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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. [ABSTRACT FROM AUTHOR]

The clinical evaluation, even today, remains a central point in the diagnosis, prognostic definition and treatment prescription regarding scoliosis. The clinical evaluation of a scoliotic patient has been established for a long time, but it has not been standardized. The aim of the present work is to report the most common clinical measures for the assessment of scoliosis, explain the usefulness of each clinical measurement, and report the repeatability and limits in order to help the physician in making appropriate clinical choices. Methods. The height of the hump, the angle of trunk rotation, the sagittal and frontal profiles, and the Trunk Aesthetic Clinical Evaluation (TRACE) have been fully described, and their reliability and repeatability have been assessed. Results. The measures analyzed showed good reliability and repeatability on the intra-operator basis. The inter-operator repeatability is usually not that good. Conclusion. The main measures of the clinical assessment of scoliotic patients have been tested, and their reliability has been evaluated. The knowledge of measurement error, as well as intra- and inter-operator reliability, are essential for the clinical evaluation and treatment of scoliosis. This is an unavoidable basis for decision making in the assessment and the treatment of scoliosis. [ABSTRACT FROM AUTHOR]

The third-dimension of scoliosis represent a great challenge for clinicians used to think in two dimensions due to the classical radiographic representation of the deformity. This caused problems in everyday clinical approaches, and led to the development of new bidimensional classifications (King, Lenke) who tried in different ways to face these problems, mainly in a surgical perspective. Recently, some three-dimensional classifications have been proposed, all developed in laboratory by bioengineers. In this paper we present the existing classifications of scoliosis, both bi-dimensional and three-dimensional and we thoroughly discuss the 3-DEMO (3-D Easy Morphological) that has been first presented years ago, and recently thoroughly published; this classification has been developed by clinicians with the main aim of being understandable and easily applicable to everyday clinical life. [ABSTRACT FROM AUTHOR]

The biomechanical action of an orthesis for the conservative treatment of AIS has two goals: correction and stabilization. These goals have been pursued through very well established principles of correction, developed over the years, divided in terms of efficacy (the correct positioning of pushes, as well as through escape ways and proper drivers of the forces and stops) and acceptability (compliance, perfect body design, maximal freedom in the ADL). To achieve all these goals, the Sforzesco brace has been developed through progressive changes and verification. Finally, we discovered we had something new, and summarised it in the SPoRT acronym: Symmetric, Patient-oriented, Rigid, Three-dimensional, active. The SPoRT concept always requires a customised construction of the brace according to the patient's individual requirements. It's possible to apply CAD-CAM technologies, which usually allow us to obtain the best results in this case, but without using pre-built forms stored in databases, as is usually done. Once done, a final test must be made on the patient so as to change the first theoretical project and adapt it in the best possible way, depending on the real interaction between the body and the brace. The results that are today available on the SPoRT concept relate to the Sforzesco brace and necessarily are short-term, because the first treated patients are now reaching the third-year follow-up examination and haven't yet completed their treatments. According to first studies we can state that: tte Sforzesco brace is more effective than the Lyon brace after six months of treatment; the Sforzesco brace is equally effective as Risser Plast brace. [ABSTRACT FROM AUTHOR]

