Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS)

Abstract

Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston brace night shift (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group (p = 0.014, p= 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; p = 0.004; ηp2 = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, p = 0.002; ηp2 = 0.11, and large (F = 8.3, p = < 0.001, ηp2 = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, p = 0.019, ηp2 = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.

Efficacy of conservative treatment on exacerbation of adolescent idiopathic scoliosis

“…In addition, it is expected to be able to deviate from the target of surgical treatment by improving the distorted appearance change in patients with a Cobb angle of 25° or more. CONTRAIS may help adolescents with scoliosis have a low quality of life and reduced self-esteem, and also when physicians consider more aggressive treatment ( Dufvenberg et al, 2021 ). In the case of surgical treatment for AIS, there is a problem that postoperative pain is large in young patients, and most patients visit a hospital for pain treatment because the postoperative pain does not resolve ( Kwan et al, 2020 ; Lee et al, 2020 ; Roye et al, 2022 ).…”

“…However, nonsurgical interventions for AIS are controversial ( Day et al, 2019 ; Fan et al, 2020 ). Previous studies have suggested that nonsurgical therapy is an effective treatment for scoliosis, particularly AIS ( Dufvenberg et al, 2021 ; Ng et al, 2017 ). However, the prevalence of scoliosis is increasing, and many researchers argue that current treatments for AIS are insufficient ( Cheung et al, 2020 ; Płaszewski and Bettany-Saltikov, 2014 ).…”

Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis

“…Patient-reported treatment adherence, motivation to carry out treatment, and capability to perform treatment were also collected using a similar scale. These data were collected at each 6-month follow-up …”

“…Detailed information 12 about the interventions is provided in the appendices of the published protocol 10 and 6-month interim patient-reported outcomes. 13 Patients in the NB group received a custom-designed, hypercorrective Boston scoliosis night brace (Camp Scandinavia AB). 14 The brace was prescribed to be worn for 8 hours during the night.…”

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

“…A range of treatments for AIS are available and these range from exercises to bracing and finally surgery for those with severe disease and a large degree of deviation (i.e., Cobb angle) ( Day et al, 2019 ; Kaelin, 2020 ; Dufvenberg et al, 2021 ; Bowden et al, 2022 ; Park et al, 2022 ; Seleviciene et al, 2022 ; Turner et al, 2022 ; Zaina et al, 2022 ). For those patients with severe disease and needing surgery, the implantation of rods and screws can alleviate the curvature-associated complications but can also affect quality of life during post-skeletal maturity.…”