Limits...
Guidelines on "Standards of management of idiopathic scoliosis with corrective braces in everyday clinics and in clinical research": SOSORT Consensus 2008.

Negrini S, Grivas TB, Kotwicki T, Rigo M, Zaina F, international Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSOR - Scoliosis (2009)

Bottom Line: The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT.The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care.If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.

View Article: PubMed Central - HTML - PubMed

Affiliation: ISICO, Milan, Italy. stefano.negrini@isico.it

ABSTRACT

Background: Reported failure rates,(defined based on percentage of cases progressing to surgery) of corrective bracing for idiopathic scoliosis are highly variable. This may be due to the quality of the brace itself, but also of the patient care during treatment. The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT. The aim of this paper was to develop and verify the Consensus on management of scoliosis patients treated with braces

Methods: We followed a Delphi process in four steps, distributing and gradually changing according to the results a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Athens Meeting with a Meeting Questionnaire (MQ). We set a 90% agreement as the minimum to be reached.

Results: We had a 71% response rate to PMQ, and 66.7% to MQ. Since the PMQ we had a good agreement (no answers below 72% - 70.2% over 90%). With the MQ the agreement consistently increased for all the answers previously below 90% (no answers below 83%, 75% over 90%). With increasing experience in bracing all numerical criteria tended to become more strict. We finally produced a set of 14 recommendations, grouped in 6 Domains (Experience/competence, Behaviours, Prescription, Construction, Brace Check, Follow-up).

Conclusion: The Consensus permits establishment of recommendations concerning the standards of management of idiopathic scoliosis with bracing, with the aim to increase efficacy and compliance to treatment. The SOSORT recommends to professionals engaged in patient care to follow the guidelines of this Consensus in their clinical practice. The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care. If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.

No MeSH data available.


Related in: MedlinePlus

Rates of surgery in scoliosis over 30°. Rates of surgery, with and without bracing (without exercises), in scoliosis over 30° reported in a metanalysis by Dolan and Weinstein [7], compared with results of bracing plus exercises in scoliosis over 30° published by SOSORT members [8-12] in terms of Efficacy Analysis (EA) and Worst Case analysis (WCA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2651850&req=5

Figure 1: Rates of surgery in scoliosis over 30°. Rates of surgery, with and without bracing (without exercises), in scoliosis over 30° reported in a metanalysis by Dolan and Weinstein [7], compared with results of bracing plus exercises in scoliosis over 30° published by SOSORT members [8-12] in terms of Efficacy Analysis (EA) and Worst Case analysis (WCA).

Mentions: Bracing today can be considered a worthwhile treatment for adolescent idiopathic scoliosis (AIS): the strength of evidence [1] of this recommendation is grade B [2,3]. The existing Guidelines support their use [4,5]. Nevertheless, doubts have been raised from a series of authors [6,7]. Recently, a metanalysis of the English literature on bracing has been published [7]. Outcomes for bracing, or observation only, were compared. The authors concluded that "Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS." Nevertheless, the authors elected to exclude from the study the groups with bracing plus exercises. Under the conditions of their analysis, therefore, according to the Material and Methods of the paper, their conclusion should have been as follows: "Based on the evidence presented here, according to the English literature and excluding the combined approach of bracing and exercises, one cannot recommend one approach over the other to prevent the need for surgery in AIS.". In fact, according to the same criteria used in the previously mentioned metanalysis [7], the papers published by some members of the international Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) [8-12], that are in the English literature but include also exercises, have yielded results that are in conflict with those of the reported systematic review [7] (Figure 1).


Guidelines on "Standards of management of idiopathic scoliosis with corrective braces in everyday clinics and in clinical research": SOSORT Consensus 2008.

Negrini S, Grivas TB, Kotwicki T, Rigo M, Zaina F, international Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSOR - Scoliosis (2009)

Rates of surgery in scoliosis over 30°. Rates of surgery, with and without bracing (without exercises), in scoliosis over 30° reported in a metanalysis by Dolan and Weinstein [7], compared with results of bracing plus exercises in scoliosis over 30° published by SOSORT members [8-12] in terms of Efficacy Analysis (EA) and Worst Case analysis (WCA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651850&req=5

Figure 1: Rates of surgery in scoliosis over 30°. Rates of surgery, with and without bracing (without exercises), in scoliosis over 30° reported in a metanalysis by Dolan and Weinstein [7], compared with results of bracing plus exercises in scoliosis over 30° published by SOSORT members [8-12] in terms of Efficacy Analysis (EA) and Worst Case analysis (WCA).
Mentions: Bracing today can be considered a worthwhile treatment for adolescent idiopathic scoliosis (AIS): the strength of evidence [1] of this recommendation is grade B [2,3]. The existing Guidelines support their use [4,5]. Nevertheless, doubts have been raised from a series of authors [6,7]. Recently, a metanalysis of the English literature on bracing has been published [7]. Outcomes for bracing, or observation only, were compared. The authors concluded that "Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS." Nevertheless, the authors elected to exclude from the study the groups with bracing plus exercises. Under the conditions of their analysis, therefore, according to the Material and Methods of the paper, their conclusion should have been as follows: "Based on the evidence presented here, according to the English literature and excluding the combined approach of bracing and exercises, one cannot recommend one approach over the other to prevent the need for surgery in AIS.". In fact, according to the same criteria used in the previously mentioned metanalysis [7], the papers published by some members of the international Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) [8-12], that are in the English literature but include also exercises, have yielded results that are in conflict with those of the reported systematic review [7] (Figure 1).

Bottom Line: The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT.The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care.If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.

View Article: PubMed Central - HTML - PubMed

Affiliation: ISICO, Milan, Italy. stefano.negrini@isico.it

ABSTRACT

Background: Reported failure rates,(defined based on percentage of cases progressing to surgery) of corrective bracing for idiopathic scoliosis are highly variable. This may be due to the quality of the brace itself, but also of the patient care during treatment. The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT. The aim of this paper was to develop and verify the Consensus on management of scoliosis patients treated with braces

Methods: We followed a Delphi process in four steps, distributing and gradually changing according to the results a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Athens Meeting with a Meeting Questionnaire (MQ). We set a 90% agreement as the minimum to be reached.

Results: We had a 71% response rate to PMQ, and 66.7% to MQ. Since the PMQ we had a good agreement (no answers below 72% - 70.2% over 90%). With the MQ the agreement consistently increased for all the answers previously below 90% (no answers below 83%, 75% over 90%). With increasing experience in bracing all numerical criteria tended to become more strict. We finally produced a set of 14 recommendations, grouped in 6 Domains (Experience/competence, Behaviours, Prescription, Construction, Brace Check, Follow-up).

Conclusion: The Consensus permits establishment of recommendations concerning the standards of management of idiopathic scoliosis with bracing, with the aim to increase efficacy and compliance to treatment. The SOSORT recommends to professionals engaged in patient care to follow the guidelines of this Consensus in their clinical practice. The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care. If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.

No MeSH data available.


Related in: MedlinePlus