 2023; 16:351-359. [PMID: 36847023 DOI: 10.3233/prm-210127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
PURPOSE This study aimed to provide a reliable and valid translation of the Scoliosis Research Society-22 (SRS-22r) questionnaire, compare it with the EQ-5D-5 L questionnaire, and analyse health-related quality of life (HRQoL) of patients with idiopathic scoliosis (IS) in Slovenia in order to potentially improve their rehabilitation processes. METHODS A matched-case-control study was performed to assess internal consistency reliability, test-retest reliability, concurrent validity, and discriminative validity. The questionnaire was returned by 25 adolescent IS patients, 25 adult IS patients, and 25 healthy controls (87%, 71%, and 100% response rate, respectively). RESULTS Internal consistency was high for all four scales in the adult IS group, but lower among the adolescent patients. Test-retest reliability of the SRS-22r was high to very high in both patient groups. Correlations between SRS-22r and EQ-5D-5 L were low or close to zero among adolescent patients and moderate or high among adult IS patients. SRS-22r domain scores were statistically significantly different between adult patients and healthy controls. CONCLUSION The study proved that the Slovenian version of SRS-22r has the psychometric properties needed to measure HRQoL, whereby it appears to be more reliable for adults than adolescents. When used with IS adolescents, SRS-22r is affected by a severe ceiling effect. It could be used for longitudinal follow-up of adult patients after rehabilitation treatment. Additionally, some important issues that adolescents and adults with IS are faced with were identified.
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Affiliation(s)
- Marina Rojc
- Valdoltra Orthopaedic Hospital, Anakaran, Slovenia
| | | | - Janez Mohar
- Valdoltra Orthopaedic Hospital, Anakaran, Slovenia
| | - Gaj Vidmar
- University Rehabilitation Institute, Ljubljana, Slovenia
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Gornitzky AL, England P, Kiani SN, Yellin JL, Flynn JM. Why Don't Adolescents Wear Their Brace? A Prospective Study Investigating Psychosocial Characteristics That Predict Scoliosis Brace Wear. J Pediatr Orthop 2023; 43:51-60. [PMID: 36194756 DOI: 10.1097/bpo.0000000000002272] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although bracing for adolescent idiopathic scoliosis can prevent curve progression and reduce the risk for future surgery, children frequently do not wear their braces as prescribed. The purpose of this study is to investigate how a broad array of psychosocial characteristics predict future compliance with scoliosis brace wear. METHODS This was a single institution, prospective cohort study. All adolescents prescribed a first-time brace for adolescent idiopathic scoliosis were eligible. Patients and their parents completed a separate series of questionnaires that assessed baseline psychosocial characteristics across 6 domains: (1) brace-specific attitudes; (2) body image and self-esteem; (3) school performance and social relationships; (4) psychological health; (5) family functioning; and (6) demographics and scoliosis-specific details (242 total questions across 12 validated questionnaires). Objective brace compliance was collected using temperature-sensitive monitors. Defining compliance as percentage of brace prescription completed, comparative analyses were performed to identify baseline psychosocial characteristics that were associated with future wear. A composite measure (Bracing Fidelity Follow-Up Scale [BFFS]) of the 12 most predictive individual questions across all domains (both parent and adolescent) was constructed to help assess which adolescents were at highest risk of failure to wear their brace. Total BFFS score for each parent-adolescent dyad who completed all the included surveys was then determined by awarding one point for each factor that positively influenced future brace wear (maximum 12 points), and a correlation was calculated between total score and percent adherence to prescribed brace wear. RESULTS A total of 41 patients were included. On average, patients with high self-esteem, above average peer relationships and poor brace-specific attitudes