Benjamin D Roye1, Matthew E Simhon1, Hiroko Matsumoto2,3, Prachi Bakarania1, Hagit Berdishevsky1, Lori A Dolan4, Kelly Grimes1, Theodoros B Grivas5, Michael T Hresko6, Lori A Karol7, Baron S Lonner8, Michael Mendelow9, Stefano Negrini10,11, Peter O Newton12, Eric C Parent13, Manuel Rigo14, Luke Strikeleather15, John Tunney1,16, Stuart L Weinstein4, Grant Wood17, Michael G Vitale1. 1. Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA. 2. Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA. hm2174@cumc.columbia.edu. 3. Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. hm2174@cumc.columbia.edu. 4. Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 5. Orthopaedics and Traumatology Department, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece. 6. Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 7. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, USA. 8. Department of Orthopaedic Surgery, Mount Sinai Hospital, 1 Gustave L. Levy Pl, New York, NY, 10029, USA. 9. Shriners Hospitals for Children-Greenville, Greenville, SC, USA. 10. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 11. IRCCS Fondazione Don Gnocchi, Milan, Italy. 12. Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA, 92123, USA. 13. Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G2G4, Canada. 14. Elena Salvá Institute (Rigo Quera Salvá S.L.P.), VÍa Augusta 185, 08021, Barcelona, Spain. 15. National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA, 22124, USA. 16. East Coast Orthotic & Prosthetic Corp., Deer Park, NY, USA. 17. Align Clinic, LLC, 700 South Claremont Street, Suite 105, San Mateo, CA, 94402, USA.
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. 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.
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. 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.
Entities:
Keywords:
Adolescent idiopathic scoliosis; Best practice guideline; Bracing
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