Rigid Braces Research Articles

Lumbar braces and other assistive devices for treatment of chronic low back pain.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of assistive technologies (i.e. non-rigid and rigid lumbar braces, belts, supports, and devices to assist mobility and gait) for improving pain and function (and consequently reducing disability) in adults with chronic low back pain.

Acute Effect of Brace Use on Upper-Extremity Functionality in Adolescent Individuals With Idiopathic Scoliosis: A Cross-Sectional Study.

It is well known that scoliosis adversely affects the functions of the upper extremities. However, the acute effect of rigid braces, which are widely used in the conservative treatment of scoliosis, on upper-extremity functionality remains unknown. The aim of this study was to investigate the acute effect of a rigid thoracolumbosacral brace use on upper-extremity functionality in individuals with adolescent idiopathic scoliosis (AIS). Thirty-eight individuals diagnosed with AIS participated in this cross-sectional study, with a mean age of 14.55 ± 1.90years and a range of 10-18years. The upper-extremity functionality was assessed using the Nine-Hole Peg Test and handgrip strength, with assessments conducted under both in-brace (with their own braces) and out-of-brace conditions. Nine-Hole Peg Test durations of the AIS patients for the nondominant side were significantly lower for in-brace conditions compared with out-of-brace conditions (p = .049, effect size = 0.136). The grip strength of the nondominant side was significantly higher for in-brace conditions compared with out-of-brace conditions (p = .025, effect size = 0.365). A weak negative correlation was found between the degree of curvature and the grip strength of the dominant side for in-brace conditions (r = -.323, p = .048). It was concluded that the brace had a positive effect on upper-extremity functionality on the nondominant side by both shortening the Nine-Hole Peg Test duration and increasing grip strength. In AIS patients, the brace may positively affect daily living by improving the functionality of the nondominant extremity.

The Effect of Schroth Exercises on Pulmonary Function in Adolescent Idiopathic Scoliosis

Background: Idiopathic scoliosis is a three-dimensional structural deformity and adolescent form is the most common type (AIS). Conservative treatment methods in AIS include brace and scoliosis-specific exercise treatments. Respiratory limitations have been reported in relation to the nature of scoliosis itself. However, the evidence regarding treatment interventions is controversial. The purpose of the study, to investigate the effects of Schroth exercises on pulmonary functions on adolescents who use rigid braces and perform Schroth exercises.

Evaluation of the effectiveness of soft braces on idiopathic scoliosis: A review of literature

Background: Various treatment approaches are used for subjects with idiopathic scoliosis, however using a brace is one of the most common approaches in this regard. The braces used for idiopathic scoliosis can be divided into soft and rigid braces. SpineCor brace is mostly recommended for subjects who refused to use rigid braces. However, it is not well understood whether soft braces are as effective as rigid braces to control scoliosis curve progression or not. Therefore, this study aimed to evaluate the effectiveness of soft braces used for idiopathic scoliotic curves compared to other available braces. Method: A search was done in databases including PubMed, Google Scholar, ISI Web of Knowledge, Ebsco, Embasco, and Scopus. Keywords of the soft brace, SpineCor were used in combination with scoliosis. The quality of the selected studies was evaluated by use of the Down and Black tool, which is a reliable method to evaluate the quality of the studies. Results: Based on the aforementioned keywords, 52 studies were achieved. After reviewing the title and abstract of each study 11 papers were selected for final analysis. Eight studies were on the evaluation of the effectiveness of the SpineCor brace on scoliosis. There were three studies on the comparison of the SpineCor with other available rigid braces. Conclusion: The results of selected studies confirmed that the SpineCor brace can be used to control the progression of idiopathic scoliosis. However, its effectiveness is limited to the curves with a severity of fewer than 30° and for the patients with Risser signs 0–3. The effectiveness of SpineCor is not comparable with a rigid brace, especially for the curve above 40°. SpineCor stabilizes the spine with high compliance and with significant improvement in posture, rib hump, lumbar predominance, and muscle contraction.