had lower brace compliance, although patients with increased loneliness and parental religiousness had higher compliance. Body image, socioeconomic status, family dynamics, and school performance had no significant relationship with brace use. Total score on the Bracing Fidelity Follow-Up Scale (BFFS) was significantly associated with improved brace wear (r=0.687, P <0.001). Those with a score of 6 or above (n=15/33 [45%], median compliance 96%) were more reliable users (15/15 with compliance >75%), and those with a score of 5 or less (n=18/33 [55%], median compliance 50%) had less consistent brace wear (9/18 with compliance <50%). CONCLUSION This prospective study identifies numerous baseline psychosocial factors that are associated with future compliance with scoliosis brace wear. Although in need of further validation before widespread clinical application, the novel BFF scale offers a potential opportunity to partially discriminate between compliant and noncompliant scoliosis brace users such that supportive resources (eg, supportive counseling, peer-support groups, additional provider-based education, etc.) can be targeted to those patients most likely to benefit. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Alex L Gornitzky
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
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14
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Cantele F, Posanti E, Pittarello C, Masiero S. Is higher compliance to brace therapy associated with poorer quality of life and self-image? A 36-months follow-up study. J Back Musculoskelet Rehabil 2023; 36:1163-1169. [PMID: 37458018 DOI: 10.3233/bmr-220361] [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] [Indexed: 07/18/2023]
Abstract
BACKGROUND Brace treatment is the most effective tool for avoiding curve progression in moderate adolescent idiopathic scoliosis and high adherence is required to achieve therapeutic success. Despite this, the compliance often is impaired by the concern about the psychological well-being of adolescents. OBJECTIVE This 36-month follow-up study investigated if the patients most adherent to brace treatment could report a stronger impairment in the quality of life and body image. METHODS 64 adolescents with idiopathic scoliosis responded to the Scoliosis Research Society-22 revised Patient Questionnaire at 12, 24, and 36 months after prescription of a TLSO rigid brace. Retrospectively, participants who wore a brace for more than 75% of the prescribed time were assigned to the good-compliance group (GC); the others formed the poor-compliance group (PC). RESULTS At 12 months the GC group showed higher scores in treatment satisfaction and at 36 months they did not differ from the PC group in the overall SRS-22r score. Moreover, they achieved a statistically significant improvement in the scoliosis severity, although they showed lower scores in the self-image domain. CONCLUSION In our patient's cohort, increased brace adherence does not compromise QoL and provides better treatment outcomes. However, more attention is needed to maintain good self-perception.
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Affiliation(s)
- Francesca Cantele
- Physical Medicine and Rehabilitation School, University of Padua, Padova, Italy
| | - Elena Posanti
- Physical Medicine and Rehabilitation School, University of Padua, Padova, Italy
| | - Chiara Pittarello
- Physical Medicine and Rehabilitation School, University of Padua, Padova, Italy
| | - Stefano Masiero
- Physical Medicine and Rehabilitation School, University of Padua, Padova, Italy
- Department of Neurosciences, Section of Rehabilitation, University of Padua, Padova, Italy
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15
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Cheung MC, Law D, Yip J, Cheung JPY. Adolescents' Experience during Brace Treatment for Scoliosis: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10585. [PMID: 36078297 PMCID: PMC9517878 DOI: 10.3390/ijerph191710585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents' experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace's visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents' feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.
