Society On Scoliosis Orthopaedic And Rehabilitation Treatment Research Articles

Role of conservative management in the reduction of Cobb angle among adolescent idiopathic scoliosis. A systematic review

IntroductionPhysiotherapy Scoliosis Specific Exercises (PSSE) is a conservative approach for the management of adolescent idiopathic scoliosis (AIS) designed according to the guidelines of the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Hence the aim of the study is to evaluate the effectiveness of PSSE and conservative management strategies for patients with AIS.MethodsA systematic review was conducted and searches were carried out on a virtual database. The primary outcome measure analysed in this paper was Cobb angle and angle of trunk rotation, while the secondary outcome included functional capacity. A total of twelve studies were included in the review, which was analysed to determine the effects of conservative management of spinal scoliosis among adolescent aged children.ResultsThe study was conducted on patients who had developed idiopathic scoliosis and had a Cobb angle of greater than 10°. The significance of the conservative management protocol was estimated based on the reduction of Cobb angle by > 5° post-intervention.ConclusionsThis review concluded that therapeutic exercises alone have added to the noninvasive standard of care in reducing magnitude of Cobb angle among AIS patients. The studies reviewed in this paper provide significant evidence that a minimum of sixteen weeks of the exercise-based protocol has been able to produce a statistically and clinically significant result in Cobb angle reduction by almost 5° to 8°.

EFFECTS OF SCHROTH PHYSIOTHERAPY METHOD ON ACTIVE RANGE OF MOTION OF THE SPINE

Abstract. One of the most common spinal deformities of the adolescent is idiopathic scoliosis. Even though the literature proposes a large number of nonsurgical treatments, existing studies for conservative treatment provide insufficient data to validate it. Physiotherapeutic scoliosis-specific exercises reflect the concept of conservative intervention recognised by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) as effective in this medical condition. Among these exercises, the Schroth method suggests promising outcomes related to the effectiveness of stopping the disease progression and correcting the spinal deformity. An important criterion used is the active range of motion of the spine. Objective methods are required to assess this parameter, given that palpation and mobilisation are too subjective to produce accurate data or to be reproduced. Thus, many authors choose the fingertip-to-floor test to assess the active mobility of the spine. In the present paper, 15 case studies were monitored, and the conservative treatment programme consisted of individualised Schroth-based exercises for the specific functional diagnostic of this method. The programme was performed 3 times per week in the clinic and 3 times per week at the patient’s home. The assessment involved performing the fingertip-to-floor test in the sagittal and frontal planes at the beginning of the therapy and 6 months later. The research results show that Schroth therapy can improve the active range of motion of the spine.

Effects of Schroth method physiotherapy on active range of motion of the spine

One of the most common spinal deformities of the adolescent is idiopathic scoliosis. Even though the literature proposes a large number of nonsurgical treatments, existing studies for conservative treatment provide insufficient data to validate it. Physiotherapeutic scoliosis-specific exercises reflect the concept of conservative intervention recognised by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) as effective in this medical condition. Among these exercises, the Schroth method suggests promising outcomes related to the effectiveness of stopping the disease progression and correcting the spinal deformity. An important criterion used is the active range of motion of the spine. Objective methods are required to assess this parameter, given that palpation and mobilisation are too subjective to produce accurate data or to be reproduced. Thus, many authors choose the fingertip-to-floor test to assess the active mobility of the spine. In the present paper, 15 case studies were monitored, and the conservative treatment programme consisted of individualised Schroth-based exercises for the specific functional diagnostic of this method. The programme was performed 3 times per week in the clinic and 3 times per week at the patient’s home. The assessment involved performing the fingertip-to-floor test in the sagittal and frontal planes at the beginning of the therapy and 6 months later. The research results show that Schroth therapy can improve the active range of motion of the spine.

Trial Protocol: The use of mindfulness-based intervention for improving bracing compliance for adolescent idiopathic scoliosis patients: protocol for a randomised, controlled trial

