The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis

Abstract

Brace treatment is the most common noninvasive treatment in adolescent idiopathic scoliosis (AIS); however it is currently not fully known whether there is a difference in effectiveness between brace types/concepts. All studies on brace treatment for AIS were searched for in PubMed and EMBASE up to January 2021. Articles that did not report on maturity of the study population were excluded. Critical appraisal was performed using the Methodological Index for Non-Randomized Studies tool (MINORS). Brace concepts were distinguished in prescribed wearing time and rigidity of the brace: full-time, part-time, and night-time, rigid braces and soft braces. In the meta-analysis, success was defined as ≤5° curve progression during follow-up. Of the 33 selected studies, 11 papers showed high risk of bias. The rigid full-time brace had on average a success rate of 73.2% (95% CI 61–86%), night-time of 78.7% (72–85%), soft braces of 62.4% (55–70%), observation only of 50% (44–56%). There was insufficient evidence on part-time wear for the meta-analysis. The majority of brace studies have significant risk of bias. No significant difference in outcome between the night-time or full-time concepts could be identified. Soft braces have a lower success rate compared to rigid braces. Bracing for scoliosis in Risser 0–2 and 0–3 stage of maturation appeared most effective.

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)

“…However, full-time bracing can negatively affect patients’ perceptions of body appearance, reduce quality of life, and cause back pain [ 11 , 12 ]. Hypercorrective night-time bracing aims to provide curve correction in supine position with reduced mechanical loading [ 13 ], and has shown comparable outcomes to full-time bracing in halting the progress of spine deformity [ 14 , 15 ]. Night-time bracing may also minimise potential limitation of daytime activities compared to full-time bracing, and may facilitate better treatment acceptability and adherence for a larger proportion of patients.…”

Brace treatment for patients with scoliosis: State of the art

“…The variability of the results found for all types of braces ( Table 1 ) shows that not one type of brace is fundamentally better than another, after all, the results vary within the individual brace families as well. When considering the best possible care for patients, an averaging of the results, as in the study by Costa et al ( 2021 ), apparently does not support the idea of identifying the best possible treatment approach.…”

“…As Simony et al (2019) did not provide patient data with in-brace corrections of < 60%, their article was not eligible to be included in a systematic review on outcomes of different braces. Therefore, because of the selection bias, the conclusions from the review by Costa et al (2021) are not justified. Coillard et al (2014) in their randomised controlled study found a success rate of 73.1% for their patients treated with the SpineCor in a cohort with curves between 15° and 30° and a Risser stage between 0 and 2.…”

“…Recent systematic reviews have come to contradictory conclusions. Whilst Ruffilli et al ( 2021 ) in their systematic review were not able to draw a conclusion about the effectiveness of night-time bracing with the Providence brace, Costa et al ( 2021 ) in their systematic review found that in principle there was no difference between part-time and full-time outcomes of brace management. The authors included the study by Simony et al ( 2019 ), although this is a selective analysis of patients with high in-brace corrections.…”

“…As Simony et al ( 2019 ) did not provide patient data with in-brace corrections of < 60%, their article was not eligible to be included in a systematic review on outcomes of different braces. Therefore, because of the selection bias, the conclusions from the review by Costa et al ( 2021 ) are not justified.…”