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The surgical management of scoliosis: a scoping review of the literature.

Evaniew N, Devji T, Drew B, Peterson D, Ghert M, Bhandari M - Scoliosis (2015)

Bottom Line: Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported.Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection.Engaging global partners may increase generalizability.

View Article: PubMed Central - PubMed

Affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada.

ABSTRACT

Background: Scoping reviews are innovative studies that can map a range of evidence to convey the breadth and depth of a large field. An evidence-based approach to the wide spectrum of surgical interventions for scoliosis is paramount to enhance clinical outcomes. The objectives of this scoping review were to identify critical knowledge gaps and direct future research.

Methods: This study was completed according to the methodology of Arksey and O'Malley. Two reviewers performed duplicate systematic screening of eligibility. Studies were classified according to patient age, scoliosis etiology, outcomes reported, study design, and overall research theme.

Results: There were 1763 eligible studies published between 1966 and 2013. The literature focused on adolescents (83% of studies) with idiopathic scoliosis (72%). There was a dominance of observational designs (88%), and a paucity of randomized trials (4%) or systematic reviews (1%). Fifty six percent of studies were conducted in North America, followed by 23% in Europe and 18% in Asia. Few high-level studies investigated surgical indications, surgical approaches, surgical techniques, or implant selection. Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported.

Conclusions: Current research priorities are to (1) undertake high-quality knowledge synthesis and knowledge translation activities; (2) conduct a series of planning meetings to engage clinicians, patients, and methodologists; and (3) clarify outcome reporting and strategies for methodological improvement. Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection. Engaging global partners may increase generalizability.

No MeSH data available.


Related in: MedlinePlus

Distribution of clinical research reporting on the surgical management of scoliosis by level of evidence.
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Fig7: Distribution of clinical research reporting on the surgical management of scoliosis by level of evidence.

Mentions: There were 65 prospective randomized controlled trials (4% of the included studies), 115 (7%) prospective non-randomized controlled studies, 571 (32%) retrospective controlled studies, and 983 (56%) uncontrolled studies (case series). Despite a dramatic increase in the total number of studies over time, the proportion of studies that were randomized controlled trials remained low, and has actually relatively decreased following a peak in 2004 (Figure 3b). There were 15 systematic reviews (<1%) and 14 systematic reviews and meta-analyses (<1%). Only three studies were classified as level I (<1%) and only 116 were graded as level II (7%), while 585 were classified as level III (33%) and 1059 were classified as level IV (60%) (Figure 7). Agreement between the two reviewers for levels of evidence was satisfactory (ICC = 0.771).Figure 7


The surgical management of scoliosis: a scoping review of the literature.

Evaniew N, Devji T, Drew B, Peterson D, Ghert M, Bhandari M - Scoliosis (2015)

Distribution of clinical research reporting on the surgical management of scoliosis by level of evidence.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307902&req=5

Fig7: Distribution of clinical research reporting on the surgical management of scoliosis by level of evidence.
Mentions: There were 65 prospective randomized controlled trials (4% of the included studies), 115 (7%) prospective non-randomized controlled studies, 571 (32%) retrospective controlled studies, and 983 (56%) uncontrolled studies (case series). Despite a dramatic increase in the total number of studies over time, the proportion of studies that were randomized controlled trials remained low, and has actually relatively decreased following a peak in 2004 (Figure 3b). There were 15 systematic reviews (<1%) and 14 systematic reviews and meta-analyses (<1%). Only three studies were classified as level I (<1%) and only 116 were graded as level II (7%), while 585 were classified as level III (33%) and 1059 were classified as level IV (60%) (Figure 7). Agreement between the two reviewers for levels of evidence was satisfactory (ICC = 0.771).Figure 7

Bottom Line: Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported.Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection.Engaging global partners may increase generalizability.

View Article: PubMed Central - PubMed

Affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada.

ABSTRACT

Background: Scoping reviews are innovative studies that can map a range of evidence to convey the breadth and depth of a large field. An evidence-based approach to the wide spectrum of surgical interventions for scoliosis is paramount to enhance clinical outcomes. The objectives of this scoping review were to identify critical knowledge gaps and direct future research.

Methods: This study was completed according to the methodology of Arksey and O'Malley. Two reviewers performed duplicate systematic screening of eligibility. Studies were classified according to patient age, scoliosis etiology, outcomes reported, study design, and overall research theme.

Results: There were 1763 eligible studies published between 1966 and 2013. The literature focused on adolescents (83% of studies) with idiopathic scoliosis (72%). There was a dominance of observational designs (88%), and a paucity of randomized trials (4%) or systematic reviews (1%). Fifty six percent of studies were conducted in North America, followed by 23% in Europe and 18% in Asia. Few high-level studies investigated surgical indications, surgical approaches, surgical techniques, or implant selection. Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported.

Conclusions: Current research priorities are to (1) undertake high-quality knowledge synthesis and knowledge translation activities; (2) conduct a series of planning meetings to engage clinicians, patients, and methodologists; and (3) clarify outcome reporting and strategies for methodological improvement. Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection. Engaging global partners may increase generalizability.

No MeSH data available.


Related in: MedlinePlus