Adolescent idiopathic scoliosis (AIS) is the most prevalent deforming orthopaedic condition; it causes significant disability when spinal curves progress beyond 45deg. Bracing is the primary treatment prescribed for adolescents with an immature skeleton who have spinal curves between 25 and 45deg. New evidence suggests that compliance with bracing significantly decreases the progression of high-risk curves to the threshold for surgery. Nonetheless, bracing is a stressful experience. Therefore, interventions that mediate health-related quality of life for AIS patients are of great interest. In the past few decades, numerous studies have documented the benefits of mindfulness training on chronic pain, stress management, anxiety and emotional disorders. Mindfulness might additionally provide AIS patients with psychosocial support. This study will investigate the effects of a mindfulness-based intervention on bracing compliance and quality of life among AIS patients with poor bracing compliance. The study also plans to evaluate if the mindfulness-based intervention effect is sustained after the intervention period. The potential mechanism by which mindfulness affects bracing compliance will be explored. Single-blind, two-arm, randomised, controlled trial. The study will recruit 120 AIS patients aged between 10 and 15 years with non-satisfactory bracing compliance. Patients who have previously practised or are currently practising meditation or mindful yoga or who cannot finish the whole intervention will be excluded. The study will take place at the Jockey Club School of Public Health and Primary Care building. Patients in the mindfulness-based intervention group will join weekly sessions for 8 weeks. This program is a short version of a mindfulness-based stress relaxation program to address the specific issues of AIS patients. Two to three experienced instructors will deliver the program. Control group patients will participate in an 8-week physiotherapy exercise program as recommended in the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2011 guideline. The primary outcome is the 6-month post-intervention total score of bracing compliance. Secondary measures are non-bracing-specific quality of life, bracing-specific quality of life, self-compassion, emotional regulation, mindful awareness and acceptance, self-efficacy, perception of stress, and general measure of health outcome. 120 participants will be assigned to either an intervention or control arm by simple randomisation, and the randomisation result will only be revealed once participants have confirmed availability to attend intervention classes. Clinicians of the scoliosis clinic and research staff will be blinded to the treatment allocation. ANCOVA will be conducted to compare the effect of mindfulness-based intervention versus physiotherapy exercise on the outcome measures. To investigate significant change over time, linear mixed models analyses will be conducted following the intention-to-treat principle. The R-package lavaan will be used to conduct structural equation modelling to study the potential mechanism of mindfulness. This will be the first psychosocial intervention study conducted on braced AIS patients with the aim of improving patients' bracing compliance and quality of life. The results from this study will potentially carry significant impact on future AIS treatment by emphasising psychosocial care for braced AIS patients.

Current knowledge of scoliosis in physiotherapy students trained in the United Kingdom

BackgroundIt has been highlighted in both Poland and the United States of America (USA) that knowledge of idiopathic scoliosis (IS) among physiotherapy students is limited with respect to the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines. Early detection of scoliosis and correct initial management is essential in effective care, and thus physiotherapists should be aware of the basic criteria for diagnosis and indications for treatment. The aim of this study was to evaluate the basic knowledge of IS in physiotherapy students trained in the United Kingdom (UK).MethodsA previously designed and tested 10-question survey, including knowledge of the 2011 SOSORT guidelines, was transcribed onto an online-survey platform. Questions were designed to analyse knowledge of definition, cause, development, prevalence, diagnosis, treatment and bracing of scoliosis.All UK universities offering physiotherapy degrees were invited to participate, with the programme lead of each institution asked to distribute the questionnaire to all penultimate and final year physiotherapy students (bachelor’s and master’s degrees). The final number of students who received the study invitation is unknown. The survey link closed after 8 weeks of data collection.Results Two hundred and six students, split over 12 institutions, successfully completed the questionnaire.Analysis showed that 79% of students recognised when IS is likely to develop, yet only 52% recognised that IS’s aetiology is unknown. Eighty-eight percent of students incorrectly defined IS as a 2-dimensional deformity, with only 24% successfully recognising the prevalence of IS within the scoliosis population. Just 12% knew the criteria for diagnosis; however, 93% were unable to recognise the appropriate treatment approach through therapeutic exercise. Finally, 54% of students managed to identify correctly when bracing is recommended for IS.In comparison to previous studies within the USA, students in the UK performed worse in relation to all questions except treatment (7% answered correctly vs 3% in the American study).ConclusionWith only 7% of students able to answer > 50% of the survey questions correctly, there is a clear lack of knowledge of appropriate IS diagnosis and care which could directly impact the information these patients are given within the first contact primary care in the UK.

Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools.

In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. Parents of children with scoliosis have complained about the so-called “wait and see” approach that far too many doctors use when evaluating children’s scoliosis curves between 10° and 25°. Observation, Physiotherapy Scoliosis Specific Exercises (PSSE) and bracing for idiopathic scoliosis during growth are all therapeutic interventions accepted by the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). The standard features of these interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture. PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery. The model is oriented to the patient. Diagnosis and patient evaluation is essential in this model looking at a patient-oriented decision according to clinical experience, scientific evidence and patient’s preference. Thus, specific exercises are not considered as an alternative to bracing or surgery but as a therapeutic intervention, which can be used alone or in combination with bracing or surgery according to individual indication. In the PSSE model it is recommended that the physical therapist work as part of a multidisciplinary team including the orthopeadic doctor, the orthotist, and the mental health care provider - all are according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy. From clinical experiences, PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, more than a year after passing the peak of growth. In non-progressive scoliosis, the regular practice of PSSE could produce a temporary and significant reduction of the Cobb angle. PSSE can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, like improving back asymmetry, based on 3D self-correction and stabilization of a stable 3D corrected posture, as well as the secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, it can also improve breathing function.This paper will discuss in detail seven major scoliosis schools and their approaches to PSSE, including their bracing techniques and scientific evidence. The aim of this paper is to understand and learn about the different international treatment methods so that physical therapists can incorporate the best from each into their own practices, and in that way attempt to improve the conservative management of patients with idiopathic scoliosis. These schools are presented in the historical order in which they were developed. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland.