Background. In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30° ranges from 22.4% to 31% when braces are used, versus the natural history rate of 28.1%. When a complete conservative approach is used (braces and exercises), this rate decreases to the range of 3.8% to 7.3%. All these studies are retrospective. Aim. The aim was to evaluate the final results of a prospective set of patients treated in a center fully dedicated to a complete conservative treatment (exercises and braces) of AIS. Materials and Methods. This is an everyday clinical, retrospective study on a prospective data base. The population included 112 AIS patients, 13.2±1.8 years old, with 23.4±11.5° Cobb degrees at the start of treatment. All the patients had been treated with a full set of conservative treatments, including exercises, according to their individual needs. We used the SEAS (Scientific Exercises Approach to Scoliosis) protocol and the ISICO approach, while the orthosis used included: Risser cast, and the Lyon, Sforzesco-SPoRT, Sibilla-Chêneau and Lapadula braces. The patients had been followed up by the same physician, braces had been made and exercises had been applied by the same team. The outcomes were established for each single patient: The absolute aim was to avoid surgery, while the minimal and optimal outcomes were defined according to the starting curve. An efficacy analysis and worst-case analysis had been performed. Results. The rate of surgery was 0.9% (efficacy analysis), and 4.5% (worst case); the minimal outcomes had been obtained in 99% of patients and the optimal ones in 84%. Overall, the curves over 40°, which numbered eleven at the start of observation, were reduced to three. In total, eight patients exited the presumable area of risk in adulthood (final curve over 30°). The treatment produced a statistically significant reduction in the worst curves, and the best results have been obtained in the curves over 40°. Conclusion. Provided the use of a complete conservative approach, there is very little doubt that it is possible to reduce the rate of surgery in AIS treatment. [ABSTRACT FROM AUTHOR]

Combining evidence-based medicine and shared decision making, current guidelines support an evidence-based personalised approach (EBPA) for idiopathic scoliosis in adolescents (AIS). EBPA is considered important for adolescents' compliance, which is particularly difficult in AIS. Benchmarking to existing Randomised Controlled Trials (RCTs) as paradigms of single treatments, we aimed to check the effectiveness and burden of care of an EBPA in high-risk AIS. This study's design features a retrospective observation of a prospective database including 25,361 spinal deformity patients < 18 years of age. Participants consisted of 1938 AIS, 11–45° Cobb, Risser stage 0–2, who were studied until the end of growth. EBPA included therapies classified for burdensomeness according to current guidelines. Using the same inclusion criteria of the RCTs on exercises, plastic, and elastic bracing, out of the 1938 included, we benchmarked 590, 687, and 884 participants, respectively. We checked clinically significant results and burden of care, calculating Relative Risk of success (RR) and Number Needed to Treat (NNT) for efficacy (EA) and intent-to-treat analyses. At the end of growth, 19% of EBPA participants progressed, while 33% improved. EBPA showed 2.0 (1.7–2.5) and 2.9 (1.7–4.9) RR of success versus Weinstein and Coillard's studies control groups, respectively. Benchmarked to plastic or elastic bracing, EBPA had 1.4 (1.2–1.5) and 1.7 (1.2–2.5) RR of success, respectively. The EBPA treatment burden was greater than RCTs in 48% of patients, and reduced for 24% and 42% versus plastic and elastic bracing, respectively. EBPA showed to be from 40% to 70% more effective than benchmarked individual treatments, with low NNT. The burden of treatment was frequently reduced, but it had to be increased even more frequently. [ABSTRACT FROM AUTHOR]

Purpose: Radiation-free systems based on dorsal surface topography can potentially represent an alternative to radiographic examination for early screening of scoliosis, based on the ability of recognizing the presence of deformity or classifying its severity. This study aims to assess the effectiveness of a deep learning model based on convolutional neural networks in directly predicting the Cobb angle from rasterstereographic images of the back surface in subjects with adolescent idiopathic scoliosis. Methods: Two datasets, comprising a total of 900 individuals, were utilized for model training (720 samples) and testing (180). Rasterstereographic scans were performed using the Formetric4D device. The true Cobb angle was obtained from radiographic examination. The best model configuration was identified by comparing different network architectures and hyperparameters through cross-validation in the training set. The performance of the developed model in predicting the Cobb angle was assessed on the test set. The accuracy in classifying scoliosis severity (non-scoliotic, mild, and moderate category) based on Cobb angle was evaluated as well. Results: The mean absolute error in predicting the Cobb angle was 6.1° ± 5.0°. Moderate correlation (r = 0.68) and a root-mean-square error of 8° between the predicted and true values was reported. The overall accuracy in classifying scoliosis severity was 59%. Conclusion: Despite some improvement over previous approaches that relied on spine shape reconstruction, the performance of the present fully automatic application is below that of radiographic evaluation performed by human operators. The study confirms that rasterstereography cannot be considered a valid non-invasive alternative to radiographic examination for clinical purposes. [ABSTRACT FROM AUTHOR]

