The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study

Abstract

BackgroundRecently an RCT confirmed brace efficacy in adolescent idiopathic scoliosis (AIS) patients. Previously, a Cochrane review suggested also producing studies according to the Scoliosis Research Society (SRS) criteria on the effectiveness of bracing for AIS. Even if the SRS criteria propose a prospective design, until now only one out of 6 published studies was prospective. Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria for AIS conservative treatment.MethodsStudy design/setting: prospective cohort study nested in a clinical database of all outpatients of a clinic specialized in scoliosis conservative treatment.Patient sample: seventy-three patients (60 females), age 12 years 10 months ±17 months, 34.4±4.4 Cobb degrees, who satisfied SRS criteria were included out of 3,883 patients at first evaluation.Outcome measures: Cobb angle at the end of treatment according to SRS criteria : (unchanged; worsened 6° or more, over 45° and surgically treated, and rate of improvement of 6° or more).Braces were prescribed for 18–23 hours/day according to curves magnitude and actual international guidelines. Weaning was gradual after Risser 3. All patients performed exercises and were managed according to SOSORT criteria. Results in all patients were analyzed according to intent-to-treat at the end of the treatment. Funding and Conflict of Interest: no.ResultsOverall 34 patients (52.3%) improved. Seven patients (9.6%) worsened, of which 1 patient progressed beyond 45° and was fused. Referred compliance was assessed during a mean period of 3 years 4 months ±20 months; the median adherence was 99.1% (range 22.2-109.2%). Employing intent-to-treat analysis, there were failures in 11 patients (15.1%). At start, these patients had statistically significant low BMI and kyphosis, high thoracic rotation and higher Cobb angles. Drop-outs showed reduced compliance and years of treatment; their average scoliosis at discontinuation was low: 22.7° (range 16-35°) at Risser 1.3 ± 1.ConclusionsBracing in patients with AIS who satisfy SRS criteria is effective. Combining bracing with exercise according to SOSORT criteria shows better results than the current literature.

Assessment of Idiopathic Scoliosis Patients' Satisfaction with Thoracolumbar Brace Treatment

“…Pod czas gdy sko lio zę I stop nia mo że my le czyć ró żny mi me to da mi fi zjo te ra pii czy re ha bi li ta cji, to od II stop nia (25-45 stop ni wg Cob ba) po win ni śmy za stoso wać gor set or to pe dycz ny do le cze nia sko lioz. Jest to naj sku tecz niej sza, udo ku men to wa na ba da nia mi na u ko wy mi me to da le cze nia nie ope ra cyj ne go idiopa tycz nej sko lio zy mło dzień czej [2][3][4][5][6]. Ko ry go wa nie sko lioz spo so ba mi nie ope ra cyj ny mi i ope ra cyj ny mi po win no być trój płasz czy zno we i uwzględ niać od tworze nie fi zjo lo gicz nej ki fo zy pier sio wej [7].…”

“…Ko ry go wa nie sko lioz spo so ba mi nie ope ra cyj ny mi i ope ra cyj ny mi po win no być trój płasz czy zno we i uwzględ niać od tworze nie fi zjo lo gicz nej ki fo zy pier sio wej [7]. Głów nym ce lem le cze nia gor se tem, no szo nym we dług kla sycznych za le ceń 18-23 h/do bę, jest za po bie ga nie pro gresji i po głę bia nia się ist nie ją ce go skrzy wie nia oraz od da le nie per spek ty wy cię żkiej i dość skom pli ko wanej ope ra cji [6,8]. Le cze nie uwa ża się za za koń czo ne z chwi lą osią gnię cia doj rza ło ści kost nej krę go słu pa. Klu czo wym czyn ni kiem, wa run ku ją cym suk ces le czenia, jest kon se kwen cja i su mien ność w no sze niu gor setu [8,9].…”

“…First-degree scoliosis can be treated with a variety of physiotherapy or rehabilitation methods, whereas for second-degree scoliosis (25°-45° according to Cobb), the orthopedic brace should be used. This is the most effective evidencebased non-surgical method for the treatment of adoles cent idiopathic scoliosis [2][3][4][5][6]. The correction scolio sis with non-surgical and surgical methods should concern all three planes and include the restoration of a physiological thoracic kyphosis [7].…”

Observational retrospective study on socio-economic and quality of life outcomes in 41 patients with adolescent idiopathic scoliosis 5 years after bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE)

“…The effectiveness of brace treatment to prevent curve progression has been validated in several studies [4][5][6][7]; moreover, a combination of bracing with PSSE has been shown to decrease spinal deformities and improve quality of life in comparison with bracing alone [1,[7][8][9][10], but adolescents may be disinclined to comply with this enduring therapy. We aimed to examine patients' socio-economic factors and quality of life after fulfilling years of brace treatment combined with PSSE.…”

Effect of SpineCor Dynamic Brace Treatment on the Result of Surgical Correction of Adolescent Idiopathic Scoliosis

“…The standards involve: observation (mild curves), orthopedic supplies in the form of corrective braces (SRS standards: curve size between 25° and 40°, Risser sign between 0 and 2, and 10 years of age or older) [1,2], and surgical treatment for severe curve, greater than 40° if preventive treatment is unsuccessful [3,4]. An important procedure in preventive treatment, and the only one that is documented, is bracing, the aim of which is to reduce the risk of curve progression in order to avoid surgical procedure [3,5,6].…”