The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
- What is the most effective brace concept?
- What is the most effective brace type (Boston brace, Providence brace, etc.)?
- What is the effect of skeletal maturity on the effectiveness of different concepts of brace treatment?
2. Materials and Methods
2.1. Protocol
2.2. Search Methods and Study Selections
2.3. Appraisal
2.4. Synthesis
3. Results
3.1. Search
3.2. Study Characteristic
- Rigid full-time braces (15 studies): 30% 20–40°, 30% 25–40°, 8% 25–45°, 8% ≥ 40°, 8% > 25°, 8% 0–45°.
- Night-time braces (8 studies): 63% 25–40°, 13% 20–45°, 13% 25–49°, 13% < 25°.
- Soft full-time braces (2 studies): 50% 25–40°, 50% 15–40°.
3.3. Study Quality
3.4. Qualitative Analysis
- Full-time, rigid braces
- Part-time, rigid braces
- Night-time, rigid braces
- Full-time soft braces
- Comparative studies
3.5. Meta-Analysis
3.6. The Role of Skeletal Maturity
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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PubMed | (((scoliosis [MeSH Terms] OR scolio * [Title/Abstract] OR spinal curvature [Title/Abstract] OR AIS [Title/Abstract]))) AND ((((brace [MeSH Terms] OR brace [Title/Abstract] OR bracing [Title/Abstract]))) AND ((time [Title/Abstract] OR parttime [Title/Abstract] OR nighttime [Title/Abstract] OR compliance [MeSH Terms] OR compliance [Title/Abstract] OR compliant [Title/Abstract] OR effect [Title/Abstract] OR treatment * [Title/Abstract] OR result [Title/Abstract] OR results [Title/Abstract] OR therap [Title/Abstract] OR mental disorder [Title/Abstract] OR hypersensitive [Title/Abstract] OR peer problem [Title/Abstract] OR depress [Title/Abstract]) OR psychologic [Title/Abstract] OR quality of life [Title/Abstract] OR quality of life [MeSH] OR life quality [Title/Abstract])))). |
Medscape | (‘scoliosis’: exp OR ‘scolio *’: ti, ab, kw OR ‘spinal curvature *’: ti, ab, kw OR ‘AIS’: ti, ab, kw) AND (‘brace’: exp OR ‘brace *’: ti, ab, kw OR ‘braci *’: ti, ab, kw) AND (‘time’: ti, ab, kw OR ‘parttime’: ti, ab, kw OR ‘nighttime’: ti, ab, kw OR ‘compliance’: exp OR ‘compliance’: ti, ab, kw OR ‘compliant’: ti, ab, kw OR ‘effect *’: ti, ab, kw OR ‘treatment *’: ti, ab, kw OR ‘result’: ti, ab, kw OR ‘results’: ti, ab, kw OR ‘therap *’: ti, ab, kw OR ‘mental disorder *’: ti, ab, kw OR ‘hypersensitiv *’: ti, ab, kw OR ‘peer problem *’: ti, ab, kw OR ‘depress *’: ti, ab, kw OR ‘psychologic *’: ti, ab, kw OR ‘quality of life’: ti, ab, kw OR ‘quality of life’: exp OR ‘life quality’: ti, ab, kw) |
1 | Design | Longitudinal studies with at least one-year follow-up from brace initiation |
2 | Population | Patients with adolescent idiopathic scoliosis |
3 | Intervention | Specification of the concept(s) of brace (prescribed wearing time(s) and brace type(s)) used |
4 | Outcome | A definition of success rate (all definitions of success rate were accepted in the qualitative synthesis in this review) |
1 | A clearly stated aim | The question address should be precise and relevant. |
2 | Inclusions of consecutive patients | All patients potentially fit for inclusion had been included in the study. |
3 | Prospective collection data | Data were collected according to a protocol established before the beginning of the study. |
4 | Endpoints appropriate to the aim of the study | Unambiguous explanation of the criteria used to evaluate the main outcome. |
5 | Unbiased assessment of the study endpoint | Blind evaluation of objective end-points and double blind-evaluation of subjective endpoints. Other explanation of the reasons for not blinding. |
6 | Follow-up period appropriate to the aim of the study | The follow-up should be should be sufficiently long to allow the assessment of the main end-points. |