Background: This report is the SOSORT Consensus Paper on Terminology for use in the treatment of conservative spinal deformities. Figures are provided and relevant literature is cited where appropriate. Methods: The Delphi method was used to reach a preliminary consensus before the meeting, where the terms that still needed further clarification were discussed. Results: A final agreement was found for all the terms, which now constitute the base of this glossary. New terms will be added after being discussed and accepted. Discussion: When only one set of terms is used for communication in a place or among a group of people, then everyone can clearly and efficiently communicate. This principle applies for any professional group. Until now, no common set of terms was available in the field of the conservative treatment of scoliosis and spinal deformities. This glossary gives a common base language to draw from to discuss data, findings and treatment. [ABSTRACT FROM AUTHOR]

The development of high-quality research is desired in all healthcare fields. Experimental and nonexperimental designs are used to investigate the effect or association of an intervention and clinical or surrogate outcome. The aims of these methods are to improve knowledge and to develop new strategies to manage a disease or condition. Randomized clinical trials are considered one of the standard methods to test the efficacy of a new drug or intervention; however, they are costly, have reduced generalizability, and cannot be feasible in all scenarios. Well-designed observational studies can provide valuable information regarding exposure factor and the event under investigation. In physical and rehabilitation medicine, where complex procedures and multiple risk factors can be involved in the same disease, the use of observational study must be planned in detail and a priori to avoid overestimations. In this article, we will give an overview of the methods used for observational design studies in physical and rehabilitation medicine using clinical examples to illustrate each method. We will describe when it is appropriate and how to use the observational studies in different scenarios explaining how to deal with potential bias and confounders using the adequate design and statistical plan for the situation. [ABSTRACT FROM AUTHOR]

Purpose: Understanding idiopathic scoliosis (IS) natural history during growth is essential for shared decision-making between patients and physicians. We developed a retrospective model with the largest available sample in the literature and we aimed to investigate if using three peri-pubertal growth periods provides better prediction than a unique model. Methods: Secondary analysis of a previous study on IS natural history data from radiographs before and at the first consult. Three groups: BEFORE (age 6–10), AT (age 11-Risser 2) and AFTER (from Risser 3) the pubertal growth spurt. Available predictors: Cobb angle, curve type, sex, observation time, and Risser score. We used linear mixed-effects models to predict future Cobb angles in each group. We internally validated prediction accuracy with over 100 patients per group (3 to 5-fold cross-validation). Results: We included 1563 participants (275 BEFORE, 316 AFTER, 782 females and 190 males AT). Curves increased over time mostly in AT, importantly in BEFORE, but also in AFTER. All models performed better than the general one. In BEFORE, 74.2% of the predictions were within ± 5o, 71.8% in AFTER, 68.2% in AT females, and 60.4% in males. The predictors (baseline curve, observation time also squared and cubic, and Risser score) were similar in all the models, with sex influencing only AFTER. Conclusion: IS curve severities increase differently during growth with puberty stages. Model accuracy increases when tailored by growth spurt periods. Our models may help patients and clinicians share decisions, identify the risk of progression and inform treatment planning. [ABSTRACT FROM AUTHOR]

Background: In respect to the prescribed regimen and the regular daily pattern, investigate how short-term results are affected by wear time adherence in terms of hours per day. Methods: This is a case-control study. The setting is outpatient clinic. There were 168 subjects, all of whom met the inclusion criteria: adolescent idiopathic scoliosis and Sforzesco brace prescription of 18 to 23 h/day. The minimum period of follow-up was 4 months, and the maximum was 6 months, which is the average time passing between the Thermobrace (TB) adoption and out-of-brace X-ray before treatment. The brace wear adherence rate, calculated from the ratio of brace wear time with the prescription, was considered in combination with the daily pattern compliance, classified as consistent (104 patients) or inconsistent according to the abnormal distribution of Thermobrace data. The short-term results were finally explored. Results: Consistent brace wear is associated with a higher probability of improvement in curve magnitude (OR 1.96 CI 95% 1.22–3.14 chi-square 7.78 p = 0.0053). Inconsistent brace wear is more likely to progress (OR 0.14 CI 95% 0.30–0.75 chi-square 10.13 p = 0.0015). Results from the logistic regression show that the most influencing factor for improvement is Cobb degrees at the start. Conclusions: In clinical everyday activity, patients must be encouraged to consistently follow their brace wear prescription, because this attitude is clearly associated with a higher probability of improvement. [ABSTRACT FROM AUTHOR]