A Hybrid Anchoring Technology Composed of Reinforced Flexible Shells for a Knee Unloading Exosuit.

Soft robotic wearables have emerged as an ergonomic alternative to rigid robotic wearables, commonly utilizing tension-based actuation systems. However, their soft structure's natural tendency to buckle limits their use for compression bearing applications. This study presents reinforced flexible shell (RFS) anchoring, a compliant, low-profile, ergonomic wearable platform capable of high compression resistance. RFS anchors are fabricated with soft and semirigid materials that typically buckle under compressive loads. Buckling is overcome using the wearer's leg as a support structure, reinforcing the shells with straps, and minimizing the space between the shells and the wearer's skin-enabling force transmission orders of magnitude larger. RFS anchoring performance was evaluated comparatively by examining the shift-deformation profiles of three identically designed braces fabricated with different materials: rigid, strapped RFS, and unstrapped RFS. The unstrapped RFS severely deformed before 200 N of force could be applied. The strapped RFS successfully supported 200 N of force and exhibited a nearly identical transient shift-deformation profile with the rigid brace condition. RFS anchoring technology was applied to a compression-resistant hybrid exosuit, Exo-Unloader, for knee osteoarthritis. Exo-Unloader utilizes a tendon-driven linear sliding actuation system that unloads the medial and lateral compartments of the knee. Exo-Unloader can deliver 200 N of unloading force without deforming, as indicted by its similar transient shift-deformation profile with a rigid unloader baseline. Although rigid braces effectively withstand and transmit high compressive loads, they lack compliance; RFS anchoring technology expands the application of soft and flexible materials to compression-based wearable assistive systems.

Knee Orthotics Do Not Influence Coordinative Skills-A Randomized Controlled Crossover Pilot Trial.

Objective: This single-blind randomized controlled crossover pilot trial investigated whether hard or soft knee orthotics affect the back in action (BIA) test battery performance. Methods: Twenty-four healthy participants (13 males, 11 females) were randomly assigned into three equal groups differentiated through the order of device use. The data were collected in a laboratory setting. BIA test battery (balance tests, vertical jumps, and parkour hop tests) was run with a rigid orthotic device, a soft brace, or no aid in a crossover order. Analysis of Variance repeated measures and Friedman Test were used to calculate depended-group differences. Results: No significant or clinically relevant effect or differences was observed between running the BIA with a soft brace, rigid orthosis, or no aid (p = 0.53–0.97) for all included tests. No adverse events have been observed. Conclusion: Soft and rigid knee braces do not affect performance in healthy participants. Missing experience with the devices might explain a few influences on feedback mechanisms. There is no disadvantage to be expected regarding healthy participants running back to sports.

Lateral Bracing Stiffness Requirements for Systems of Parallel Compression Members

AbstractPractical models have been developed to determine the threshold stiffness for lateral bracing components used in systems of parallel compression members or sub‐assemblages. Model formulation is based on the analysis of n parallel compression members with intermediate tie‐bracing and flexible anchorages. Intermediate bracing options include both continuous lateral tie‐bracing with flexible shear connectors, and discrete tie‐braces (blocking) directly linking adjacent members without connectors. Anchor bracing cases include both rigid and flexible braces and connectors, and both equal and unequal stiffnesses. Analytical solutions for the threshold stiffness were derived using equilibrium, compatibility, and constitutive relationships for a system that modeled bracing with linear‐elastic springs. The resulting eigenvalue problem is solved with computational efficiency and speed that far exceeds that of a root‐finding solution scheme reliant on symbolic computations. Two approximate expressions for the ideal tie‐brace stiffness have also been developed. Comparisons with the exact solutions indicate satisfactory accuracy for both approximations, with mean percent errors of 1% ‐ 2% for realistic variable values. A design procedure using these approximations is also proposed.

