Increased curve flexibility is ‘strongly associated’ with increased initial in-brace correction in idiopathic scoliosis patients

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A recently published systematic literature review has suggested that increased curve flexibility is strongly associated with initial in-brace correction in patients with idiopathic scoliosis (IS).

The study—the findings of which were published in the journal Spine by Charles Peeters (University Medical Centre Groningen, Groningen, The Netherlands) et al—sought to, using available literature, provide an overview of reported predictive factors on initial in-brace correction in patients with IS.

The researchers note that brace therapy “is the best non-surgical treatment for IS” and that there is “strong evidence that lack of initial in-brace correction is associated with brace treatment failure”.

A systematic literature search was performed using the Pubmed, Embase, Web-of-Science, Scopus, Cinahl, and Cochrane databases in November 2020. Studies which reported factors influencing initial in-brace correction in IS patients treated with brace therapy were considered eligible for inclusion.

Of the 4,562 potentially eligible articles identified, 28 studies fulfilled the inclusion criteria and were thus included in the systematic review. Nine of these studies (32%) were classified as high-quality studies and the remaining 19 studies (68%) as low-quality. A total of 34 different reported factors were collected from the studies.

The findings of the literature review showed that there was strong evidence that increased curve flexibility is a favourable predictive factor for initial in-brace correction. The researchers note that moderate evidence was found for thoracolumbar or lumbar curve pattern as a favourable predictive factor, and double major curve pattern was an unfavourable predictive factor for initial in-brace correction.

In addition, moderate evidence was also found that there is no significant difference on initial in-brace correction between computer-aided design (CAD) and computer-aided manufacturing (CAM) systems braces with or without finite element models (FEM) simulation, and braces fabricated using conventional plaster-cast.

Speaking to Spinal News International, Peeters said: “The results of this systematic review indicate strong evidence for increased curve flexibility, and moderate evidence for thoracolumbar or lumbar curve pattern as favourable predictive factors for initial in-brace correction.

“Although curve type and curve flexibility are patient factors which cannot be influenced by the orthotist, this information is useful to clarify differences between patients. In addition, measuring curve flexibility can provide a very close estimation of the actual in-brace correction in clinical practice.

“The results of this systematic review indicate also that CAD/CAM (/FEM) technology do not significantly improve initial in-brace correction compared to a conventional plaster-cast method. An added value of CAD/CAM (/FEM) braces on brace comfort was, however, reported.

“Better brace comfort could improve compliance and subsequently brace treatment success. Furthermore, CAD technology can be useful to 3-dimensionally quantify the trunk and brace characteristics to further investigate the effect of brace modifications on initial in-brace correction.”


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