A Comparative Study on Short-Term Effects of Compression Orthosis and Exercises in the Treatment of Pectus Carinatum: A Randomized Controlled Pilot Feasibility Trial

Abstract

Introduction Pectus carinatum (PC) is a congenital chest wall deformity which is characterized by the protrusion of the sternum and costal cartilages. Although orthotic and exercise therapies are commonly offered by physicians for PC treatment, there is a lack of evidence on the benefits of exercises and how long the orthosis should be worn. The aim of this study is to investigate the effects and feasibility of custom-made compression orthosis and exercises in the treatment of PC. Materials and Methods Patients with PC aged 7 to 17 years old were randomized into three groups: compression orthosis 23 hours, compression orthosis 8 hours, and control group. All groups received exercises for 1 hour a day for 3 weeks. Additionally, compression orthosis 23 hours group wore the orthosis for 23 hours a day, while compression orthosis 8 hours group wore the orthosis for 8 hours a day. PC protrusion, pressure of correction, thorax lateral and anteroposterior parameters, external chest wall measurements, and Nuss Questionnaire were evaluated before and after the treatment. Also, adverse effects, retention, and compliance were assessed. Feasibility was evaluated by calculating the percentages of recruitment, retention, and safety. Results The compression orthosis 23 hours group showed greater improvements than the other groups. After treatment, all groups showed significant changes in protrusion, pressure of correction, and external chest wall measurements. Adverse events occurred with similar frequency across groups. Retention percentages did not differ among groups. Conclusion Compression orthosis use for 23 hours can be recommended rather than its use for 8 hours because 23 hours of orthosis use has better correction and similar adverse effects.

Bracing of Pectus Carinatum in Children: Current Practices

“…Although COB is mentioned in international guidelines in the therapeutic algorithm for the treatment of PC, high-quality long-term data and a standardized wearing protocol are still not available [19][20][21]. Hunt et al confirmed the need for robust level I randomized data with a clearly standardized bracing protocol, objective measurement of outcomes, and recording of results at the end of the bracing treatment program in sufficiently powered sample sizes over a significant follow-up period [22].…”

Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A preliminary randomized-controlled study

“…Beginning from 1970's, patients with PC have been treated using compression braces that restore the normal thoracic shape by applying external compression over the thoracic wall. This method yielded predominantly favorable outcomes [10][11][12][13][14][15][30][31][32][33][34]. Nevertheless, treatment give-up rates due to noncompliance, in particular, were high and reached 40% in some studies [10,14,30].…”

“…Marcelo Martinez-Fero et al [4] stated that the physiotherapist lied in the center of non-surgical treatment, and was an essential member of the healthcare team for improvement of the posture. Giray et al [15] applied exercise treatment to 3 groups of patients during a period of one month. The groups used brace either for 8 hours, 23 hours, or not at all.…”

“…Sample size was determined with GPower 3.1 software (Kiel University, Kiel, Germany) to achieve a 95% power ratio with a 0.05 margin of error within 95% con dence interval. Based on our calculations, we needed 8 patients in each group for a total of 16 patients [14,15]. In consideration of the possible lack of compliance with brace use or exercise, we decided to include 15 patients in each group.…”

Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A randomized controlled study

“…Sample size was determined with GPower 3.1 software (Kiel University, Kiel, Germany) to achieve a 95% power ratio with a 0.05 margin of error within 95% confidence interval. Based on our calculations, we needed 8 patients in each group for a total of 16 patients [14,15] To increase mobility of the spine and thorax, manipulation and mobilization methods were applied to proper regions in vertebras, and mobilization was applied to sternocostal joints and area of protrusion. Additionally, postural awareness exercises were performed along with respiratory exercises, while standing in front of a mirror (10 minutes for each physiotherapy session).…”