Search

The article presents a summary of the research into the natural history and treatment of adolescent idiopathic scoliosis. Evidence-based practice has been defined by Straus and Sackett's as the best research evidence when combined with clinical experience. The diagnosis is made when other causes of scoliosis have been ruled out. Two to three percent of children younger than sixteen years of age will have a certain curvature.

Background: Randomized controlled trials are powerful tools to evaluate the outcomes of clinical treatments. However, these trials tend to be expensive and time-consuming, and their conclusions can be threatened by several limitations. This study estimated the strength of three common limitations (underenroilment, selective enrollment, and nonadherence to protocol) in a proposed study of adolescent idiopathic scoliosis. Methods: Patients with scoliosis and their parents were asked to complete a web-based survey about their preferences concerning a hypothetical randomized trial. Adolescents without scoliosis and their parents also participated. Surveys included questions about treatment preference, likelihood of participation, required risk reduction, and propensity to drop out or choose a different treatment while enrolled in the study. Results: Ninety adolescents and eighty-three parents participated. Observation was preferred to bracing by the majority of subjects. Overall, 33% of the parents and adolescents would both agree to participate in the hypothetical trial. Of the subjects who would not agree to participate, the majority would rather share the decision-making responsibility with the physician than have the treatment chosen in a random fashion. Many of the subjects would consider changing treatments during the course of the trial if they were not satisfied with the outcomes; the majority of parents who preferred bracing would consider crossing over to the bracing arm if their children were randomized to observation. Conclusions: Recruitment into a randomized trial of bracing compared with observation for the treatment of adolescent idiopathic scoliosis may well be problematic, considering the relatively small percentage of families who said they would consider randomization. Additionally, the threat of nonadherence to protocol may be strong and must be addressed in the protocol of the trial. Most families wanted to make the treatment decision with the physician in lieu of randomization; therefore, the role of the physician in patient recruitment and retention should not be underestimated. [ABSTRACT FROM AUTHOR]

The article presents an overview of adolescent idiopathic scoliosis (AIS), which is a structural, lateral, rotated curvature of the spine that develops in otherwise healthy children at or around puberty. A discussion of the Adams' forward bend test which is used to diagnose the disorder is presented. The etiopathogenesis, natural history and non-operative treatments for AIS are discussed. Surgical treatment for the disorder and possible causes of it, including an abnormality in melatonin metabolism are examined. INSET: Search strategy and selection criteria.

A response from the authors of the article "Effects of Bracing in Adolescents With Idiopathic Scoliosis," published in the October 17, 2013 issue is presented.

Study Design: The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) included skeletally immature high-risk patients with adolescent idiopathic scoliosis (AIS) with moderate curve sizes (20°- 40°). BrAIST was a multicenter, controlled trial using both randomized and preference treatment arms into either an observation group or a brace treatment group.Objective: The aim of this study was to analyze and compare body image and quality-of-life (QOL) in female AIS patients who were observed or treated with a brace.Summary Of Background Data: Brace treatment is an effective means for controlling progressive scoliosis and preventing the need for surgery, but there is no consensus regarding the effect of brace treatment on body image or on QOL in adolescents with AIS.Methods: Data from female BrAIST patients in the randomized (n = 132) or preference (n = 187) arms and were observed (n = 120) or brace treated (n = 199) were analyzed. Patients completed the Spinal Appearance Questionnaire (SAQ) and the Pediatric Quality of Life Inventory (PedsQOL) 4.0 Generic Scales at baseline and 6 month follow-up visits up to 2 years. Items on the SAQ measured three body image constructs (self, ideal, and overall). The PedsQOL measured health, activities, feelings, social factors, and school.Results: . In general, there were no significant differences within or between study arms or treatments regarding body image or QOL through 2 years of follow-up. Poorer body image was significantly correlated with poorer QOL during the first 2 years of follow-up regardless of study arm or treatment. Patients who crossed-over to a different treatment and patients with largest Cobb angles ≥ 40 degrees had significantly poorer body image, in particular self-body image, compared with those that did not.Conclusion: This study does not support findings from previous research indicating that wearing a brace has a negative impact on or is negatively impacted by body image or QOL.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]