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Bracing In The Treatment Of Adolescent Idiopathic Scoliosis: Evidence To Date

Authors Karavidas N

Received 29 June 2019

Accepted for publication 18 September 2019

Published 8 October 2019 Volume 2019:10 Pages 153—172


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Alastair Sutcliffe

Nikos Karavidas

Schroth Scoliosis & Spine Clinic, Physiotherapy Department, Athens, Greece

Correspondence: Nikos Karavidas
Schroth Scoliosis & Spine Clinic, Physiotherapy Department, Kolokotroni 5, Athens 15451, Greece
Tel +306974801432

Abstract: Brace effectiveness for adolescent idiopathic scoliosis was controversial until recent studies provided high quality of evidence that bracing can decrease likelihood of progression and need for operative treatment. Very low evidence exists regarding bracing over 40º and adult degenerative scoliosis. Initial in-brace correction and compliance seem to be the most important predictive factors for successful treatment outcome. However, the amount of correction and adherence to wearing hours have not been established yet. Moderate evidence suggests that thoracic and double curves, and curves over 30º at an early growth stage have more risk for failure. High and low body mass index scores are also associated with low successful rates. CAD/CAM braces have shown better initial correction and are more comfortable than conventional plaster cast braces. For a curve at high risk of progression, rigid and day-time braces are significantly more effective than soft or night-time braces. No safe conclusion on effectiveness can be drawn while comparing symmetrical and asymmetrical brace designs. The addition of physiotherapeutic scoliosis-specific exercises in brace treatment can provide better outcomes and is recommended, when possible. Despite the growing evidence for brace effectiveness, there is still an imperative need for future high methodological quality studies to be conducted.

Keywords: scoliosis, brace, non-operative treatment, orthosis, evidence

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