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Affiliation(s)
- Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Derry Law
- Department of Design, Caritas Institute of Higher Education and Caritas Bianchi College of Careers, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Joanne Yip
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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16
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Li H, Yang Z, Li D, Qiao F. A Novel Low-Cost 3D Printed Brace Design Method for Early Onset Scoliosis. J Med Device 2022. [DOI: 10.1115/1.4054998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Early onset scoliosis (EOS) is a type of spine deformity that presents before 10 years of age. The biomechanical properties in scoliosis have been found to be di?erent, especially in the case of the concave and convex paraverte-bral muscles. Based on this fact, a novel 3d printed patient-specific asymmetric stiffness brace design method is proposed in this paper, aiming to provide asymmetric stiffness to match "imbalanced" biomechanical properties of the concave and convex paravertebral muscles, respectively, and treat EOS by applying the block-structure brace.A 3d CAD draft model of the brace contour was implemented from 3D scanning. The asymmetric stiffness block-structure brace was designed in Rhinoceros and the Finite Ele-ment (FE) model was imported into ABAQUS. FE simulation was employed to study the mechanical characteristics of the brace, which provided a quan-titative index for the "imbalanced" property of brace stiffness. The results of the FE simulation showed that the stiffnesses of the concave and convex sides were 145.88 N/mm and 35.95 N/mm, respectively. The block-structure brace was fabricated using 3d printing. Asymmetric stiffness was evaluated by corrective force measurements, which were obtained from a thin-film pressure sensor equipped on the brace. The patient-specific asymmetric stiffness brace was applied to clinical practice in a one-year old EOS patient. A novel low-cost 3D printed brace design method for EOS was proposed in this study that could potentially be useful in patient treatment acceptance.
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Affiliation(s)
- Hongwei Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University , Xi'an, Shaanxi 710049, China
| | - Zhangkai Yang
- Department of Neurosurgery, Xi'an Children's Hospital, The Affiliated Children's Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi 710003, China
| | - Dichen Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University , Xi'an, Shaanxi 710049, China
| | - Feng Qiao
- Honghui Hospital, Xi'an Jiaotong University , No.555, Youyidong Rd, Xi'an, Shaanxi 710054, China
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Ionițe C, Rotariu M, Osean V, Mitran C, Condurache I. Scoliosis incidence and treatment methods. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Scoliosis is defined as a three-dimensional deformity of the spine that is of particular interest to the lateral curvature of the spine. Various types of treatment approaches have been recommended for patients with scoliosis. The aim of this study was to provide an up-to-date review of scoliosis, focusing on issues such as its incidence and treatment methods. The ISI-Thomson Web Of Science International Virtual Library was accessed for this review. The search criteria selected were 'title', 'abstract' and 'keywords'. In the ISI Thomson Web of Science virtual library platforms, the keywords in the articles search were "scoliosis incidence" and "scoliosis treatment". Over the years, different therapeutic strategies have been addressed for patients with scoliosis, they differ depending on the type of scoliosis, the patient's age and the available therapeutic means.
Keywords: Scoliosis, Incidence, Physical Treatment;
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Affiliation(s)
- Cătălin Ionițe
- Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iași, Ro-mania
| | - Mariana Rotariu
- Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iași, Ro-mania
| | | | | | - Iustina Condurache
- Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iași, Ro-mania
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Does Risser Casting for Adolescent Idiopathic Scoliosis Still Have a Role in the Treatment of Curves Larger Than 40°? A Case Control Study with Bracing. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050760. [PMID: 35626937 PMCID: PMC9139702 DOI: 10.3390/children9050760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
Abstract
Background: The most common conservative treatment for Adolescent Idiopathic Scoliosis (AIS) is bracing. However, several papers questioned the effectiveness of bracing for curves between 40° and 50° Cobb: the effectiveness in preventing curve progression could be as low as 35%. Seriate casting is considered a standard approach in early onset scoliosis; however, in the setting of AIS, cast treatment is seldom utilized, with only few studies reporting on its effectiveness. Aim of the study: The main aim of the study is to determine whether a seriate casting with Risser casts associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. Furthermore, the secondary endpoints were: (1) is there a difference in effectiveness of casting between Thoracic (T) and Thoracolumbar/Lumbar (TL/L) curves? (2) Does the ‘in cast’ correction