Scoliosis and Spinal Disorders journal: a new, cutting-edge frontier in spine publishing.

Scoliosis and Spinal Disorders journal: a new, cutting-edge frontier in spine publishing.

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth.

BackgroundThe International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).MethodsAll types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.ResultsThe contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.ConclusionThese Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements

Background context It is a broad consensus today that scoliosis curves cannot be improved through bracing, and the Scoliosis Research Society (SRS) methodological criteria for bracing have the avoidance of progression as their only objective. Consequently, in curves more than 45°, fusion is considered as basically the only possible treatment. Purpose The purpose of the study was to verify in a series of patients who utterly refused surgery if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment (bracing and exercises). Study design/setting Retrospective cohort from a prospective database. Patient sample Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°–58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment. Outcome measures Self-report measurement: SRS-22; physiological measures: Cobb degrees, Bunnell angle of trunk rotation (ATR), aesthetic index (AI), and sagittal plumb line distances. Methods The methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed. Results Reported compliance in the 4.10±1.2 treatment years was 94%, with satisfaction regarding treatment and excellent results at the SRS-22. Two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements have been found in 71% of patients and a 5° Cobb progression in one patient. Statistically, we found highly significant reductions of the main (−9.25°), average (−6.6°), thoracic (−7.8°), and lumbar (−15.9°) curves. Statistically significant improvements have been found for the AI and ATR, with a general decrease in plumb line distances. Conclusions Bracing can be successfully used in patients who do not want to undergo operations for IS with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance. Future studies could demonstrate the percentages at which this result can be achieved.

Cochrane Review: Braces for idiopathic scoliosis in adolescents

AbstractBackgroundAdolescent Idiopathic Scoliosis (AIS) is a three‐dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Braces are traditionally recommended to stop curvature progression in some countries and criticized in others. They generally need to be worn full time, with treatment extending over years.ObjectivesTo evaluate the efficacy of bracing in adolescent patients with AIS.Search strategyThe following databases (up to July 2008) were searched with no language limitations: the Cochrane Central Register of Controlled Trials, MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982) and reference lists of articles. An extensive handsearch of the grey literature was also conducted.Selection criteriaRandomised controlled trials and prospective cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces.Data collection and analysisTwo review authors independently assessed trial quality and extracted data.Main resultsWe included two studies. There was very low quality evidence from one prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth (success rate 74% (95% CI: 52% to 84%)), better than observation (success rate 34% (95% CI:16% to 49%)) and electrical stimulation (success rate 33% (95% CI:12% to 60%)). There is low quality evidence from one RCT with 43 girls that a rigid brace is more successful than an elastic one (SpineCor) at curbing curve progression when measured in Cobb degrees, but there were no significant differences between the two groups in the subjective perception of daily difficulties associated with wearing the brace.Authors' conclusionsThere is very low quality evidence in favour of using braces, making generalization very difficult. Further research could change the actual results and our confidence in them; in the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short and long‐term patient‐centred outcomes, in addition to measures such as Cobb angles. RCTs and prospective cohort studies should follow both the Scoliosis Resarch Society (SRS) and Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) criteria for bracing studies.Plain Language SummaryBraces for idiopathic scoliosis in adolescentsScoliosis is a condition where the spine is curved in three dimensions (from the back the spine appears to be shaped like an “s”). It is often idiopathic, or having an unknown cause. The most common type of scoliosis is discovered at 10 years of age or older, and is defined as a curve that measures at least 10° (called a Cobb angle; measured on x‐ray). Because of the unknown cause and age of diagnosis, it is called Adolescent idiopathic scoliosis (AIS).While there are usually no symptoms, the appearance of AIS frequently has a negative impact on adolescents. Increased curvature of the spine can present health risks in adulthood and in the elderly. Braces are one intervention that may stop further progression of the curve. They generally need to be worn full time, with treatment lasting for two to four years. However, bracing for this condition is still controversial, and questions remain about how effective it is.This review included two studies; one multicenter international cohort study (a study where treatment groups were defined according to the centre where patients were treated) of 286 girls and a randomised controlled study (an experimental study that randomised the participants to treatment groups) of 43 girls. There is very low quality evidence that braces are more effective than observation (wait‐and‐see) or electrical stimulation in curbing the increases in the curves of the spine. There is low quality evidence that rigid braces are more effective than a soft, elastic one. Adverse effects of braces were not discussed.Limitations of this review include the sparse data and studies available, and the fact that available studies only included girls (even if there is only one male with scoliosis for every seven females), making it very difficult to generalize the results to males. Due to the very low quality of the evidence in favour of bracing, patients and their parents should regard these results with caution and discuss their treatment options with a multi‐professional team.Further research is very likely to change the results and our confidence in them.

