Predictive factors for brace treatment outcome in adolescent idiopathic scoliosis: a best-evidence synthesis
To evaluate predictive factors for brace treatment outcome in adolescent idiopathic scoliosis (AIS) by a systematic review of the literature.
Eligible studies evaluating one or more predictive factors for brace treatment outcome were included following a systematic search in PubMed and EMBASE on October 23, 2017. Inclusion criteria were: (1) subjects diagnosed with AIS, (2) age ≤ 18 years, (3) treated with a thoraco-lumbo-sacral orthosis (TLSO), and (4) evaluated one or more predictive factors of treatment outcome (failure and/or success). The methodological quality of included studies was independently assessed by two authors. Pooling was not possible due to heterogeneity in statistical analysis. Predictive factors were presented according to a best-evidence synthesis.
The literature search identified 26 studies that met the inclusion criteria, and multiple types of TLSO braces were identified (Boston, Wilmington, Chêneau, Osaka Medical College, Dresdner Scoliosis Orthosis and SPoRT). A total of 19 radiographic and 8 clinical predictive factors were reported. Strong evidence was found that lack of initial in-brace correction is associated with treatment failure. Moderate evidence suggests that brace wear time is associated with failure and success, whereas initial curve magnitude and curve type are not.
The results of this review suggest that lack of initial in-brace correction is strongly associated with brace treatment failure. Future studies on the threshold for minimal immediate in-brace correction, as a potential indication for brace treatment, are recommended.
KeywordsAdolescent idiopathic scoliosis Brace Treatment Outcome Predictive
Compliance with ethical standards
Conflict of interest
- 2.Horne JP, Flannery R, Usman S (2014) Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Phys 89:193–198Google Scholar
- 5.Zaina F, De Mauroy JC, Grivas T et al (2014) Bracing for scoliosis in 2014: state of the art. Eur J Phys Rehabil Med 50:93–110Google Scholar
- 6.Negrini S, Minozzi S, Bettany-Saltikov J et al (2010) Braces for idiopathic scoliosis in adolescents. In: Negrini S (ed) Cochrane database of systematic reviews. Wiley, ChichesterGoogle Scholar
- 16.Hayden JA, Côté P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144:427–437. https://doi.org/10.7326/0003-4819-144-6-200603210-00010 CrossRefGoogle Scholar
- 20.Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363Google Scholar
- 32.Rahman T, Bowen JR, Takemitsu M, Scott C (2005) The association between brace compliance and outcome for patients with idiopathic scoliosis. J Pediatr Orthop 25:420–422. https://doi.org/10.1097/01.bpo.0000161097.61586.bb CrossRefGoogle Scholar
- 43.Nachemson AL, Peterson LE, Bradford DS et al (1995) Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Jt Surg Ser A 77(6):815–822. https://doi.org/10.2106/00004623-199506000-00001 CrossRefGoogle Scholar