predicts the treatment outcome? (3) What is the effect on thoracic kyphosis of casting? Methods: This is a retrospective monocentric case−control study; through an Institutional Database search we identified all the patients treated at our institution between 1 January 2017 and 31 December 2020, with a diagnosis of AIS, Risser grade between 0 and 4 at the beginning of the treatment, at least one curve above 40° Cobb and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Standing full spine X-rays in AP and LL are obtained before and after the cast treatment; only AP standing full spine X-rays ‘in-cast’ are obtained for each cast made. Patients were stratified according to the curve behavior at the end of treatment (Risser 5): progression was defined as ≥6° increase in the curve magnitude or fusion needed; stabilization is defined as a change in curve by ±5°; and improvement was defined as ≥6° reduction in the curve. Results: For the final analysis, 55 compliant patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 27 (4 M, 23 F, mean age 13.6 ± 1.6) in the CG. Eight (14.5%) patients in the SG failed the conservative treatment while 14 (51.3%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1, 3−2.6, p = 0.001), and the Number Needed to Treat was 2,4. No significant difference was found between the T and TL/L curves concerning the ‘progressive’ endpoint (z-score 0.263, p = 0.79). The mean percentage of ‘in cast’ curve reduction was 40.1 ± 15.2%; no significant correlation was found between the percentage of correction and the outcome (Spearman Correlation Coefficient 0.18). Finally, no significant differences between baseline and end of FU TK were found (32° ± 16.2 vs. 29.6 ± 15.8, p = ns). Discussion: Seriate Risser casting for AIS with larger curves (>40° Cobb) is effective in reducing curve progression when compared with full time bracing alone in treatment compliant patients. The treatment is equally effective in controlling T and TL/L curves; furthermore, a slight but non-significant decrease in TK was observed in patients treated with casting. This type of treatment should be considered for AIS patients who present with large curves to potentially reduce the percentage of surgical cases. Short Abstract: The aim of the study is to determine whether seriate Risser casting associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. This is a retrospective monocentric case−control study; we identified all the patients treated at our institution with a diagnosis of AIS, Risser grade 0−4 at the beginning of the treatment, at least one curve above 40° Cobb (35° if treated with bracing alone) and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Fifty-five patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 30 (5 M, 25 F, mean age 13.9 ± 1.7) in the CG. Eight (14,5%) patients in the SG failed the conservative treatment while fifteen (50%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1.3−2.6, p = 0.001), and the Number Needed to Treat was 2,4. Seriate Risser casting for AIS with larger curves (>40°) is effective in reducing curve progression when compared with full time bracing alone. This type of treatment should be considered for AIS patients who present with large curves.
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Nakayama K, Kotani T, Kimura H, Osaki M, Ichikawa Y, Sakuma T, Iijima Y, Sakashita K, Sunami T, Asada T, Sato K, Akazawa T, Kishida S, Sasaki Y, Inage K, Shiga Y, Minami S, Ohtori S, Koda M, Yamazaki M. The Optimal Anatomical Position and Threshold Temperature of a Temperature Data Logger for Brace-Wearing Compliance in Patients with Scoliosis. Spine Surg Relat Res 2022; 6:133-138. [PMID: 35478984 PMCID: PMC8995123 DOI: 10.22603/ssrr.2021-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/06/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Although strict compliance with brace wearing is important for patients with scoliosis, no study has analyzed the most ideal conditions for temperature logger accuracy. We evaluated the optimal brace position and threshold temperature for the logger and determined the reliability of its measurements in patients with scoliosis. Methods Five temperature loggers were embedded into holes generated at five different brace positions (right scapula, right chest, left chest, lumbar, and abdomen) within the brace. We compared measurement errors at each position using different threshold temperatures to determine the ideal anatomical position and threshold temperature. Under the ideal conditions determined, we calculated the reliability of the temperature logger readings in three healthy participants. Results Measurement errors (i.e., differences between the actual and logger-recorded brace wearing times) were the lowest at the 28°C and 30°C threshold temperatures when the logger was positioned at the left chest and at 30°C at the abdomen. Among these three temperature/position combinations, we considered the abdomen to be the least affected by the shape of the brace; thus, the placement of the temperature logger at the abdomen using a threshold temperature of 30°C was the most ideal condition. Conclusions The placement of the temperature logger at the abdomen using a threshold temperature of 30°C was the most ideal condition, with the reliability of the logger being 97.9%±0.9%. This information might be useful for scoliosis management teams, and this temperature logger provides a valuable clinical tool.
