Efficacy of bracing versus observation in the treatment of idiopathic scoliosis

Abstract

Study design: Systematic review.Objectives: (1) Does brace treatment compared with observation of curves lead to lower rates of surgery and failure for patients with idiopathic scoliosis? (2) Does brace treatment compared with observation of curves lead to better quality of life outcomes for patients with idiopathic scoliosis? (3) Does brace treatment compared with observation of curves lead to improved curve angle for patients with idiopathic scoliosis?Methods: A systematic review of the English-language literature was undertaken for articles published between 1970 and December 2010. Electronic databases and reference lists of key articles were searched to identify studies comparing brace treatment with observation of curves in patients with idiopathic scoliosis. Two independent reviewers assessed the strength of evidence using the GRADE criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.Results: We identified eight studies meeting our inclusion criteria. The pooled studies comparing surgical rates between observation and brace treatment showed no statistical significance (P = .65). One study showed a statistically significant difference in failure rate between observation (45%) and brace (15%) treatment (P < .001). Findings with respect to posttreatment quality of life at 2 years were inconsistent. Two studies favored the brace group, and one the observation group using the SRS-22 and Quality of Life Profile for Spine Deformities (QLPSD) measures. Two of three studies reporting pretreatment and posttreatment curve angles demonstrated a treatment effect favoring bracing; however, statistical significance for these treatment effects could not be calculated. One study described a treatment effect favoring observation but the differences were not statistically significant (P = .26).Conclusion: This systematic review identified and summarized only the highest level of evidence by limiting to comparison studies. Case-series were not included. This allowed for comparisons among the same patient populations. Findings with respect to surgical rates, quality of life, and change in curve angle demonstrate either no significant differences or inconsistent findings favoring one treatment or the other. If bracing does not cause a positive treatment effect, then its rejection will lead to significant savings for healthcare providers and purchasers. Given the very low to low level of evidence and inconsistent findings, a randomized trial is necessary to determine if bracing should be recommended.

Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews

“…Eighteen SRs addressed the effectiveness of non-surgical interventions: five SRs addressed SSE methods [33] , [51] – [54] , four evaluated manual therapies [6] , [7] , [55] , [56] and five addressed bracing [16] , [24] , [36] , [43] , [57] . Four SRs compared the effectiveness of different interventions: bracing, therapeutic SSEs, lateral electrical surface stimulation (LESS), observation and/or surgery, or else their combinations (e.g.…”

“…As the aim of this overview was to analyze existing SRs, potential authors of unpublished SRs were not contacted neither were searches for gray literature, registered titles and review protocols conducted. The exception was one SR [43] for whom the first author was contacted with a request for supporting material mentioned in the paper which was not available from the publisher. An update of a Brace Cochrane review [33] , co-authored by JB-S, being currently under review, was also considered.…”

Does Scoliosis-Specific Exercise Treatment in Adolescence Alter Adult Quality of Life?

“…Other papers either considered surrogate outcomes (e.g., curve severity, trunk rotation) [ 24 – 26 ] or failed to find relevant studies in terms of study design and/or methodological rigour [ 27 ]. The systematic review, by Davies et al [ 57 ], regarded bracing and other nonsurgical interventions and found limited evidence suggesting that bracing may negatively influence quality of life. Remarkably, Davies et al concluded that it was not known whether bracing was more effective in reducing curve progression than Side-Shift therapy (a method of SSE) [ 57 ].…”

“…The systematic review, by Davies et al [ 57 ], regarded bracing and other nonsurgical interventions and found limited evidence suggesting that bracing may negatively influence quality of life. Remarkably, Davies et al concluded that it was not known whether bracing was more effective in reducing curve progression than Side-Shift therapy (a method of SSE) [ 57 ].…”

Adolescent idiopathic scoliosis: current perspectives

“…64,66,67 Dolan and Weinstein's 64 evidence-based review critically analyzed the literature to determine a pooled estimate of the prevalence of surgery after observation and after brace treatment in AIS. The review included a total of 18 studies …”