Study Design: Comparative effectiveness study OBJECTIVE.: To evaluate factors leading to higher percentage of brace failures in a cohort of North American patients with adolescent idiopathic scoliosis relative to their peers in Italy.Summary Of Background Data: Studies of bracing in United States have shown worse outcomes than studies from European centers, possibly due to sample characteristics or treatment approaches.Methods: Sample: Braced patients, aged 10 to 15, Risser <3, Cobb 20°- to 40°, observed to Cobb ≥40° and/or ≥Risser 4 selected from prospective databases. Comparators: Bracing per Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) (TLSO) and Italian Scientific Spine Institute (ISICO) protocol (SPoRT braces with or without SEAS exercises). Baseline characteristics (sex, age, BMI, Risser, Cobb, curve type) and average hours of brace wear/day. Differences in programs (e.g., SEAS, type of brace, weaning protocol) were captured by a variable named "SITE."Outcome: Treatment failure (Cobb ≥40 before Risser 4).Statistics: Comparison of baseline characteristics, analyses of risk factors, treatment components, and outcomes within and between cohorts using logistic regression.Results: A total of 157 BrAIST and 81 ISICO subjects were included. Cohorts were similar at baseline but differed significantly in terms of average hours of brace wear: 18.31 in the ISICO versus 11.76 in the BrAIST cohort. Twelve percent of the ISICO and 39% of the BrAIST cohort had failed treatment. Age, Risser, Cobb, and a thoracic apex predicted failure in both groups. SITE was related to failure (odds ratio [OR] = 0.19), indicating lower odds of failure with ISICO versus BrAIST approach. With both SITE and wear time in the model, SITE loose significance. In the final model, the adjusted odds of failure were higher in boys (OR = 3.34), and those with lowest BMI (OR = 9.83); the odds increased with the Cobb angle (OR = 1.23), and decreased with age (OR = 0.41) and hours of wear (OR = 0.86).Conclusion: Treatment at the ISICO resulted in a lower failure rate, primarily explained by longer average hours of brace wear.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace—MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life. We aimed to compare the short-term results of the two braces. Methods: The retrospective study included 231 consecutive AIS treated with a MI brace (N = 53) or Sforzesco brace (N = 178). The main outcome was the first 6-month follow-up out-of-brace radiograph Cobb angle change. Secondary outcomes included the in-brace Cobb degrees and aesthetics (TRACE), prominence (angle of trunk rotation and mm), kyphosis, and lordosis changes. Results: The two groups were similar at baseline, apart from more immature patients in MI brace. Both braces reduced the Cobb angle (−6° out-of-brace; −16° in-brace) without differences between groups. All secondary outcomes improved, apart from a statistically and clinically insignificant 3° kyphosis reduction. The MI brace participants were 4.9 times more likely to improve the Cobb angle than the Sforzesco brace (OR = 4.92; 95%CI 1.91–12.64; p = 0.001). Conclusions: These findings suggest that the MI-brace can be safely used instead of the classical Sforzesco brace. However, further studies of different designs and longer follow-ups are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To compare the validity of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire with that of the Scoliosis Research Society 22 (SRS22) questionnaire, the criterion standard for health-related quality of life (HRQOL) measurement in adolescents with spinal deformities. Design: Cross-sectional study. Setting: Outpatient clinic. Subjects: Consecutive adolescents (10–18 years; 541 wearing brace) affected by idiopathic scoliosis (642 females, 100 males) or hyperkyphosis (87 females, 109 males). Interventions: NA. Main measures: The Spearman's correlation coefficient (rho) between ISYQOL and SRS22 was used to assess ISYQOL concurrent validity. Sex, age, severity, bracing, trunk appearance and deformity type were assessed for known-groups validity. Cohen's d quantified between-groups differences. Multiple linear regression exploring the effect of sex, age, body mass index (BMI), severity, bone age, trunk appearance, physiotherapy, bracing and