Which interventions may improve bracing compliance in adolescent idiopathic scoliosis? A systematic review and meta-analysis

Li, Xue; Huo, Zhaohua; Hu, Zongshan; Lam, Tsz Ping; Cheng, Jack Chun Yiu; Chung, Vincent Chi‐Ho; Yip, Benjamin Hon Kei

doi:10.1371/journal.pone.0271612

Cited by 14 publications

(18 citation statements)

References 79 publications

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“…The review found that actual compliance to the orthotic treatment was generally lower than the prescribed wearing time and exhibited wide variation due to the heterogeneities of calculation period, measurement methods, and orthosis prescription time. More importantly, electronic compliance monitors show promise in regular orthotic treatment not only because of their high reliability 36,37 but also due to their effectiveness in improving compliance 17,38,39 . For example, Morton et al found that objective monitor recorded the patients' compliance to the orthosis as 47% of the prescribed time, while the subjective compliance reported by physicians, orthotists, parents, and patients were 64%, 66%, 72%, and 75%, respectively 40 .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels

Liu,

Ho,

Hassan Beygi

et al. 2023

JBJS Reviews

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Background: Wearing spinal orthosis for 16 to 23 hours a day during the teenage years could be challenging and stressful for patients with adolescent idiopathic scoliosis (AIS). The investigation of clinical outcomes under various orthosis-wearing compliances can provide helpful insight into orthotic treatment dosage. This systematic review aims to investigate actual orthosis-wearing compliance and evaluate the effectiveness of orthotic treatment in controlling scoliotic curvature and preventing surgery for patients with AIS under various levels of orthosis-wearing compliance. Methods: A literature search of 7 electronic databases, namely PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL Complete, Web of Science, and Embase, was conducted on May 19, 2023. Participant characteristics, orthotic treatment protocols, compliance information, outcome measures, and key findings were extracted. The Newcastle-Ottawa Scales were used to evaluate the quality of included cohort and case-control studies. Results: This study systematically reviewed 17 of 1,799 identified studies, including 1,981 subjects. The actual compliance was inconsistent and ranged from 7.0 to 18.8 hours daily. The proportion of compliant subjects in each study varied from 16.0% to 78.6% due to the heterogeneity of calculation period, measurement methods, and orthosis prescription time. Thirteen studies were investigated to determine the effectiveness of orthotic treatment in controlling curve deformity under different compliance groups, and 2 studies compared the compliance under different treatment outcomes. The rate of curve progression, defined as surpassing the measurement error threshold of 5° or 6° after orthotic treatment, varied from 1.8% to 91.7% across the studies. Ten studies defined the treatment failure, surgery, or surgery indication as Cobb angle progressing to a certain degree (e.g., 40°, 45°, or 50°) and reported failure/surgery/surgery indication rates ranging from 0.0% to 91.7% among different compliance level groups. Conclusion: This review found that the actual compliance with orthotic treatment was generally lower than the prescribed wearing time and exhibited wide variation among different studies. The electronic compliance monitors show promise in regular orthotic treatment practice. More importantly, the group with higher and consistent compliance has significantly less curve progression and lower surgery or failure rate than the group with lower and inconsistent compliance. Further studies are proposed to investigate the minimal orthosis-wearing compliance in patients with AIS treated with different types of orthoses. Level of Evidence: Level III, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels

Liu,

Ho,

Hassan Beygi

et al. 2023

JBJS Reviews

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“…For example, the improvement in brace compliance might ironically play a role in decreasing scores. The routine introduction of sensors into scoliosis braces, which took place at our institution ubiquitously around 2010, has been shown to improve brace compliance [ 21 ]. However, bracing has unfortunately been linked to lower SRS scores in both the activity and self-image domains [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The evolution of pre-operative SRS scores over time in patients with adolescent idiopathic scoliosis

Jamnik

Thornberg

et al. 2023

Spine Deform

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Purpose To determine if preoperative Health Related Quality of Life (HRQoL) has declined in the past two decades for patients with Adolescent Idiopathic Scoliosis (AIS), as measured by the Scoliosis Research Society (SRS) questionnaire. Methods A retrospective review was conducted on AIS patients that underwent surgery at a single institution between 2002 and 2022. Patients were included if they completed an SRS questionnaire preoperatively. A multivariate linear regression was performed with the SRS domains as the dependent variables. The independent variables were surgery year, gender, race/ethnicity, BMI, Lenke type, and major Cobb angle. A second regression was performed where the SRS scores for AIS patients were dichotomized as being above or below normal based on a threshold set at two standard deviations below the mean SRS scores of a healthy adolescent population. The binary SRS scores were used as the outcome of interest in a second regression. Results A total of 1380 patients (79.2% female, mean age 14.9 ± 2.0 years old) were included for analysis. Surgery year had a negative association with Pain (coefficient = − 0.03, p < 0.0001), Activity (coefficient = − 0.02, p < 0.0001), Mental Health (coefficient = − 0.01, p < 0.0001), and Total score (coefficient = − 0.01, p < 0.0001), indicating declining HRQoL over time. Similarly, AIS patients became more likely to fall below 2SD of the healthy adolescent means in Pain (OR: 1.061, p < 0.0001), Appearance (OR: 1.023, p = 0.0301), Activity (OR: 1.044, p = 0.0197), and Total score (OR: 1.06, p < 0.0001). Conclusion Over the past two decades, patients with surgical AIS have experienced a significant decline in various HRQoL domains preoperatively.

