Orthotic treatment is successful in adolescent idiopathic scoliosis
CHICAGO — Bracing significantly decreased progression of high-risk curves in patients with adolescent idiopathic scoliosis to the threshold for surgery, according to a presenter at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, here.
Lori Dolan, PhD, described results from the Bracing in Adolescent Idiopathic Scoliosis (BrAIST) study.
The goal of the BrAIST study was to produce credible evidence about bracing, primarily with a TLSO, using an improved research design meant to fill in the gaps in the literature, which has shown mixed results, she said. The study also sought to determine the relationship between dose and curve response, and develop a predictive model for curve progression based on patient characteristics at initial presentation and after bracing.
The multicenter, partially randomized study included high-risk patients between the ages of 10 years and 15 years, Risser 0, 1, 2, with a Cobb angle of 20° to 40° and apex at or caudal to T7, who received no previous orthopedic treatment. Patients in the treated group received an in-orthosis X-ray 4 weeks to 6 weeks after delivery and an orthotist evaluation at least every 6 months. On average, patients in the treatment group wore the orthosis 12 hours per day. Both treated and observation-only groups completed questionnaires on general health, function, quality of life and appearance. Primary endpoints were skeletal maturity, Risser 4/5.
The trial was stopped early due to treatment success. In 116 patients, 74.5% had treatment success compared with 41.5% in the observation-only group.
Dolan, who is from the department of Orthopedics and Rehabilitation at the University of Iowa, Iowa City, said that as the average hours of orthosis wear increased, so did the success rate, up to a point.
“We found a very strong correlation between average hours per day in the brace and success rate. The kids who were wearing their braces zero to 6 hours a day, they may not have been wearing it at all. But wearing it more than 18 hours a day is unnecessary. We don’t see a huge gain.” — by Carey Cowles
Disclosure: The BrAIST study received support from the National Institutes of Health. Dolan has no relevant financial disclosures.