Abstract
Brace treatment is the most common noninvasive treatment in adolescent idiopathic scoliosis (AIS); however it is currently not fully known whether there is a difference in effectiveness between brace types/concepts. All studies on brace treatment for AIS were searched for in PubMed and EMBASE up to January 2021. Articles that did not report on maturity of the study population were excluded. Critical appraisal was performed using the Methodological Index for Non-Randomized Studies tool (MINORS). Brace concepts were distinguished in prescribed wearing time and rigidity of the brace: full-time, part-time, and night-time, rigid braces and soft braces. In the meta-analysis, success was defined as ≤5° curve progression during follow-up. Of the 33 selected studies, 11 papers showed high risk of bias. The rigid full-time brace had on average a success rate of 73.2% (95% CI 61–86%), night-time of 78.7% (72–85%), soft braces of 62.4% (55–70%), observation only of 50% (44–56%). There was insufficient evidence on part-time wear for the meta-analysis. The majority of brace studies have significant risk of bias. No significant difference in outcome between the night-time or full-time concepts could be identified. Soft braces have a lower success rate compared to rigid braces. Bracing for scoliosis in Risser 0–2 and 0–3 stage of maturation appeared most effective.
Highlights
Observation is indicated for mild curves and brace treatment is normally recommended in curves between 20◦ and 45◦ [2,3]
The meta-analysis was performed on the outcomes of studies with low risk-of-bias that reported on the effectiveness of different brace concepts or braces as defined as ≤5◦ coronal curve angle progression during study follow-up
This systematic review and meta-analysis aimed to compare the effectiveness of different concepts of and bracing for treatment aimed of Adolescent Idiopathic Scoliosis (AIS)
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The application of many different brace concepts (distinguished in prescribed wearing time and rigidity of the brace: full-time, part-time, and night-time, rigid braces and soft braces) have been described in the literature They all apply different degrees of external corrective forces to the trunk to correct the complex 3-D spinal deformity. The aim of this systematic review and meta-analysis is to evaluate the literature on the effectiveness of different concepts of brace treatment, in terms of effect on spinal curve magnitude. Many definitions of success rate such as ≤5◦ , ≤10◦ , or avoidance of surgery are used in scoliosis brace studies As this heterogeneity would have affected the outcome of this review, the authors agreed to use, at least for the meta-analysis, the most used definition: ≤5◦ of curve progression as successful treatment
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