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“…Therefore, the duration of brace wear is an important factor in treatment outcomes, but patient compliance will in uence the duration of brace wear. Causes of nonadherence are related to the adverse effects of brace therapy, such as a negative cosmetic appearance, functional discomfort at pressure points, hot weather, exercise limitations, emotional discomfort, and impact on quality of life may all be important reasons for adherence [10]. Meanwhile, the psychological impact of long-term brace wear on adolescents cannot be ignored [11].…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy Study of Schroth Exercise Combined with Orthotic Treatment of Different Wearing Times in Adolescent Idiopathic Scoliosis—A Randomized Controlled Trial

Meng

Luo

et al. 2023

Preprint

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Background The International Scientific Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) proposes that the effect of brace treatment combined with physiotherapeutic scoliosis-specific exercises is significantly better than that of either alone. Wearing full-time rigid braces 23 h a day can effectively control the progression of scoliosis. However, long-term wearing of braces can cause psychological disorders, dyskinesia, lung function disorders, and other issues. Nevertheless, exercise can increase muscle function, correct the physical line, and compensate for the side effects of orthotic treatment. Objective To explore the clinical effects of wearing a full-time rigid brace for 20–24 h/day compared to a part-time rigid brace for 14–18 h/day combined with Schroth three-dimensional exercises on scoliosis correction and quality of life in patients with adolescent idiopathic scoliosis (AIS). Methods Sixty AIS patients were randomly assigned to the full-time brace group and the part-time brace combined with Schroth exercise group, with 30 patients in each group. Patients in the full-time brace group were treated with a rigid thoracolumbar orthosis and were required to wear it for 20–23 h/d. Patients in the part-time brace combined with Schroth exercise group were treated with Schroth three-dimensional exercise, with home and outpatient training together at least 5 times per week. The weekly training time was at least 4–5 hours, and the orthotic device was worn for 14–18 h/d. The two groups of patients were evaluated for Cobb angles and the angle of trunk rotation (ATR), thoracic expansion, and scoliosis research society 22-item (SRS-22) patient questionnaire before enrollment and after 6 months of treatment. Results In the intragroup comparison, Cobb angles, ATR, and thoracic expansion were significantly improved in the combined treatment group after 6 months of treatment compared to before treatment (p < 0.01), and the four indices of SRS-22 were improved before and after treatment, but there was no significant difference (p > 0.05). In the full-time brace group, there was a significant reduction in the Cobb angles (P < 0.01), but there was no statistically significant difference in the ATR, thoracic expansion, or SRS-22 before and after treatment. Comparing between groups, the combined treatment group showed greater improvement in Cobb angles, ATR, thoracic expansion, and the items of pain and psychology in the SRS-22 compared to the full-time brace group (p < 0.05). There were no differences between the two groups in self-image and function on the SRS-22 (P > 0.05). The satisfaction survey in the SRS-22 of the combined treatment group was better than that of the brace group, but there was no significant difference (P > 0.05). Conclusion The full-time brace and the Schroth 3D motion combined with a part-time brace both decreased the Cobb angle in AIS patients after 6 months of treatment. In addition, the brace combined with Schroth exercise showed significant improvement in the ATR, thoracic expansion, and psychological status and relieved pain. Adequate Schroth exercise can appropriately reduce the time of brace wear without affecting clinical outcomes and support brace treatment. Therefore, conservative treatment of idiopathic scoliosis with bracing combined with Schroth 3D exercise is recommended.

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Which interventions may improve bracing compliance in adolescent idiopathic scoliosis? A systematic review and meta-analysis

Cited by 14 publications

References 79 publications

Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels

Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels

The evolution of pre-operative SRS scores over time in patients with adolescent idiopathic scoliosis

Clinical Efficacy Study of Schroth Exercise Combined with Orthotic Treatment of Different Wearing Times in Adolescent Idiopathic Scoliosis—A Randomized Controlled Trial

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