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Affiliation(s)
- Keita Nakayama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Hiromi Kimura
- Department of Nursing, Seirei Sakura Citizen Hospital
| | - Minako Osaki
- Department of Nursing, Seirei Sakura Citizen Hospital
| | - Yuri Ichikawa
- Medical Affairs Division, Seirei Sakura Citizen Hospital
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Kotaro Sakashita
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | | | | | - Kosuke Sato
- Department of Orthopedic Surgery, University of Tsukuba
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University, School of Medicine
| | - Shunji Kishida
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Yu Sasaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba
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Effectiveness of Acupuncture for Scoliosis: A Systematic Review. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2021.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Scoliosis is a 3-dimensional change of the spine, presenting 10° above Cobb angle. Various acupuncture methods are being increasingly performed to correct scoliosis. However, no systematic review has been published. Therefore, we report on the effectiveness of acupuncture on mild scoliosis in this systematic review. We searched various databases for acupuncture treatment for scoliosis published before June 2021. The primary outcome was Cobb angle, and the secondary outcomes were patient-centered scores. Six studies were identified. RCTs that compared combination therapy with acupuncture, and other treatment methods and showed significant improvement in the Cobb angle, and effective rate, but, with low quality evidence. Acupuncture monotherapy resulted in significant improvement in the Cobb angle and had high heterogeneity compared with other treatment methods, but no significant improvement in the effective rate was observed, and the quality of evidence was low. Regardless of the type of scoliosis, acupuncture monotherapy or combination therapy with acupuncture showed significant improvement in the Cobb angle, and the quality of evidence was moderate. No serious adverse events were observed in the 6 studies reviewed. Acupuncture is considered safe, and it is more effective when performed with other conventional treatments.
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Dufvenberg M, Diarbakerli E, Charalampidis A, Öberg B, Tropp H, Aspberg Ahl A, Möller H, Gerdhem P, Abbott A. Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS). J Clin Med 2021; 10:4967. [PMID: 34768487 PMCID: PMC8585057 DOI: 10.3390/jcm10214967] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/23/2022] Open
Abstract
Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston brace night shift (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group (p = 0.014, p= 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; p = 0.004; ηp2 = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, p = 0.002; ηp2 = 0.11, and large (F = 8.3, p = < 0.001, ηp2 = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, p = 0.019, ηp2 = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.
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Affiliation(s)
- Marlene Dufvenberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, SE 581 83 Linköping, Sweden; (B.Ö.); (A.A.)
| | - Elias Diarbakerli
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, SE 141 86 Stockholm, Sweden; (E.D.); (A.C.); (H.M.); (P.G.)
- Department of Reconstructive Orthopaedics, Karolinska University Hospital Huddinge, SE 141 86 Stockholm, Sweden
| | - Anastasios Charalampidis
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, SE 141 86 Stockholm, Sweden; (E.D.); (A.C.); (H.M.); (P.G.)
- Department of Reconstructive Orthopaedics, Karolinska University Hospital Huddinge, SE 141 86 Stockholm, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, SE 581 83 Linköping, Sweden; (B.Ö.); (A.A.)
| | - Hans Tropp
- Department of Biomedical and Clinical Sciences, Linköping University, SE 581 83 Linköping, Sweden;
- Center for Medical Image Science and Visualization, Linköping University, SE 581 83 Linköping, Sweden
- Department of Orthopaedics, Linköping University Hospital, SE 581 83 Linköping, Sweden
| | - Anna Aspberg Ahl
- Department of Orthopaedics, Ryhov County Hospital, SE 551 85 Jönköping, Sweden;
| | - Hans Möller
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, SE 141 86 Stockholm, Sweden; (E.D.); (A.C.); (H.M.); (P.G.)
