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Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis

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Study design



Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS). The purpose of this study was to establish best practice guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal consensus building techniques.

Summary of background data

Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS.


We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised and repeat voting for consensus was performed.


Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached consensus on 67 items across 10 domains of bracing which were consolidated into the final best practice recommendations.


We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research.

Level of evidence

Level IV.

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We thank Cynthia Almonte, Sabrina Donzelli, Matthew F Halsey, Elizabeth Janssen, Andrea Lebel, Sanja Schreiber, and Fabio Zaina for participation throughout the Delphi process and nominal group face-to-face meeting.


This work was conducted with the support of a grant from the Scoliosis Research Society.

Author information

Authors and Affiliations



BDR: Conceptualization, data analysis, data interpretation, revising manuscript, final approval. MES: Data curation, Resources, Conception and design, data interpretation, visualization, original draft, revision, final approval. HM: Conception and design, supervision, final approval. PB, HB, LAD, KG, TBG, MTH, LAK, BSL, MM, SN, PON, ECP, MR, LS, JT, SLW, GW: Investigation, revision, final approval. MGV: Conception and design, supervision, final approval.

Corresponding author

Correspondence to Hiroko Matsumoto.

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This work is approved by the Institutional Review Board at Columbia University (Protocol AAAR6403).

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Roye, B.D., Simhon, M.E., Matsumoto, H. et al. Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis. Spine Deform 8, 597–604 (2020).

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