Evaluation of scoliosis today: Examination, X-rays and beyond

Purpose. The purpose of this paper is to provide an overview of the techniques of evaluation of patients, suffering from idiopathic scoliosis.Methods. The presentation is provided, concerning the medical history, clinical examination, conventional radiography, stereo-radiography, surface topography, ultrasounds, computer tomography, and magnetic resonance imaging, focusing on the points specific for the pathology of idiopathic scoliosis.Results. Use of the scoliometer became systematic in the clinical evaluation. Quality of life questionnaires, including those endorsed by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), oriented towards scoliotic patients, gain on popularity and are extremely helpful to objectively evaluate the disability related to scoliosis. Classical radiography serves as the basic exam to determine the curve type and magnitude. Ultrasounds, computer tomography and magnetic resonance imaging are indicated in precisely defined clinical situations. Stereo-radiography and surface topography seem to be the most promising techniques, however requiring standardisation.Conclusions. Apart from sophisticated measurements, the experience of a physician cannot be underestimated. High standard clinical evaluation will probably continue to serve as a reference for other methods of assessment of patients with scoliosis. Stereo-radiography and surface topography deserve common use, after standardization is achieved.

Bracing adolescent idiopathic scoliosis today

Purpose. The purpose of this report is to give an overview of the existing literature on bracing for scoliosis, and to introduce a special issue of the journal on this topic. We look critically at this treatment, considering not only the possible efficacy but also other key points such as compliance, acceptability and the patient's quality of life, as well as the variability of existing braces.Method. Review of the literature.Results. Bracing is questioned in terms of efficacy, but in most cases no alternative exists other than to wait for eventual surgery, or perhaps to do nothing and facing the likelihood of problems with increasing age. Compliance is a critical point, but it isn't a reason to quit. On the contrary, it should be a stimulus for professionals to find the better ways to help their patients in this respect. When faced with the possible alternatives, patients do prefer bracing to the so-called ‘wait and see’ strategy, but we must continue to work to reduce the impairment to quality of life due to the orthosis. The actual variability of braces should be faced, and the BRACE MAP classification is proposed as a unifying tool for the future.Conclusions. Bracing is not the best possible treatment, but in the case of scoliosis the alternatives are even more challenging. Thanks to the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) serious research is ongoing, and in the next few years we will have more data, not only on efficacy but also on compliance, acceptability and quality of life, biomechanics, evaluation tools, informatics in bracing, etc. Hopefully this will lead to better results and choices for our patients.

What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology

Purpose. Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment, as it is clearly stated in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). It is also through these SSS programs that almost all of our current knowledge on the natural history and curve progression of IS has been made known. The present study summarizes the contribution of SSS in research of IS aetiology.Method. We reviewed all the reports in relation to research of IS aetiology, which were published in peer-review journals and were originated from the Thriasio SSS program.Results. Analysis comprises of reports for (i) IS prevalence, (ii) aetiological studies originated from school screening referrals which implicate numerous environmental and biological factors in IS pathogenesis, (iii) suggestions for a more efficient screening, (iv) IS natural history, and (v) the evolving aim of SSS based on the reported research.Conclusions. SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology.

Physical exercises in the treatment of idiopathic scoliosis at risk of brace treatment -- SOSORT consensus paper 2005.

BackgroundBased on a recognized need for research to examine the premise that nonsurgical approaches can be used effectively to treat signs and symptoms of scoliosis, a scientific society on scoliosis orthopaedic and rehabilitation treatment (SOSORT) was established in Barcelona in 2004. SOSORT has a primary goal of implementing multidisciplinary research to develop quantitative, objective data to address the role of conservative therapies in the treatment of scoliosis. This international working group of clinicians and scientists specializing in treatment of scoliosis met in Milan, Italy in January 2005.MethodsAs a baseline for developing a consensus for language and goals for proposed multicenter clinical studies, we developed questionnaires to examine current beliefs, before and after the meeting, regarding (1) the aims of physical exercises; (2) standards of treatment; and (3) the impact of such treatment performed by specialists in the field.ResultsThe responses to the questionnaires show that, in principle, specialists in scoliosis physiotherapy do not disagree and that several features can be regarded, currently, as standard features in the rehabilitation of scoliosis patients. These features include autocorrection in 3D, training in ADL, stabilizing the corrected posture, and patient education.