Serial casting for early onset scoliosis and its effects on health-related quality of life during and after discontinuation of treatment

Abstract

Introduction Serial body casting plays an important role in the treatment of early onset scoliosis (EOS), serving as a safer method compared to surgical intervention. There is no published evidence documenting the impact of casting on healthrelated quality of life (HRQoL) of patients and their caregivers. The purpose of this study was to utilize the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) to compare the HRQoL of patients with EOS and the burden of care for their caregivers before, during, and after treatment with Mehta casting. Methods In this multicenter retrospective cohort study, two EOS databases were queried for patients with EOS who underwent serial casting from 2005 to 2016. Patients who had treatment prior to their initial cast application, including bracing or surgical intervention, were excluded from the study. Patients were stratified into two subgroups and analyzed separately: those with idiopathic etiology, and those with non-idiopathic etiology. HRQoL and burden of care were assessed using the EOSQ-24 completed before, during, and after cast treatment. Results 91 patients were identified in this study (mean age at the index casting: 2.1 ± 1.2 years, mean age at final cast removal: 4.1 ± 1.3 years). 59 (64.8%) had EOS of idiopathic etiology, while 32 (35.2%) had EOS of non-idiopathic etiology, including 10 congenital, 6 neuromuscular, and 16 syndromic. Idiopathic patients and non-idiopathic patients experienced an improvement in the coronal deformity from 45° pre-cast to 26° post-cast, and from 59° pre-cast to 34° post-cast, respectively. Patients with idiopathic scoliosis experienced a decrease from baseline in nearly all EOSQ-24 sub-domain scores except for general health. Furthermore, even after the removal of the cast, patients with idiopathic etiology suffered residual negative effects of casting on emotion and transfer sub-domains. Among patients with non-idiopathic etiology, decreased scores from baseline were observed only in transfer and emotion sub-domains during the casting intervention. After brace removal, patients with non-idiopathic etiology had increased scores compared to their baseline scores in most sub-domains. Discussion Serial body casting can prevent curve correction in patients with EOS. However, the psychosocial stresses secondary to this non-operative intervention can have significant negative impacts on HRQoL for both idiopathic and non-idiopathic patients during the course of treatment. Although non-idiopathic patients experience improved HRQoL following treatment, idiopathic patients do not seem to exhibit much improvement in HRQoL from baseline even years after the final cast removal. Keywords Early onset scoliosis (EOS)• Serial body casting • Health-related quality of life (HRQoL) • 24-Item Early Onset Scoliosis Questionnaire

Does Transitioning to a Brace Improve HRQoL After Casting for Early Onset Scoliosis?

“…A retrospective cohort study by Matsumoto and colleagues found that, except for the general health subdomain, EOSQ-24 scores showed a decrease in HRQoL from baseline during cast treatment in patients with IEOS. They also found a lasting decreased HRQoL score in the emotion and transfer subdomains even after completion of cast treatment 17. Similarly, our study suggests that casting leads to decreased HRQoL but unlike the study by Matsumoto and colleagues, we found reversible declines in HRQoL when patients were transitioned to a brace.…”

“…They also found a lasting decreased HRQoL score in the emotion and transfer subdomains even after completion of cast treatment. 17 Similarly, our study suggests that casting leads to decreased HRQoL but unlike the study by Matsumoto and colleagues, we found reversible declines in HRQoL when patients were transitioned to a brace. There is a need for additional high-quality randomized controlled trials to assess the efficacy of bracing for the treatment of IEOS, some of which are currently underway.…”

“…The average follow-up was 3.2 (0.90-6.8) years. The average number of casts applied was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). At the most recent follow-up, 61 subjects were being treated with a brace, 3 with a cast, and 2 with growing rods.…”

When Will You Succeed Casting Patients With Early-onset Scoliosis? Prospective Evaluation of Predictive Radiographic Parameters

“…Even though there may be some evidence that casting may lower quality of life for patients and families during the treatment period, it still is an attractive option for young patients. We know that growth-friendly surgery in very young children has high complication rates, and therefore even in cases where cure is not attainable, delaying surgical treatment can benefit the patient 4,5,11…”

Impact of the COVID-19 Pandemic on Health-related Quality of Life in Children with Early Onset Scoliosis

“…3 This instrument has been utilized to measure and compare HRQoL and burden of care as outcomes of different treatments as well as its associations with various patient characteristics, such as EOS etiology. [8][9][10][11][12] Etiologies of EOS are divided conventionally into idiopathic, congenital, syndromic, and neuromuscular. Congenital scoliosis includes structural causes of curves such as hemivertebrae, fused ribs, VATER, etc.…”