- Stockholm Center for Spine Surgery, SE 171 64 Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics and Biotechnology, Karolinska Institutet, SE 141 86 Stockholm, Sweden; (E.D.); (A.C.); (H.M.); (P.G.)
- Department of Reconstructive Orthopaedics, Karolinska University Hospital Huddinge, SE 141 86 Stockholm, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, SE 581 83 Linköping, Sweden; (B.Ö.); (A.A.)
- Department of Orthopaedics, Linköping University Hospital, SE 581 83 Linköping, Sweden
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Alvarez I, Poppino K, Karol L, McIntosh AL. Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure. J Orthop Surg Res 2021; 16:540. [PMID: 34465348 PMCID: PMC8406839 DOI: 10.1186/s13018-021-02650-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not. Methods All skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation. Results Ninety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014). Conclusions Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays. Trial registration ClinicalTrials.gov—NCT02412137, initial registration date April 2015 Level of evidence III
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Affiliation(s)
| | - Kiley Poppino
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Lori Karol
- Children's Hospital Colorado, Aurora, CO, USA
| | - Amy L McIntosh
- University of Texas-Southwestern, Dallas, TX, USA. .,Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
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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.
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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
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Scoliosis Research Society survey: brace management in adolescent idiopathic scoliosis. Spine Deform 2021; 9:697-702. [PMID: 33580371 DOI: 10.1007/s43390-020-00265-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/24/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE While the Scoliosis Research Society (SRS) has established criteria for brace initiation in adolescent idiopathic scoliosis (AIS), there are no recommendations concerning other management issues. As the BrAIST study reinforced the utility of bracing, the SRS Non-Operative Management Committee decided to evaluate the consensus or discord in AIS brace management. METHODS 1200 SRS members were sent an online survey in 2017, which included 21 items concerning demographics, bracing indications, management, and monitoring. Free-text responses were analyzed and collated into common themes. Data were analyzed using Microsoft Excel 2013. RESULTS Of 218 respondents; 207 regularly evaluate and manage patients with AIS, and 205 currently prescribe bracing. 99% of respondents use bracing for AIS and the majority (89%) use the published SRS criteria, or a modified version, to initiate bracing. 85% do not use brace monitoring and 66% use both %-Cobb correction and fit criteria to evaluate brace adequacy. In contrast, other aspects of brace management demonstrated a high degree of practice variability. This was seen with a radiographic assessment of maturity level, hours prescribed, timing and frequency of radiographic evaluation, the use of nighttime bracing only, and the method and timing of brace discontinuation. CONCLUSION Although there is consensus in brace management amongst SRS members with respect to brace initiation and evaluation of adequacy, there is striking variability in how bracing for AIS is used. This variability may impact the overall efficacy of brace treatment and may be decreased with more robust guidelines from the SRS. LEVEL OF EVIDENCE III.
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25
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Lertudomphonwanit T, Pengrung N, Kriwattanapong C, Angsanuntsukh C, Leelapattana P, Chanplakorn P. Novel questionnaire to enhance brace wear adherence in patients with adolescent idiopathic scoliosis and the relationship of the quality of life. Orthop Rev (Pavia) 2021; 13:8840. [PMID: 33907613 PMCID: PMC8056326 DOI: 10.4081/or.2021.8840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022] Open
Abstract
Bracing is an effective non-operative treatment, in patients with adolescent idiopathic scoliosis (AIS). The relationship between patients’ quality of life (QOL) and brace wear adherence has been reported. This study aims to determine brace wear adherence for AIS patients with novel questionnaire. A nested case-control study was conducted, included patient age 10-18 years, coronal Cobb angle 20-50°, and Risser grade 0-3. Correlation between patients’ QOL and the average hours of daily brace-wear were determined. Patients were divided into 3 groups based on brace wear adherence and were compared. QOL domains associated with the incompleteness of brace-wearing were determined by Cox proportional-hazards regression. Mean age of patients was 13.3 years (range 11-17.3 years) with initial Cobb angle of 33.5° (range 20-48°). There were significant negative correlations between total QOL scores and brace wearing time. Increased social domain scores was significantly associated with less brace wearing time (HR 1.5, 95% CI 1.12-2.04). Significant correlations between patients’ QOL and the average hours per day of brace wear. Poor social QOL have a significant impact on brace wear adherence.
