S Negrini

It is possible to make patients use braces the hours prescribed: first results from the thermobrace clinical everyday usage.

Materials and methods Population: 68 scoliosis consecutive patients (79% females, age 14.2±2.4) who accepted to use Thermobrace and had finished at least one period of treatment on the 31st December 2010 [1,2]. Actual hours worn per day were measured; compliance (percentage of prescription) and reported compliance (percentage of hours reported by the patient) were calculated. For reliability purposes, we use two different data processing methods.

Adolescent with 10° to 20° Cobb scoliosis during growth: efficacy of conservative treatments. A prospective controlled cohort observational study.

Materials and methods Population: 288 consecutive scoliosis patients over 10 years of age, curves range 10-20°, Risser 0-3 (190 Females, Age 12.8±1.5). We had 5 groups: · Brace (BG, 40 patients): bracing 18 hours per day · SEAS (101 patients): specific SEAS exercises (at least 3 controls per year) · Usual Physiotherapy (UP, 70 patients): different type of exercises · Not Compliant (NC, 46 patients): SEAS exercises 2 (or less) controls per year · Controls (CG, 31 patients): no treatment. Main outcome (after 12±4 months): Relative Risk of failure of treatment (worsening of 5°C or brace prescription).

Efficacy of bracing immediately after the end of growth: final results of a retrospective case series

Methods In this retrospective study, the population included all AIS patients with Risser 4-5 at start that reached the end of treatment since our database started in 2003. We had 23 females and 2 males, average age of 16.5 ± 1.6 years, and an average Cobb angle measurement of 27.4° ± 8.4°. Patients received bracing treatment with Lyon or SPoRT braces for 18 to 24 hours per day, in addition to specific exercises, respecting SOSORT criteria, with a rapid weaning (2-3 hours every 6 months). Outcome criteria included the following parameters: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated; 2 years follow-up); clinical (ATR, hump, Aesthetic Index, plumbline distances); radiographic (Cobb degrees); and ISICO (optimum; minimum). ANOVA and chi-test were used for data analysis. Results The reported compliance during the 2.6 ± 0.6 treatment years was 95.1 ± 7.8%, while residual growth was 0.9 ± 1.1 cm. No patients progressed over 45°, no one was fused, and this remained true at the 2 years follow-up for the 25% that reached it. Improvements were found in 48% and 36% of worst and average curves, and in 45%, 58% and 36% of Thoracic, Thoracolumbar and Lumbar curves respectively. We found highly statistically significant reductions of maximal (-4.4°), average (-4.2°), thoracic (6.0°) and thoracolumbar (-6.6°) curves. Statistically significant improvements were found for Aesthetic Index, but not for ATR or plumbline distances. Clinically, 30% of patients improved over the measurement error for Aesthetic Index. According to ISICO criteria, 50% of patients had minimum and 35% optimal results.

Efficacy of conservative treatment of adolescent idiopathic scoliosis: end-growth results respecting SRS and SOSORT criteria

Methods In this retrospective study, the population included all AIS patients meeting the SRS inclusion criteria (age 10 years or older, Risser test 0-2, Cobb degrees 25-40°, no prior treatment, less than 1 year post menarche) that reached the end of treatment since our database started in 2003. We had 44 females and 4 males, average age at the start of 12.8 years ± 1.6 years. According to individual needs, 2 patients were treated with Risser casts followed by Lyon brace, 40 with Lyon or SPoRT braces (14 for 23 hours per day, 23 for 21 hours per day, and 7 for 18 hours per day), and 2 with exercises only. Outcome criteria included the following: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated; 2 years followup); clinical (ATR, hump, Aesthetic Index, plumbline distances); radiographic (Cobb degrees); and ISICO (optimum; minimum). ANOVA and chi-test were used for statistical analysis.

It is possible to maintain a high compliance even in the long term: results from the Thermobrace study