Development of a bespoke 3D-printed spinal brace for lumbar support

Low back pain (LBP) is a significant contributor to disabilities in the UK. Many factors cause LBP, including poor posture, obesity, and spinal fractures, all resulting in spiralling healthcare costs. If spinal fractures are not properly braced, they can lead to weakened vertebrae in the spine and larger risks that can reoccur. There are many problems with flexible, semi-rigid and rigid braces currently available on the market. We present the user-centred design approach undertaken by a multidisciplinary design team consisting of product designers, design engineers, technical specialists, and healthcare professionals to develop a bespoke 3D-printed spinal brace using a digital design workflow.

Actuator and Contact Force Modeling of an Active Soft Brace for Scoliosis.

Scoliosis is an abnormality of the spinal curvature that severely affects the musculoskeletal, respiratory, and nervous systems. Conventionally, it is treated using rigid spinal braces. These braces are static, rigid, and passive in nature, and they (largely) limit the mobility of the spine, resulting in other spinal complexities. Moreover, these braces do not have precise control over how much force is being applied by them. Over-exertion of force may deteriorate the spinal condition. This article presents a novel active soft brace that allows mobility to the spine while applying controlled corrective forces that are regulated by varying the tensions in elastic bands using low-power light weight twisted string actuators (TSAs). This article focuses on the actuator and contact force modeling of the active soft brace (ASB). The actuator modeling is required to translate the twisting of string in terms of contraction of the string’s length, whereas the contact force modeling helps in estimating the net resultant force exerted by the band on the body using single point pressure/force sensors. The actuators (TSAs) are modeled as helix geometry and validated using a laser position sensor. The results showed that the model effectively tracked the position (contraction in length) with root mean square error (RMSE) of 1.7386 mm. The contact force is modeled using the belt and pulley contact model and validated by building a custom testbed. The actuator module is able to regulate the pressure in the range 0–6 Kpa, which is comparable to 0–8 Kpa pressure regulated in rigid braces. This makes it possible to verify and demonstrate the working principle of the proposed active soft brace.

Impact of the Free-Pelvis Innovation in Very Rigid Braces for Adolescents with Idiopathic Scoliosis: Short-Term Results of a Matched Case-Control Study.

We introduced pelvis semi-rigid material (ethylene vinyl acetate) (Free-Pelvis) to improve the comfort and adaptability of very rigid braces (VRBs) for adolescents with idiopathic scoliosis (AIS), but this can also negatively impact the corrective forces on the trunk. Study Design: This was a matched retrospective cohort study. The inclusion criteria were AIS, age 10–16, VRB 23 h/day, X-rays available, primary curve 36°–65°, and angle of trunk rotation 7–23°. The cases were Sforzesco VRB with Free-Pelvis (FPB). The controls included classical Sforzesco VRB matched for Risser (range 0/4), menarche age (10/15), weight (33.5/83 kg), height (140/180 cm), BMI (13.5/29 kg/sqm), aesthetics (TRACE 4/12), plumbline distances (S1: −60/35; C7 + L3: −10/115 mm), and referred brace use (22/24 h/day). Statistics: predictors of the results have been tested with linear and logistic regression according to the outcome variable type. We performed logistic regression for improved vs. worsened. The explanatory variable was brace type. We included 777 VRB and 25 FPB, age 13 ± 1, 47° ± 8° Cobb, and 11% men. The few baseline statistical differences were not clinically relevant. We achieved in-brace corrections of 15.2° ± 7.7° and 17.4° ± 6.5° for VRB and FPB, respectively (p = 0.21); out-of-brace corrections at 5 ± 2 months were 7.8° ± 0.2° for VRB and 8.1° ± 1.3° for FPB (p = 0.83). The type of brace did not influence the Cobb angle at either time interval or affect the odds of improvement. Free-Pelvis innovation, introduced to improve comfort and adaptability, does not change the in-brace or short-term results of classical VRB and consequently can be safely applied.

