Matthew Halsey1, Lori A Dolan2, Richard A Hostin3, Raphael D Adobor4, Romain Dayer5, Eugenio Dema6, Olavo B Letaif7. 1. Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Sam Jackson Hall, Suite 2360, 3181 S.W. Sam Jackson Park Road, Portland, OR, USA. halseyma@ohsu.edu. 2. Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA. 3. Southwest Scoliosis Institute, Plano, TX, USA. 4. Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway. 5. Pediatric Orthopedic Unit, Geneva University Hospital, Geneva, Switzerland. 6. Scoliosis and Spinal Surgery Centre, Hesperia Hospital, Modena, Italy. 7. Department of Orthopaedics and Traumatology, University of Sao Paulo, Sao Paulo, Brazil.
Abstract
PURPOSE: While the Scoliosis Research Society (SRS) has established criteria for brace initiation in adolescent idiopathic scoliosis (AIS), there are no recommendations concerning other management issues. As the BrAIST study reinforced the utility of bracing, the SRS Non-Operative Management Committee decided to evaluate the consensus or discord in AIS brace management. METHODS: 1200 SRS members were sent an online survey in 2017, which included 21 items concerning demographics, bracing indications, management, and monitoring. Free-text responses were analyzed and collated into common themes. Data were analyzed using Microsoft Excel 2013. RESULTS: Of 218 respondents; 207 regularly evaluate and manage patients with AIS, and 205 currently prescribe bracing. 99% of respondents use bracing for AIS and the majority (89%) use the published SRS criteria, or a modified version, to initiate bracing. 85% do not use brace monitoring and 66% use both %-Cobb correction and fit criteria to evaluate brace adequacy. In contrast, other aspects of brace management demonstrated a high degree of practice variability. This was seen with a radiographic assessment of maturity level, hours prescribed, timing and frequency of radiographic evaluation, the use of nighttime bracing only, and the method and timing of brace discontinuation. CONCLUSION: Although there is consensus in brace management amongst SRS members with respect to brace initiation and evaluation of adequacy, there is striking variability in how bracing for AIS is used. This variability may impact the overall efficacy of brace treatment and may be decreased with more robust guidelines from the SRS. LEVEL OF EVIDENCE: III.
PURPOSE: While the Scoliosis Research Society (SRS) has established criteria for brace initiation in adolescent idiopathic scoliosis (AIS), there are no recommendations concerning other management issues. As the BrAIST study reinforced the utility of bracing, the SRS Non-Operative Management Committee decided to evaluate the consensus or discord in AIS brace management. METHODS: 1200 SRS members were sent an online survey in 2017, which included 21 items concerning demographics, bracing indications, management, and monitoring. Free-text responses were analyzed and collated into common themes. Data were analyzed using Microsoft Excel 2013. RESULTS: Of 218 respondents; 207 regularly evaluate and manage patients with AIS, and 205 currently prescribe bracing. 99% of respondents use bracing for AIS and the majority (89%) use the published SRS criteria, or a modified version, to initiate bracing. 85% do not use brace monitoring and 66% use both %-Cobb correction and fit criteria to evaluate brace adequacy. In contrast, other aspects of brace management demonstrated a high degree of practice variability. This was seen with a radiographic assessment of maturity level, hours prescribed, timing and frequency of radiographic evaluation, the use of nighttime bracing only, and the method and timing of brace discontinuation. CONCLUSION: Although there is consensus in brace management amongst SRS members with respect to brace initiation and evaluation of adequacy, there is striking variability in how bracing for AIS is used. This variability may impact the overall efficacy of brace treatment and may be decreased with more robust guidelines from the SRS. LEVEL OF EVIDENCE: III.
Entities:
Keywords:
Adolescent idiopathic scoliosis; Brace management; Bracing; Practice variability; Scoliosis research society; Survey
Authors: Davide Bizzoca; Andrea Piazzolla; Lorenzo Moretti; Giovanni Vicenti; Biagio Moretti; Giuseppe Solarino Journal: World J Orthop Date: 2022-05-18