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Affiliation(s)
- Thamrong Lertudomphonwanit
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nachapan Pengrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Kriwattanapong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Angsanuntsukh
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pittavat Leelapattana
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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26
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Wang H, Tetteroo D, Arts JJC, Markopoulos P, Ito K. Quality of life of adolescent idiopathic scoliosis patients under brace treatment: a brief communication of literature review. Qual Life Res 2021; 30:703-711. [PMID: 33098493 PMCID: PMC7952337 DOI: 10.1007/s11136-020-02671-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify the life domains that are most frequently reported to be affected in scoliosis patients undergoing brace treatment. METHODS A search within the PubMed database was conducted and a total of 60 publications were selected. We classified the studies based on the methods used to measure patients' quality of life (QoL) and categorized the life domains reported to be affected. RESULTS Self-image/body configuration was the most reported affected domain of patients' QoL, identified in 32 papers, whilst mental health/stress was the second most reported affected domain. Mental health was identified in 11 papers, and 11 papers using the BSSQ questionnaire reported medium stress amongst their participants. Vitality was the third most reported affected domain, identified in 12 papers. CONCLUSIONS Our review indicates that scoliotic adolescents treated with bracing suffer in their quality of life most from psychological burdens. To improve these patients' life quality, more attention should be focussed on supporting their mental health.
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Affiliation(s)
- Huan Wang
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands.
| | - Daniel Tetteroo
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - J J Chris Arts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Panos Markopoulos
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Keita Ito
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Choi SK, Jo HR, Park SH, Sung WS, Keum DH, Kim EJ. The effectiveness and safety of acupuncture for scoliosis: A protocol for systematic review and/or meta-analysis. Medicine (Baltimore) 2020; 99:e23238. [PMID: 33327244 PMCID: PMC7738006 DOI: 10.1097/md.0000000000023238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Scoliosis is a disease that affects all age groups and alters the three-dimensional deviation of the spinal axis. It is diagnosed when Cobb angle presents over 10 degrees and the reasons include aging, traumatic injuries, unknown origin, and disorders of congenital, neurological, musculoskeletal, and connective tissue. Scoliosis treatments are divided into surgical and conservative options. Surgery can correct the curved spine but has associated risks and economic burden. Conservative treatments, particularly bracing, prevent the progression of scoliosis, but still remains potential ingredient of curvation and patients poor compliance. Recent studies reported that various types of acupuncture can improve the curvation and the associated pain. However, there has been no systematic review on this issue. Therefore, this study will review the effectiveness and safety of acupuncture on scoliosis. METHODS Searching randomized controlled trials about the use of acupuncture for scoliosis will be performed using multiple electronic databases, manual search, and contact to authors e-mail if needed. We will select studies by the pre-defined criteria and summarize the data on study participants, interventions, control groups, outcome measurement, adverse events, and risk of bias. The primary outcome will be the Cobb angle, which is objective, and the secondary outcomes are associated with patient-centered indices (pain, functional status, and quality of life), which are subjective and adverse events. We will use Review Manager software (Version 5.3; Copenhagen; The Nordic Cochrane Center, The Cochrane Collaboration, 2014) to perform a meta-analysis and Cochrane Collaboration "risk of bias" tools to assess the risk of bias. RESULTS Our study will investigate the clinical evidence on the effectiveness and safety of acupuncture on scoliosis. CONCLUSION Our study will be informative to scoliosis patients, clinicians, policy makers, and researchers working with conservative management for scoliosis.