Pediatric Research in Sports Medicine Research Interest Group Spine/Spondylolysis Clinical Practice SurveY

Background:The Pediatric Research in Sports Medicine (PRiSM) society is a multi-disciplinary group of healthcare providers who provide clinical care to young athletes with a variety of conditions, including isthmic spondylolysis. It is thought that significant practice differences exist in the way providers diagnose, image, and treat this condition.Hypothesis/Purpose:The purpose of this study is to survey the members of PRiSM on clinical practice patterns in the diagnosis, imaging, and management of isthmic spondylolysis in young athletes.Methods:An electronic, thirty-three question REDCaps survey was distributed to the PRISM membership via email during the 2021 virtual annual meeting and one reminder was sent after the meeting. Responses were collected during a 6-week period. The survey collected information based upon the following: demographics, diagnosis, imaging, and management.Results:Ninety-eight surveys were completed. Most of the respondents were divided between orthopaedic surgeons, non-operative sports medicine physicians and physical therapists, approximately half of which are fellowship trained. Approximately 42% of respondents make the diagnosis based upon MRI results in addition to history, physical examination, and plain radiographs. Approximately 24% obtain oblique radiographs as part of their assessment. MRI is the most frequently used advanced imaging modality with nearly 90% of respondents using this. The use of rigid bracing varies widely among respondents, with 20.6% bracing regularly, 35.3% sometimes bracing, and 44.1% not using rigid braces at all. The use of non-rigid bracing is similarly varied with 17.6% prescribing this regularly, 44.1% sometimes, and 38.2% not using non-rigid bracing at all. There is variance as well with regards to initiation of physical therapy (PT): prescribing immediately (42.6%) versus prescribing a period to rest prior to PT (57.4%). When young athletes are returned to sport, 52.9% of respondents indicated that they would impose restrictions to activity and 47.1% would not.Conclusion:Although there are similarities in how the diagnosis of isthmic spondylolysis in young athletes is made by PRISM members, there is variability in management, especially the use of bracing, the timing of physical therapy, and return to sport restrictions. MRI is the most common advanced imaging modality being used to help with the diagnosis.

Active Soft Brace for Scoliotic Spine: A Finite Element Study to Evaluate in-Brace Correction

Scoliosis is a spinal disorder that is conventionally treated using rigid or soft braces. Computational methods such as finite element-based models are used to investigate the mechanics of the spine and the effect of braces. Most spinal braces are either passive, static, or rigid and do not allow mobility to the spine, resulting in muscle atrophy, skin deterioration and other spine complexities. Lack of control over the amount of force being exerted by braces on the human spine could have adverse effects. Therefore, developing an active soft brace which allows mobility to the spine while applying controlled corrective forces could be a promising solution. This study presents finite element analysis (FEA) of an active soft brace that applies corrective forces using elastic bands. The pressure exerted by the brace on the spine can be controlled by varying the tensions in the elastic bands. The elastic band tensions are controlled using low-power, lightweight, and twisted string actuators (TSAs). This study aims to demonstrate the immediate corrections induced by the soft active brace using a scoliotic spine finite element (FE) model. A FE model of the patient’s trunk was created and validated with in vitro study. The brace model was installed on the simulated trunk to evaluate in-brace correction in both sagittal and coronal planes. The brace was evaluated under various load cases by simulating the actuator action.

Affective association with and preference for flexible brace colors in older adults with spinal deformities

AbstractPatients with adult spinal deformities, often suffer from the physical shortcomings of rigid braces and psychological hurdles of traditional rigid bracing treatment. The color of flexible braces is a physical element that influences user perception and treatment acceptance. This study aims to investigate the affective valence and preferences of patients with adult spinal deformities toward contextless colors and flexible brace colors, respectively, then understand their color requirements of flexible braces in terms of the color attributes (lightness and chroma). A total of 32 Chinese participants with adult spinal deformities (25 females and 7 males aged 61.9 ± 4.16) participated in the study. Participants are required to score 36 contextless and brace colors using the affective appraisal scale and the colors are measured using spectrophotometer. The experimental results showed that context is an important factor in influencing the affective perception but not the color preferences of participants. Adult spinal deformities patients have a more positive affective connotations toward the brace color with lighter achromatic shades. This study provides new insights for the choosing of colors during the design process of medical orthoses.

