Research quality in scoliosis conservative treatment: state of the art.

Fabio Zaina,Manuel Rigo,Michele Romano,Theodoros B Grivas,Stefano Negrini,Toru Maruyama,Jean Claude De Mauroy,Tomasz Kotwicki,Patrick Knott,Joseph O’Brien

doi:10.1186/s13013-015-0046-7

Abstract

The publication of research in the field of conservative treatment of scoliosis is increasing after a long period of progressive decline. In 2014, three high quality and scientifically sound papers gave new strength to the conservative scoliosis approach. The efficacy of treatment over observation was demonstrated by two RCTs for bracing, and one for scoliosis-specific exercises provided by a physical therapist. It is difficult to design strong studies in this field due to the long time needed for follow up and the challenge of recruiting patients and families willing to be involved in the decision process. Nevertheless, the main methodological errors are not related to the study design but rather on the way it is performed, which very frequently affects the reliability of results. The most common errors are: selection bias, with many studies including functional rather than a true structural scoliosis; inappropriate outcome measures, utilizing parameters not related to scoliosis progression or quality of life; inappropriate follow up, reporting only immediate results and not addressing end of growth results; an incorrect interpretation of findings, with an overestimation of results; and missing the evaluation of skeletal maturity, without which results cannot be considered stable. Being aware of these errors is extremely important both for authors and for readers in order to avoid questionable practices based on inconclusive studies that could harm patients.

Highlights

Research in the field of conservative treatment of scoliosis is increasing in frequency after a long period of progressive decline lasting from the 1980s to the early 2000s [1,2,3]
In 2014 three RCTs gave new strength to conservative scoliosis treatment For years we have waited for a Randomized Clinical Trial (RCT) to validate the effectiveness of brace treatment for scoliosis, with the evidence up until now based only on prospective observational studies [8, 9]
In the field of scoliosis, improper practice based on marketing and not on science, is common, and it is a major reason for concern

Summary

Introduction

Research in the field of conservative treatment of scoliosis is increasing in frequency after a long period of progressive decline lasting from the 1980s to the early 2000s [1,2,3]. The combination of patient need and an upward trend in published papers provides a good opportunity to increase the number of researchers in this field, as well as to involve a new generation of physiatrists, together with orthopedic surgeons, in the care of patients with scoliosis. The year 2014 will be remembered for three published Randomized Clinical Trials (RCTs) which were milestones in demonstrating the efficacy of conservative scoliosis treatment.

Results

Conclusion