Evidence For Bracing

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Conservative Scoliosis Management Clay Owens and Erica Jeszke Bellarmine DPT Class of 2015 Logo Logo Introduction Evidence For Bracing Results and Conclusions Evidence ForPT and Bracing • Bracing versus no treatment showed 50-80% reduction in failure rate. 4 • Nachemson found 15% failure with underarm brace and 45% failure without intervention. ³ • Sforzesco brace showed comparable results to Risser cast. 4 • 61% decrease in lumbar spine motion with surgery and 37% decrease with bracing was found. 4 • Vital capacity is improved with both surgery and bracing. 4 • 66% of patients with curves between 20 and 35 degrees progressed only 6 degrees following brace intervention.4 • Conflicting evidence exists between QOL with bracing versus surgery. 4 • Lessinck et al report that bracing does not seem to alter the progression of scoliosis or reduce surgery rate. ³ • Ersen et al found that Cobb angle decreased 1.5 degrees in patients treated with SpineCor brace versus an increase of 1.1 degrees in curves treated with a rigid brace. 5 Question: Is bracing and physical therapy more effective than bracing alone in adolescents with idiopathic scoliosis? • Some studies found that the best bracing results were found with braces worn for the most number of hours, some found that there was not a difference between 12 hours and 2 hours of bracing. • Studies often focused on one specific brace or a specific therapy program, such as SpineCor, that involved specific kinds of therapy combined with a specifically designed brace making it difficult to compare bracing with and without PT. • Studies do not take into account the primary corrective effect of the brace. One team believes this to be important in it’s therapeutic effect.² • Conservative treatments may involve more radiographs to monitor progression of curve than would non conservative treatments.² • There is some discrepancy about QOL between patients that are and are not braced. 4 • Surgery may control curve progression more effectively than bracing. 4 • Current level of evidence for conservative management is not high.¹ • We conclude that there is not enough high quality evidence to determine whether physical therapy and bracing is more effective than bracing alone in the management of idiopathicscoliosis. • Therapy and RCS bracing was performed on 106 patients, nine were lost, 6 had surgery, worst case scenario being 14.1% surgerycompared to a 28.1% surgery rate in untreated individuals.² • Milwaukee brace and exercise showed no additional effect of bracing however less than 5 degrees of change was noted regardless of group.³ • Study by Athanasopoulos et al showed increased ability to perform aerobic work in patients that had bracing and training versus a 9.2% decrease in ability to perform aerobic work in patients that just underwent bracing.³ • A study by el-Sayyad and Conine found a 4.05 degree reduction in curve with exercise and Milwaukee brace while Carmen et al found a 3.7 degree reduction with exercise and bracing but a 3.4 degree reduction with bracing alone. ³ Scoliosis •Scoliosis is a three dimensional deformity of the spine containing lateral and rotational components.¹ • Adolescent idiopathic scoliosis is the most common type of scoliosis.¹ • Idiopathic scoliosis has no clear underlying cause³ • Idiopathic adolescent scoliosis is a curve of 10 degrees or more, discovered at ten years of age or older.¹ • More females tend to be diagnosed than males. • Up to 0.1% of the population is at risk for requiring surgery.¹ • Problems associated with scoliosis include reduced quality of life, disability, pain, cosmetic deformity, functional limitations, sometimes lung problems and sometimes progression as and adult.¹ • Treatments often include surgery, bracing, and therapeutic exercise.¹ • Disagreement exists within the medical community concerning most effective treatment for curves under 50 degrees. ¹ • No treatment approach is able to restore or create a completely typical spine.¹ • The goal of brace treatment is to limit or stop the progression of an abnormal spinal curve. 4 • Types of Scoliosis Braces: - Thoraco-Lumbo-Sacral-Orthosis (TLSO) - Milwaukee Brace (CTLSO) - Charleston Bending Brace - Sforzesco Brace - Boston Brace Bibliography • Cook T, Rigo M., De Mauroy JC et al. Physical Therapy for Adolescents with Idiopathic Scoliosis .In: BettanySaltikov J, ed . Physical Therapy Perspectives in the 21st Century-Challenges and Possibilities. Rijeka, Croatia: InTech; 2012: 3-40. • 2. Rigo M, Reiter CH, Weiss HR. Effect of conservative management in the prevalence of surgery in patients with idiopathic scoliosis. Pediatric Rehabilitation. 2003; 6: 209-214. • 3. Lenssinck MB, Frijlink AC, Berger MY, Bierma-Zeisnstra S, et al. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Physical Therapy. 2005; 85:1329-1339. • 4. Maruyama T, Grivas TB, Kaspiris A. Effectiveness and outcomes of brace treatement: a systematic review. Physiotherapy Theory and Practice. 2011; 27: 26-42. • 5. Ersen O, Bileki B, Bilgic S, Oguz E, Sehirlogu A. Difference between spinecor brace and rigid brace during treatment. Scoliosis. 2013; 8: suppl 8. • 6. Weiss HR. The method of Katharina Schroth – history, principles, and current development. Journal of Scoliosis. 2011; 6: 17. http://www.livingwithcerebralpalsy.com/schth-method.php http://www.friendswithbends.org/2010/04/11/hello-world/ http://www.denversouthchiro.com/scoliosis-treatment-denver