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Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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European Journal of Physical and Rehabilitation Medicine 2014 February;50(1):87-92


lingua: Inglese

Actual evidence in the medical approach to adolescents with idiopathic scoliosis

Negrini S. 1, 2, De Mauroy J. C. 3, Grivas T. B. 4, Knott P. 5, Kotwicki T. 6, Maruyama T. 7, O’Brien J. P. 8, Rigo M. 9, Zaina F. 10

1 Physical and Rehabilitation Medicine Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy; 2 IRCCS Don Gnocchi Foundation, Milan, Italy; 3 Department of Orthopedic Medicine Clinique du Parc, Lyon, France; 4 Trauma and Orthopedic Department “Tzanio” General Hospital of Piraeus, Piraeus, Greece; 5 Rosalind Franklin University of Medicine and Science North Chicago, IL, USA; 6 Department of Pediatric Orthopedics University of Medical Sciences, Poznan, Poland; 7 Department of Orthopedic Surgery Saitama Medical Center, Saitama Medical University; 8 National Scoliosis Foundation, Stoughton, MA, USA; 9 Elena Salvá Institut, Barcelona, Spain; 10 ISICO (Italian Scientific Spine Institute), Milan, Italy


Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with IS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Recently, a controlled prospective trial including a randomised arm gave more strength to this conclusion. Another Cochrane review shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the Scoliosis Research Society (SRS) criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agreement among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients’ behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is their main goal. A systematic review shows that there are no studies on manual treatment. The SOSORT Guidelines offer the actual standard of conservative care.

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