The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis.

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.

Effect of Different Knee Braces in ACL-Deficient Patients.

Knee braces are often used during rehabilitation after ACL injury. There are two main concepts, rigid and soft braces, but studies comparing the two show conflicting results. Most studies used movement tasks with low translational or rotational loads and did not provide joint kinematics. Therefore, the purpose of this study was to investigate the influence of two different knee braces (rigid vs. soft) on knee joint kinematics in ACL-deficient patients compared to an unbraced control condition using two tasks (walking and 180° cutting) provoking knee movements in the frontal and transverse planes. 17 subjects with ACL-deficient knees participated in this study. 3D knee joint kinematics were recorded. To provoke frontal plane knee joint motion a laterally tilting plate was applied during a walking task. Both braces reduced the maximum valgus angle compared to the unbraced condition, stabilizing the knee joint against excessive valgus motion. Yet, no differences in peak abduction angle between the two braces were found. However, a significant extension deficit was observed with the rigid brace. Moreover, both braces increased transverse plane RoM and peak internal rotation angle, with the effects being significantly larger with the rigid brace. These effects have been associated with decreased knee stability and unphysiological cartilage loading. Therefore, the soft brace seems to be able to limit peak abduction with a lesser impact on physiological gait compared to the rigid brace. The cutting task was selected to provoke transverse plane knee movement and large external knee rotation was expected. However, none of the braces was able to reduce peak external knee rotation. Again, an increase in transverse plane RoM was observed with both braces. Based on these results, no brace outmatched the other in the second task. This study was the first attempt to clarify the effect of brace design for the stabilization of the knee joint during movements with frontal and transverse plane loading. However, to provide physicians and patients with a comprehensive guideline for brace usage, future studies will have to extent these findings to other daily or sportive movement tasks.

Finite element analysis of cold-formed thin-walled steel skeleton wall with rigid diagonal braces

In order to investigate the shear resistance of cold-formed thin-walled steel skeleton wall under monotonic load, the finite element analysis of six walls was carried out to obtain the shear capacity of different walls and reveal the wrecking mode of the wall. The results show that the arrangement of rigid cross brace and rigid diagonal brace in the wall can significantly improve the shear resistance of the wall, the vertical continuous splay layout with two spans has the largest lifting range.

Non-Invasive Treatment of Adolescent Idiopathic Scoliosis: Systematic Literature Review by Using Citation Network Analysis

There are many nonsurgical treatment options from adolescent idiopathic scoliosis (AIS) to control the progression of the spinal curvature. However, the existing studies are so diverse and diffuse that it is challenging to find potential trends for further studies without a more comprehensive review in place for reference purposes. Thus, the objective of this review article is to conduct a systematic literature review on the noninvasive treatment of AIS with a citation network analysis. The Web of Science (WoS) was searched using 9 reference keywords to collect published articles in English on nonsurgical treatment options for AIS from 1979 to 2019. Each eligible article focused on the nonsurgical options for treating AIS. In addition, the HistCite and the UCINet softwares were referred to for article distribution and citation network analysis. Only non-invasive treatment options of AIS were included. Studies that estimated the amount of spinal curvature, causes of or risk factors for AIS and any invasive treatments, such as surgery, were not focused on. The articles were independently extracted by 3 authors based on the predefined eligibility criteria. The title, authors, year of publication, country or region of publication, reference list, keywords and other bibliographic information from each article was extracted and analyzed purely based on the data with the HistCite and UCINet programs. At last, a total of 146 articles out of 1594 articles were selected for the literature review after the exclusion of 1357 irrelevant articles and 91 inappropriate studies, such as letters and proceedings papers. Of these 146 articles, the majority were empirical studies (74.0%). There was also a lack of meta-analyses in this research field. Based on the results of the citation network analysis, most of the top 10 articles with the highest local citation scores (LCSs) focused on bracing as a treatment. The popularity of bracing as a research topic was also supported by the citation network structure, as brace treatment was in the largest of the five research clusters; this cluster also included posture training through exercise, managing the corrective forces of braces, 3D analysis of braces and quality of life during brace treatment. However, most of these studies focused on rigid braces. A few studies on non-rigid braces and other types of nonsurgical treatment were available in the current literature, which might indicate potential research areas for future studies. To conclude, noninvasive treatment for AIS has been on the academic radar recently; but there are still research gaps, such as the lack of research on semi-rigid and flexible braces or posture training exercises with biofeedback systems. Further studies could explore these research directions.

