A prospective study, “The Effectiveness of Combined Bracing and Exercise in Adolescent Idiopathic Scoliosis Based on SRS and SOSORT Criteria: A Prospective Study,” published August 6 in the journal BMC Musculoskeletal Disorders, evaluated the effects of bracing and exercise on the treatment of patients with adolescent idiopathic scoliosis (AIS). The study concludes that bracing is effective in patients with AIS who satisfy the Scoliosis Research Society (SRS) proposed inclusion criteria for studies on brace effectiveness. Further, combining bracing with exercise according to the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria increases treatment efficacy and shows better results than the current literature.
In 1995, the SRS proposed methodological inclusion criteria for studies on brace effectiveness such that the patient had to be at least ten years old at brace prescription; start at Risser 0-2; have primary curve angles between 25 and 40 degrees; have had no previous treatment; if female, she must be either premenarchal or less than one year postmenarchal. For outcome assessment: curve progression less than 6 degrees or more than 5 degrees; curves exceeding 45 degrees at maturity; and surgery recommended/undertaken. For the last criterion, a two-year follow-up beyond maturity is required. Design should be prospective, and an intent to treat analysis should be performed, including all patients.
According to the authors, the SOSORT criteria includes 14 recommendations, grouped in six domains (experience/competence, behaviors, prescription, construction, brace check, and follow-up). SRS criteria were used to measure outcomes at the end of treatment and include the following Cobb angles: unchanged; worsened 6 degrees or more; over 45 degrees and surgically treated; and rate of improvement of 6 degrees or more.
The cohort prospective study included all patients referred to the authors’ outpatient clinic that specializes in idiopathic scoliosis clinical evaluation and treatment. The patient sample included 73 patients (60 females) who were 12 years ten months of age (plus or minus 17 months), had 34.4 Cobb angles (plus or minus 4.4 degrees), and satisfied the SRS criteria.
All patients used braces that were personalized by physicians, which were prescribed for 18-23 hours per day according to curve magnitude and actual international guidelines, and with gradual weaning after Risser 3. Patients were also prescribed physiotherapy-specific exercises (PSE). Three patients did not perform any exercise, 35 followed usual physiotherapy, and 35 were taught PSE according to the Scientific Exercise Approach to Scoliosis (SEAS) at the clinic where the study authors worked.
Overall, 46 patients (49.3 percent) improved and seven patients (9.6 percent) worsened, of which one patient progressed beyond 45 degrees and underwent spinal fusion surgery, according to the study’s authors.