7 | Loss to follow-up less than 5% | All patients should be included in the follow-up. Otherwise, the proportion lost should not exceed the proportion experiencing the major end-points. |
8 | Prospective calculation of the study size | Information of the size of detectable difference of interest with a calculation of 95% confidence interval. |
9 | An adequate control group | Having a gold standard diagnostic test or therapeutic intervention recognized as the optimal intervention according to the available published data. |
10 | Contemporary groups | Control and studied group should be managed during the same time period. |
11 | Baseline equivalence of groups | The groups should be similar regarding criteria and studied end-point. |
12 | Adequate statistical analysis | Whether the statistics were in accordance with the type of study with calculation of confidence interval or relative risk. |
Brace Type | Rigidity | Prescribed Wearing Time |
---|---|---|
Boston [22,23,24] | Rigid brace | Full-time/part-time |
Cheneau brace [25,26,27,28] | Rigid brace | Full-time/part-time |
PASB (Progressive Action Short Brace) [29] | Rigid brace | Full-time |
Lyon brace [30] | Rigid brace | Full-time |
Gensingen Brace [31] | Rigid brace | Full-time |
OMC (Osaka Medical College) brace [32] | Rigid brace | Full-time |
Pressure-adjustable orthosis [33] | Rigid brace | Full-time |
Charleston brace [34,35] | Rigid brace | Night-time |
Providence brace [5,36,37,38,39] | Rigid brace | Night-time |
SpineCor [40,41] | Soft brace | Full-time |
First Author | Year | Risk of Bias | Sample Size | Cobb Angle | Skeletal Maturity | Type of Brace | Brace | Timing | Follow-Up | Definition of Success Rate | Success Rate |
---|---|---|---|---|---|---|---|---|---|---|---|
Weinstein [6] | 2014 | 14/24 | 146 | 20–40 | Risser 0–2 | Rigid | TLSO | Full-time | 7 years | >50° | 72% |
96 | Control group | 42% | |||||||||
Xu [22] | 2019 | 8/16 | 90 | 40–45 | Risser 0–3 (divided in subgroups) | Rigid | Boston brace | Full-time | 2 years | ≤5° | 51.1% |
Yrjonen [23] | 2007 | 10/24 | 51 | >25° | Risser 0–3 | Rigid | Boston brace | Full-time | > 1 year | ≤5° | Girls 78.4% |
51 | Boys 62.7% | ||||||||||
Grivas [24] | 2003 | 7/16 | 28 | 20–40 | Pre or < 1 year post-menarche and Risser | Rigid | modified Boston brace | Full-time | mean of 2.3 years | ≤5° | 82% |
Pasquini [25] | 2016 | 5/16 | 843 | 20–40 | Risser 0–2 | Rigid | modified Cheneau brace | Full-time | ≥2 years | ≤5° | 81% |
Fang [26] | 2015 | 10/16 | 32 | 25–40 | Risser 0–2 | Rigid | Cheneau brace | Full-time | 2 years | no curve progression ≥ 50° | 81% |
Pham [27] | 2007 | 7/16 | 63 | 20–45 | Risser 0–2 | Rigid | Cheneau brace | Full-time | 2 years after discontinuing brace therapy | <10° | 85.7% |
Zabrowska Sapeta [28] | 2010 | 7/16 | 79 | 20–45 | Risser 0–4 | Rigid | Cheneau brace + exercises | Full-time | 1–5 years | ≤5° | 48% |
Maruyama [44] | 2015 | 9/16 | 33 | 25–40 | Risser 0–2 and pre or 1 year post-menarche | Rigid | Rigo- Cheneau brace | Full-time | Mean 2.8 years | ≤5° | 76% |
Aulisa [29] | 2009 | 6/16 | 50 | 25–40 | Risser 0–2 | Rigid | PASB | Full-time | > 2 years | ≤5° | 100% |
Aulisa [45] | 2020 | 12/16 | 163 | 20–60 mean 28 | Risser 0–4 | Rigid | PASB | 10y after termination | ≤5° | 65.6% | |
Aulisa [30] | 2015 | 4/16 | 69 | 25–40 | Risser 0–2 | Rigid | Lyon brace | Full-time | 2 years | ≤5° | 98.5% |
Weiss [31] | 2017 | 9/16 | 25 | ≥40 | Risser 0–2 | Rigid | Gensingen Brace | Full-time | ≥ 1.5 years | ≤5° | 92% |
Kuroki [32] | 2015 | 10/16 | 31 | 20–40 | Risser 0–2 | Rigid | OMC brace | Full-time | 2 years after discontinuing brace therapy | no curve progression ≥ 50° | 67.8% |
Yangmin Lin [33] | 2020 | 6/16 | 24 | 20–40 | Risser 0–2 | Rigid | Pressure-adjustable orthosis | 1 year | ≤5° | 100% | |