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

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 40ο 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 30ο 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.

Structural Evaluation of Torsional Rigidity of New FRP–Aluminum Space Truss Bridge with Rigid Transverse Braces

A unique fiber-reinforced polymer (FRP)–aluminum spatial truss structure with upper I-type, transverse beam braces was developed for deployable bridging, yielding the operational advantages of bestraddled erection bridges. Experimental testing and numerical simulation were performed to evaluate the torsional rigidity of a fabricated cantilever, full-scale experimental structure. The predictions obtained based on a computational finite element model were strongly consistent with the experimental results. Moreover, a numerical decomposition and reconstruction procedure was employed to understand the load-bearing mechanism of the structure. The results demonstrated that the improved transverse braces possessed adequate capacity for providing sufficient rigidity and lateral stability to the complete twin-treadway structure under torsion. The torsional center of the improved structure was located at the axis of symmetry of the twin-treadway bridge deck. The representative torsional rigidity of the twin-treadway module was approximately 87.5 kN·m2/degree. Compared to the original construction, the improved structure exhibited only minor discrepancies regarding the torsional rigidity, and consistent characteristics in terms of the load-bearing mechanism. The torsional rigidity of the improved twin-treadway structure was primarily generated by the vertical bending rigidities of its two parallel single treadways through the rigid transverse braces. This significant finding specifically pertains to the unique twin-treadway hybrid bridge. The results presented in this work are expected to provide valuable insights, which could, in turn, lead to further the development of similar lightweight structural systems.

End-growth results of a personalised conservative approach in 1938 high risk adolescents with idiopathic scoliosis: Prospective observational multicentre study

End of growth RCTs showed the efficacy of bracing and physiotherapic scoliosis specific exercises (PSSE). Current guidelines propose PCA according to the step-by-step theory: invasivity increases with treatment intensity, from observation to PSSE to soft, rigid and very rigid bracing. This requires to set individualised outcomes and propose the less invasive treatment according to the outcome. Inclusion criteria: AIS, 11–45°, Risser 0–2, age 10–16, first consultation, no previous bracing. End of observation: Risser 3, medical prescription. Groups were defined according to the main end outcome (SRS-SOSORT Consensus): low degree (LD) (< 31° at start) remain < 30°; high degree (HD) (> 30° at start) remain < 50°. Treatment: PCA including observation, PSSE (SEAS school), soft (SpineCor), hard (Sibilla) and very rigid (Sforzesco) braces. Classical statistics and propensity scores have been applied. We excluded 207 (10.7%) drop-outs and 274 (14.1%) still in therapy. Treatment intensity increased with Cobb degrees, as well as rate of improvement (from 13.6% to 56.1% – P < 0.05). Rate of progression was higher in the less intensively treated very low degree curves (11–20°) ( P < 0.05), while did not change significantly in those above 20° (between 12.9 and 15.9%). Rate of patients < 30° were 69.3% at start and 78.3% at the end ( P < 0.05); patients > 50° at the end were 1.6%. Defining different outcomes according to PCA allows to perform less aggressive treatments for LD, and concentrating the efforts in HD. Failure rates can be low in both groups. Progression is not the best outcome for all patients and type of treatments.