ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2023 April;59(2):212-21

DOI: 10.23736/S1973-9087.23.07605-0

Copyright © 2023 THE AUTHORS

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language: English

Intensive bracing management combined with physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis patients with a major curve ranging from 40-60° who refused surgery: a prospective cohort study

Tianyuan ZHANG ¹, Zifang HUANG ², Wenyuan SUI ¹, Wenqing WEI ³, Xiexiang SHAO ¹, Yaolong DENG ¹, Junlin YANG ^{1, 4} ✉, Jingfan YANG ^{1, 4}

¹ Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; ² Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ³ School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China; ⁴ Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

BACKGROUND: Current guidelines for brace management of adolescent idiopathic scoliosis (AIS) are mostly recommended for curves between 25° to 40°. For AIS patients with curves >40°, surgery is often considered since bracing may be less effective; however, there are still some patients and families who refuse operation. Therefore, further research is necessary to determine optimal bracing management in this group. To date, few protocols for such have been reported in literature.
AIM: The aim of this study was to introduce and evaluate the effectiveness of the treatment protocol comprising of intensive bracing management and physiotherapeutic scoliosis-specific exercises (PSSE) in AIS patients with a major curve of 40-60° who refuse surgery.
DESIGN: This is a prospective cohort study.
SETTING: The study was carried out in an outpatient clinic.
POPULATION: 10-18-year-old AIS patients having 40-60°curves and a Risser grade of 0-3, but firmly refusing surgery were eligible. Patients who had a proximal thoracic curve or had undergone any other form of treatment previously were excluded from the study.
METHODS: A total of 82 patients were recruited and received the treatment. The primary outcome was defined as “success” when the main curve was below 50° upon reaching skeletal maturity, and “failure” if otherwise. The secondary outcome was defined as improved (>5° reduction), unchanged (≤5° change) or progressed (>5° increase) based on the evolution of the main curve. The per protocol (PP) and intent to treat (ITT) analyses were performed to quantify success rates, while the dropouts were considered as failures. Risk factors associated with bracing failure were identified and a receiver operating characteristic (ROC) curve was used to determine the cut-off value.
RESULTS: A total of 77 patients completed the treatment, while 5 dropped out. The average main curve was 47.40±5.93° at baseline and 38.56±11.85° at last follow-up (P<0.001). Our management was successful in 83% and 78% of patients based on the PP and ITT analyses, respectively. When compared with the curve magnitude at baseline, 65% patients improved, 30% remained unchanged, and 5% progressed when using a 5° threshold. Univariate comparison and logistic regression analysis demonstrated that patients with successful outcomes had a significantly smaller baseline curve, larger Risser Stage, and larger in-brace correction (IBC) rate.
CONCLUSIONS: For AIS patients with 40-60° curves who refused surgery, our intensive bracing management along with PSSE was practical and effective, achieving success in 78% of patients based on an ITT analysis. A larger baseline curve, smaller Risser Stage, and smaller IBC rate were associated with treatment failure.
CLINICAL REHABILITATION IMPACT: Our intensive management provides new insights into improving the effectiveness of bracing in patients with AIS who refuse surgery. This is a promising option for patients with 40-60° curves, since their scoliosis may be treated using a non-surgical technique instead of surgery in the future.

KEY WORDS: Adolescent; Scoliosis; Physical therapy modalities