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

Abstract

Study design

Survey.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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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Fig. 1

References

  1. Roach JW, Weinstein SL, Dolan LA et al (2008) Adolescent idiopathic scoliosis. Lancet 371(9623):1527–1537. https://doi.org/10.1016/S0140-6736(08)60658-3

    Article  Google Scholar 

  2. Negrini S, Minozzi S, Bettany-Saltikov J et al (2010) Cochrane review: braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. https://doi.org/10.1002/ebch.620

    Article  PubMed  Google Scholar 

  3. Dolan L, Weinstein S (2009) The best treatment for adolescent idiopathic scoliosis: what do current systematic reviews tell us? Scoliosis 4(Suppl 1):O67. https://doi.org/10.1186/1748-7161-4-S1-O67

    Article  Google Scholar 

  4. Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521. https://doi.org/10.1056/NEJMoa1307337

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Gomez JA, Hresko MT, Glotzbecker MP (2016) Nonsurgical Management of Adolescent Idiopathic Scoliosis. J Am Acad Orthop Surg 24(8):555–564. https://doi.org/10.5435/JAAOS-D-14-00416

    Article  PubMed  Google Scholar 

  6. Romano M, Minozzi S, Zaina F et al (2013) Exercises for adolescent idiopathic scoliosis: a cochrane systematic review. Spine (Phila Pa 1976) 38(14):E883–E893. https://doi.org/10.1097/BRS.0b013e31829459f8

    Article  Google Scholar 

  7. Negrini S, Minozzi S, Chockalingam N et al (2015) Braces for idiopathic scoliosis in adolescents (review). Summ Find Main Comp. https://doi.org/10.1002/14651858.CD006850.pub3.www.cochranelibrary.com

    Article  Google Scholar 

  8. Negrini S, Donzelli S, Aulisa AG et al (2018) 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Vol 13. Scoliosis Spinal Disord. https://doi.org/10.1186/s13013-017-0145-8

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dunn J, Henrikson NB, Morrison CC, Nguyen M, Blasi PR, Lin JS (2018) Screening for adolescent idiopathic scoliosis. Agency for healthcare research and quality (US). https://www.ncbi.nlm.nih.gov/pubmed/29638297. Accessed 5 Jun 2019

  10. OCEBM Levels of Evidence Working Group, Durieux N, Pasleau F, Howick J (2011) The Oxford 2011 levels of evidence. Group 1(version):5653

    Google Scholar 

  11. Pill J (1971) The delphi method: substance, context, a critique and an annotated bibliography. Socioecon Plann Sci 5(1):57–71. https://doi.org/10.1016/0038-0121(71)90041-3

    Article  Google Scholar 

  12. Okoli C (2004) The delphi method as a research tool: an example, design considerations and applications. Inf Manag 42:15–29. https://doi.org/10.1016/j.im.2003.11.002

    Article  Google Scholar 

  13. Dalkey N, Helmer O (1963) An experimental application of the delphi method to the use of experts. Manag Sci https://doi.org/10.1287/mnsc.9.3.458

  14. Roye BD, Campbell ML, Matsumoto H et al (2019) Establishing consensus on the best practice guidelines for use of halo gravity traction for pediatric spinal deformity. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001379

    Article  PubMed  Google Scholar 

  15. Vitale MG, Riedel MD, Glotzbecker MP et al (2013) Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 33(5):471–478. https://doi.org/10.1097/BPO.0b013e3182840de2

    Article  PubMed  Google Scholar 

  16. Vitale MG, Skaggs DL, Pace GI et al (2014) Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deform 2(5):333–339. https://doi.org/10.1016/j.jspd.2014.05.003

    Article  PubMed  Google Scholar 

  17. Vitale M, Minkara A, Matsumoto H et al (2018) Building consensus: development of best practice guidelines on wrong level surgery in spinal deformity. Spine Deform 6(2):121–129. https://doi.org/10.1016/j.jspd.2017.08.005

    Article  PubMed  Google Scholar 

  18. Linstone HA, Turoff M (1975) The delphi method: techniques and applications. Addison-Wesley Pub. Co, Boston, MA. https://doi.org/10.2307/1268751

  19. Gordon TJ (1994) The delphi method. Futur Res Methodol 2(3):1–30

    Google Scholar 

  20. Brown BB (1968) Delphi process. https://www.rand.org/pubs/papers/P3925.html. Accessed 22 Feb 2016

  21. McMillan SS, King M, Tully MP (2016) How to use the nominal group and delphi techniques. Int J Clin Pharm 38(3):655–662. https://doi.org/10.1007/s11096-016-0257-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Vitale MG, Riedel MD, Glotzbecker MP et al (2017) Building consensus: development of a Best Practice Guideline (BPG) for Surgical Site Infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 33(5):471–478. https://doi.org/10.1097/BPO.0b013e3182840de2

    Article  Google Scholar 

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Acknowledgements

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.

Funding

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

Author information

Authors and Affiliations

Authors

Contributions

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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IRB approval/research ethics committee

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). https://doi.org/10.1007/s43390-020-00060-1

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  • DOI: https://doi.org/10.1007/s43390-020-00060-1

Keywords

  • Adolescent idiopathic scoliosis
  • Bracing
  • Best practice guideline