BackgroundThe importance of compliance monitors is well known;in a previous study, it has been demonstrated that it ispossible to obtain a good real compliance (close to thereferred one), in a setting respecting SOSORT criteriafor bracing. Still, we don x90t know if, in the long term,compliance remains stable.AimTo verify if it is possible to maintain good brace compli-ance for scoliosis patients, and evaluate what factorscould influence the adherence to the treatment in thelong term.MethodsPopulation. Prospective cohort of 98 Adolescents withspinal deformities (19 males) that have been monitoredwith a heat sensor (Thermobrace) at least twice; 94.9%had AIS. The average monitoring period was: 591.33 +-119.31 days. All patients were treated with brace accord-ing to the SpoRT concept, with a prescription from 8 to23 hours per day; and SEAS exercises; team approachfollowed the SOSORT Bracing Management Guidelines.ResultsReferred compliance remained close to the real, even inthe long period. Most of the patients remained within 2hours from the prescr iption. Median compliance was92.5% (IC 95% 58.8-100.8) for the first download; for thesecond download the median was 92.8% (IC 95% 45.06-102.5%); for the third download the median was 95.5%(IC95% 58.1-105.5) for the fourth download the mediancompliance was 93.70 (IC95% 76.9-108) for all periods itwas 94.6% (Range 9.0-118.9%). At first download 53.6% ofthe patients had at least 90% real compliance; this percen-tage showed a tendency to increase at the second check(60.9%; P=0.11), remaining at 59.6% at the third. In thissample, gender, age, Risser, curve magnitude, and bracetype did not influence compliance. When the weaning per-iod begins, compliance increases; in patients who need tocontinue with a full time prescription, compliance slightlydecreases, even if it remains over 80%.ConclusionIt is possible to maintain a high compliance, even in thelong term; this underlines the importance of the treatingteam, whose aim is to guarantee good end of growthresults. A longer period of monitoring is needed to clearlyrecognize factors influencing compliance.

Physical Therapy for Adolescents with Idiopathic Scoliosis

Scoliosis is a three-dimensional deformity of the spine. In its most common form, idiopathic scoliosis (70% to 80% of cases), the causes are unknown (Rowe 2003). AIS is discovered at 10 years of age or older, and is defined as a curve of at least 10°, measured on a standing radiograph using the Cobb technique (Parent et al, 2005). While the prevalence of AIS is around 3% in the general population, almost 10% of those diagnosed with AIS will require some form of treatment; usually observation or scoliosis-specific exercises (SSE) for mild curves, braces for moderate curves and spinal surgery for severe curves (Cobb angle >500). Up to 0.1% of the population is at risk of requiring surgery (Lonstein, 2006). A severe form of AIS is more commonly found in females. Typically, AIS does not cause any health problems during growth (except for extreme cases). However, the resulting surface deformity frequently has a negative impact on adolescents` bodyimage and self-esteem that can give rise to quality of life (QoL) issues and in worst cases, psychological disturbances (Maclean et al, 1989). Adolescent patients are generally treated in an attempt to halt the progressive nature of the deformity. No treatments succeed in full correction to a normal spine, and even reduction of the deformity is difficult (Danielson and Nachemson, 2001). If scoliosis surpasses a critical threshold, usually considered to be 30o Cobb, at the end of growth, the risk of health and social problems in adulthood increases significantly (Negrini, 2005). Problems include reduced quality of life, disability, pain, increased cosmetic deformity, functional limitations, sometimes

Efficacy of bracing in worst cases (over 45°): end-growth results of a retrospective case series

Methods In this retrospective study, the population included all AIS patients with at least one 45° degree curve at first evaluation that reached the end of treatment since our database started in 2003. We had 14 females and 2 males. 6 had a previous, failed brace treatment. At the start of their treatment, the mean age was 14.1 ± 1.7 years, and the mean Cobb angle measurement was 49.4° ± 4.3° (range 45°58°). Patients received full time treatment (23 or 24 hours per day) for one year with a Risser cast (11) or a Sforzesco brace (5) respecting SOSORT criteria, in addition to specific exercises. Outcome criteria included the following: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated; 2 years follow-up); clinical (ATR, hump, Aesthetic Index, plumbline distances); radiographic (Cobb degrees); and ISICO (optimum; minimum). ANOVA and chi-test were used in data analysis. Results The reported compliance in the 4.5 ± 1.6 treatment years was 90.5 ± 15.5%. At the end, 5 patients (31%) were still measuring over a 45° Cobb angle (range 32°-50°). No one was fused, and this remained true at the 2 years follow-up for the 50% that reached it. Improvements were found in 69% and 56% of worst and average curves, and in 56% and 80% of Thoracic and Lumbar curves respectively. We found highly statistically significant reductions of maximal (-8.6°), average (-4.8°), thoracic (-6.0°) and lumbar (-10.2°) curves. Statistically significant improvements were found for Aesthetic Index and Thoracic ATR, with a decrease of plumbline distances. According to ISICO criteria, 75% of patients had minimum and 63% optimal results.

