Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis

Abstract

BackgroundIt is recommended that research in patients with idiopathic scoliosis should focus on short- and long-term patient-centred outcome. The aim of the present study was to evaluate outcome in patients with late-onset juvenile or adolescent idiopathic scoliosis 16 years or more after Boston brace treatment.Methods272 (78%) of 360 patients, 251 (92%) women, responded to follow-up examination at a mean of 24.7 (range 16 - 32) years after Boston brace treatment. Fifty-eight (21%) patients had late-onset juvenile and 214 had adolescent idiopathic scoliosis. All patients had clinical and radiological examination and answered a standardised questionnaire including work status, demographics, General Function Score (GFS) (100 - worst possible) and Oswestry Disability Index (ODI) (100 - worst possible), EuroQol (EQ-5D) (1 - best possible), EQ-VAS (100 - best possible), and Scoliosis Research Society - 22 (SRS - 22) (5 - best possible).ResultsThe mean age at follow-up was 40.4 (31-48) years. The prebrace major curve was in average 33.2 (20 - 57)°. At weaning and at the last follow-up the corresponding values were 28.3 (1 - 58)° and 32.5 (7 - 80)°, respectively. Curve development was similar in patients with late-onset juvenile and adolescent start. The prebrace curve increased > 5° in 31% and decreased > 5° in 26%. Twenty-five patients had surgery. Those who did not attend follow-up (n = 88) had a lower mean curve at weaning: 25.4 (6-53)°. Work status was 76% full-time and 10% part-time. Eighty-seven percent had delivered a baby, 50% had pain in pregnancy. The mean (SD) GFS was 7.4 (10.8), ODI 9.3 (11.0), EQ-5D 0.82 (0.2), EQ-VAS 77.6 (17.8), SRS-22: pain 4.1 (0.8), mental health 4.1 (0.6), self-image 3.7 (0.7), function 4.0 (0.6), satisfaction with treatment 3.7 (1.0). Surgical patients had significantly reduced scores for SRS-physical function and self-image, and patients with curves ≥ 45° had reduced self-image.ConclusionLong-term results were satisfactory in most braced patients and similar in late-onset juvenile and idiopathic adolescent scoliosis.

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 socio-economic outcome in this study was better than previously described: none of the study participants was unemployed, whereas Lange et al and Danielsson et al [19,20,23]. reported rates of employment or current education between 82 and 91% ( Table 4).…”

“…In contrast to the compared studies [19,20,25,26], where FTRB was the only treatment, in our study population continuous PSSE, supervised at regular intervals, was standard of care, as in a short-term follow-up study [27] (satisfaction with treatment MS 3.9). In addition to the positive impact of PSSE on the effectiveness of the treatment described elsewhere [8][9][10], PSSE might also lead to higher satisfaction with the treatment [8].…”

“…Compared to studies with a longer follow-up [19,20,25,26] and accordingly higher mean age (between 32 and 41 years), our results were in range of the published data in all of the quality of life-related domains of the SRS-24 (pain, selfimage, and general function) but in the domain satisfaction with treatment where we received slightly more positive feedback from our study population (this study: MS 4.2 vs compared studies: MS 3.5-3.8). In contrast to the compared studies [19,20,25,26], where FTRB was the only treatment, in our study population continuous PSSE, supervised at regular intervals, was standard of care, as in a short-term follow-up study [27] (satisfaction with treatment MS 3.9).…”

Bracing scoliosis: The evolution to CAD/CAM for improved in-brace corrections

“…Rigid braces may be symmetric or asymmetric. Examples of symmetric braces are the Boston brace 9 or the symmetric, patient-oriented rigid trunk orthosis (SPORT) brace from Italy 10 . No in-brace corrections are reported for the latter brace ( Figure 1).…”

Remodelling of trunk and backshape deformities in patients with scoliosis using standardized asymmetric computer-aided design/computer-aided manufacturing braces

“…Biomechanically, correction may vary according to brace type, and each brace is tolerated differently, which may affect compliance. We may also assume that bracing outcomes will differ when comparing symmetric braces to asymmetric ones [14][15][16][17][18][19][20] . One problem in the literature regarding bracing is the comparison of patient samples with different prognoses, for example varying Risser classification and/or curve magnitude.…”