Lateur [46] | 2017 | 10/16 | 142 | <25 | Risser 0–3 | Rigid | Night-time brace | Night-time | >1 year mean 3.75 y | ≤5° | 83% |
Price [34] | 1990 | 7/16 | 139 | 25–49 | Risser 0–2 | Rigid | Charleston brace | Night-time | > 1 year | ≤5° | 83% |
Lee [35] | 2012 | 9/16 | 95 | 25–40 | Risser 0–2 | Rigid | Charleston brace | Night-time | > 2 years after skeletal maturity | ≤5° | 84.2% |
Davis [36] | 2019 | 6/16 | 56 | 25–40 | Risser 0–2 | Rigid | Providence brace | Night-time | mean 2.21 years | ≤5° | 51.8% |
Ohrt-Nissen [37] | 2016 | 7/16 | 63 | 25–40 | Risser 0–2 | Rigid | Providence brace | Night-time | 2 years | ≤5° | 57% |
D’ Amato [5] | 2001 | 8/16 | 102 | 20–42 | Risser 0–2 | Rigid | Providence brace | Night-time | Min 2 y after stop bracing | ≤5° | 74% |
Bohl [38] | 2014 | 6/16 | 34 | 25–40 | Risser 0–2 | Rigid | Providence brace | Night-time | 2 years after maturity | ≤5° or >45 degrees | 50% >5°, 59% >45° |
Simony [39] | 2019 | 10/16 | 80 | 20–45 | Pre or < 1 year post-menarche | Rigid | Providence brace | Night-time | Till 1 year after stop bracing | ≤5° | 89% |
Coillard [40] | 2007 | 8/16 | 170 | 25–40 | Risser 0–2 | Soft | SpineCor | Full-time | 2 years after discontinuing brace therapy | ≤5° | 59.4% |
Coillard [41] | 2014 | 16/24 | 32 | 15–30 | Risser 0–2 | Soft | SpineCor brace | Full-time | 5 years | ≤5° | 73% |
36 | control group | 57% |
First Author | Year | Risk of Bias | Sample Size | Cobb Angle | Skeletal Maturity | Type of Brace | Brace | Timing | Follow-Up | Definition of Success Rate | Success Rate |
---|---|---|---|---|---|---|---|---|---|---|---|
Minsk [47] | 2017 | 11/24 | 13 | 25–40 | Risser 0–2 | Rigid | Rigo- Cheneau | Full-time | >1 year | ≤5°; no need of surgery | Spinal surgery: 0% >6°:31% |
93 | Boston | Spinal surgery: 34% | |||||||||
Hanks [42] | 1988 | 11/24 | 75 | >25 | Risser 0–4 | Rigid | Wilmington Jacket | Full-time | 1 year after discontinuing brace | <10° | Full-time 80% |
25 | Part-time | 84% | |||||||||
Katz [43] | 2010 | 11/24 | 57 | 25–40 | Risser 0–2 | Rigid | Boston brace | Full-time | >1 year | ≤5° | 82% > 12 h |
43 | Part-time | 31% > 7 h | |||||||||
Yrjonen [4] | 2006 | 12/24 | 36 | >25° | Risser sign 0–3 | Rigid | Providence brace | Night-time | mean 1.8 years | ≤5° | 72% |
36 | Rigid | Boston brace | Full-time | 78% | |||||||
Janicki [48] | 2007 | 10/24 | 35 | 25–40 | Risser 0–2 | Rigid | Providence brace | Night-time | >2 years | ≤5° | 31% |
48 | Rigid | Custom TLSO | Full-time | 15% | |||||||
Ohrt-Nissen [49] | 2019 | 13/24 | 40 | 25–40 | Risser 0–2 | Rigid | Providence brace | Night-time | 2 years | ≤5° (primary outcome); curve progression ≥45° | 45% |
37 | Rigid | Boston brace | Full-time | 38% | |||||||
Weiss [50] | 2005 | 8/24 | 12 | 15-30 and >30 for rigid brace | Risser sign 0 (one exeption with 1) Tanner 2 or 3 | Soft | SpineCor | Full-time | mean 3.5 years | ≤5° | 8% |
10 | Rigid | Cheneau brace | Full-time | 80% | |||||||
Guo [51] | 2014 | 13/24 | 20 | 20–30 | Risser 0–2 Pre or < 1 year post-menarche | Soft | SpineCor brace | Full-time | 2 years after discontinuing brace therapy | ≤5° | 65% |
18 | Rigid | TLSO | Full-time | 94% |
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Costa, L.; Schlosser, T.P.C.; Jimale, H.; Homans, J.F.; Kruyt, M.C.; Castelein, R.M. The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis. J. Clin. Med. 2021, 10, 2145. https://doi.org/10.3390/jcm10102145
Costa L, Schlosser TPC, Jimale H, Homans JF, Kruyt MC, Castelein RM. The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2021; 10(10):2145. https://doi.org/10.3390/jcm10102145
Chicago/Turabian StyleCosta, Lorenzo, Tom P. C. Schlosser, Hanad Jimale, Jelle F. Homans, Moyo C. Kruyt, and René M. Castelein. 2021. "The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 10, no. 10: 2145. https://doi.org/10.3390/jcm10102145