SOSORT Award Winner 2015: a multicentre study comparing the SPoRT and ART braces effectiveness according to the SOSORT-SRS recommendations

BackgroundData comparing different braces for adolescent idiopathic scoliosis (AIS) are scant. The SRS criteria represent some guidelines for comparing results from different studies, but controlled studies are much more reliable. Recently, super-rigid braces have been introduced in clinical practice with the aim of replacing Risser and EDF casts. The aim of the present study is to compare the short-term radiographic results of two super-rigid braces, the ART and the SPORT (Sforzesco) brace.MethodsA group of consecutive patients with Cobb >40°, Risser 0–4, age >10 treated with the ART brace for 6 months were matched with a group of similar patients taken from a prospective database of patients treated with the Sforzesco brace. Patients were matched according to Cobb severity, pattern and localization of the curve.All patients had a full-time brace prescription (23–24 hours per day) and an indication to perform scoliosis-specific exercises and were assessed radiographically both immediately in the brace and after 6 months of treatment out of brace. Curves were analyzed according to the pattern and localization taking into consideration both the in-brace correction and the 6-month out-of-brace results.Statistical analysis: t-test, ANOVA, linear regression, alpha set at 0.05.ResultsTwenty-six patients were included in the ART brace group, and 26 in the Sforzesco brace group. At baseline, no differences were noted for gender (3 males for each group), age (14.1u2009±u20090.3 for ART vs 13.9u2009±u20090.3 for Sforzesco), ATR (11.8u2009±u20093.2 vs 11.5u2009±u20094.2 for thoracic curves and 7.8u2009±u20094.0 vs 7.1u2009±u20096.1 for lumbar/thoracolumbar), Cobb angle (44.8u2009±u20092 vs 45.5u2009±u20092 for thoracic; 43.8u2009±u20092 vs 46.0u2009±u20092 for lumbar/thoracolumbar) or Risser sign (median 2 for both groups).The in-brace correction was slightly better for the ART brace, but didn’t reach statistical significance (24.3u2009±u20098.5 vs 28.0u2009±u20096.8 for thoracic; 23.7u2009±u200910.4 vs 29.9u2009±u20094.2 for lumbar/thoracolumbar). At 6xa0months, results were similar both for thoracic (34.4u2009±u200910.4 vs34.8u2009±u20096.8) and for lumbar/thoracolumbar (32.8u2009±u200910.8 vs 36.6u2009±u20095.2). Also, with regard to the pattern, results were similar for double major and for thoracic, while there were not enough data for single lumbar to make a comparison.No differences for ATR were found (7.8u2009±u20093.2 vs 8.6u2009±u20092.9 for thoracic; 4.3u2009±u20093.4 vs 4.3u2009±u20093.7 for lumbar/thoracolumbar).ConclusionThese two super-rigid braces showed similar short-term results, despite the better in-brace correction for lumbar curves shown by the ART brace. According to our data, the asymmetric design showed results similar to the symmetric one. After these preliminary data, further studies are needed to check end growth results and the impact of compliance, rigidity of curve, exercise and assessing quality of life.

Validity of distances from the plumbline in sagittal plane deformities: repeatability, correlation with kyphosis angles and normative values

Methods We performed 4 different studies in 4 different populations of adolescent idiopathic scoliotic and hyperkyphotic patients. In the first study we report the normative data of the plumbline measures in a general population of 180 adolescents. In the second study we compared the sagittal distances from the plumbline of C7, T12 and L3 with the measures of the Video Rasterstereography at the same levels and the angles of Kyphosis and Lordosis in 100 AIS patients. In the third study we evaluated the intra and inter-rater repeatability and the measurement error of kyphosis and lordosis angles measured with the Inclimed in 100 AIS patients. These data have been compared with the plumbline measures. In the last study we evaluated the repeatability of the sagittal distances from the plumbline by using a 1 mm change instead of 5 mm in a population of 40 patients. Statistical analysis: Repeatability has been evaluated according to Bland and Altman, to identify the limits of variation that are clinically significant.

Efficacy of specific SEAS exercises for hyperkyphosis: end-growth results of a controlled prospective study

Methods This study design is a controlled prospective study using a population of 40 adolescent outpatients (19 male, 21 female) with hyperkyphosis who were divided into 2 exercise groups and treated with exercise until end-growth. SEAS Groups (18 subjects) were treated with specific SEAS exercises at our centers. The control group (22 subjects) were treated with classical exercises at different facilities.