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Affiliation(s)
| | | | - Seo-Hyun Park
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | | | - Dong-Ho Keum
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Bayrak A, Duramaz A, Koluman A, Belen B, Öztürk V. The Influence of Lumbar Modifiers on Functional and Radiological Outcomes in the Brace Treatment of Lenke Type 1 Adolescent Idiopathic Scoliosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:666-673. [PMID: 33233010 DOI: 10.1055/a-1269-0000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Brace treatment prevents the progression of scoliosis and reduces surgical treatment rates. However, the efficacy of brace treatment varies depending on the patient's age, gender, curve magnitude and type, structure of the curve, and patient compliance at the beginning of treatment. METHODS Between January 2009 and April 2015, 106 Lenke type 1 AIS consecutive patients (69 females, 37 males) who were treated with a brace were examined in three groups according to Lenke classification lumbar modifiers. The patients were evaluated at pre-bracing and 1 and 2 years after bracing. The Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) were used for functional evaluation. Radiological evaluation revealed the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, trunk shift, shoulder asymmetry, and body height difference. RESULTS Functional and radiological evaluation showed a statistically significant improvement in Lenke 1A, 1B, and 1C at 1 and 2 years after bracing compared to the pre-bracing (p = 0.000, p = 0.000, and p = 0.000, respectively). Lenke 1C had the best ODI score and followed by decreasing values of 1B and 1A respectively (p = 0.009). Lenke 1B had the best SRS-22 score and the mean scores of 1A and 1C were equal (p = 0.017). There was no significant difference between the groups in the parameters other than the trunk shift in radiological evaluation (p = 0.043). CONCLUSIONS Significant improvement was observed in all types of lumbar modifiers at the end of the 2nd year compared to pre-bracing. The best improvement in the ODI score was in the 1C modifier, whereas the best improvement in the SRS-22 score was in the 1B modifier. The type of lumbar modifier should be directly taken into consideration before starting brace treatment in Lenke type 1 AIS. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Alkan Bayrak
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Altug Duramaz
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Alican Koluman
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Burak Belen
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Vedat Öztürk
- Orthopedics and Traumatology, Istanbul Haseki Egitim Ve Arastirma Hastanesi, Istanbul, Turkey
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Zhang Y, Li X. Treatment of bracing for adolescent idiopathic scoliosis patients: a meta-analysis. 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 2019; 28:2012-2019. [PMID: 31332572 DOI: 10.1007/s00586-019-06075-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/08/2019] [Accepted: 07/14/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE A meta-analysis was conducted to compare the efficacy and safety of bracing and other treatments in adolescent idiopathic scoliosis (AIS) patients. METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials that investigated bracing and other treatments for AIS. The Mantel-Haenszel method with fixed-effects or random-effects model was used to calculate the relative risks and 95% confidence intervals (CIs). The results of heterogeneity, sensitivity analysis, and publication bias were analyzed. RESULTS Seven studies that met the eligibility criteria with 791 participants were included. The results of meta-analysis suggested significant differences between bracing and observation groups in successful outcomes [OR 3.58, 95% CI (1.92, 6.68), P < 0.0001; P for heterogeneity = 0.008, I2 = 65%], quality of life [MD = 2.13, 95% CI (0.51, 3.75), P = 0.01; P for heterogeneity = 0.89, I2 = 0%], and adverse events [OR 5.31, 95% CI (2.42, 11.66), P < 0.0001; P for heterogeneity = 0.78, I2 = 0%]. CONCLUSION The findings of this meta-analysis suggested that bracing is efficient and safe for the treatment of AIS. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Yuhao Zhang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xingwei Li
- Department of Bone and Joint Rehabilitation, Yunnan Province Disabled Rehabilitation Center, Kunming, China.
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