sport on HRQOL of scoliosis patients was used to assess concurrent validity further. Results: Satisfactory correlations were found between ISYQOL and SRS22 (scoliosis, rho = 0.71; kyphosis, rho = 0.56). Known-groups validity analysis showed that ISYQOL detects all the between-groups differences detected by SRS22 and a males-females difference undetected by SRS22. ISYQOL Cohen's d was larger than SRS22 Cohen's d in three between-groups comparisons and similar in the others. Brace, sport and scoliosis severity were independently related to ISYQOL (linear regression: R 2 = 0.23; p < 0.001). Brace, sport and physiotherapy were related to SRS22 (R 2 = 0.17). Conclusions: ISYQOL showed high validity when used to measure HRQOL in adolescents with spinal deformities. Moreover, ISYQOL performs better than SRS22, having better known-groups validity and (contrary to SRS22) detecting the impact of disease severity on HRQOL. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to assess if the angle of trunk rotation (ATR) in combination with other readily measurable clinical parameters allows for effective non-invasive scoliosis screening. Methods: We analysed 10,813 patients (4–18 years old) who underwent clinical and radiological evaluation for scoliosis in a tertiary clinic specialised in spinal deformities. We considered as predictors ATR, Prominence (mm), visible asymmetry of the waist, scapulae and shoulders, familiarity, sex, BMI, age, menarche, and localisation of the curve. We implemented a Logistic Regression model to classify the Cobb angle of the major curve according to thresholds of 15, 20, 25, 30, and 40 degrees, by randomly splitting the dataset into 80–20% for training and testing, respectively. Results: The model showed accuracies of 74, 81, 79, 79, and 84% for 15-, 20-, 25-, 30- and 40-degrees thresholds, respectively. For all the thresholds ATR, Prominence, and visible asymmetry of the waist were the top five most important variables for the prediction. Samples that were wrongly classified as negatives had always statistically significant (p ≪ 0.01) lower values of ATR and Prominence. This confirmed that these two parameters were very important for the correct classification of the Cobb angle. The model showed better performances than using the 5 and 7 degrees ATR thresholds to prescribe a radiological examination. Conclusions: Machine-learning-based classification models have the potential to effectively improve the non-invasive screening for AIS. The results of the study constitute the basis for the development of easy-to-use tools enabling physicians to decide whether to prescribe radiographic imaging. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Clinical evaluation of the ability of a proprietary scoliosis traction chair to de-rotate the spine: 6-month results of Cobb angle and rotational measurements," by Stitzel and colleagues in the 2014 issue is presented.

Purpose: Treatment selection for idiopathic scoliosis is informed by the risk of curve progression. Previous models predicting curve progression lacked validation, did not include the full growth/severity spectrum or included treated patients. The objective was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis. Methods: This is an analysis of 2317 patients with idiopathic scoliosis between 6 and 25 years old. Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult. Radiographs were re-measured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effect models were used to examine the effect of data from the first available visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (maximum Cobb angle) and time (from the first available radiograph to prediction) on the Cobb angle outcome. Interactions of the first available angle with time, of time with sex, and time with Risser were also tested. Results: We included 2317 patients (83% of females) with 3255 prior X-rays where 71% had 1, 21.1% had 2, and 7.5% had 3 or more. Mean age was 13.9 ± 2.2yrs and 81% had AIS. Curve types were: 50% double, 26% lumbar/thoracolumbar-lumbar, 16% thoracic, and 8% other. Cobb angle at the first available X-ray was 20 ± 10° (0–80) vs 29 ± 13° (6–122) at the outcome visit separated by 28 ± 22mths. In the model using data at and prior to the specialist consult, larger values of the following variables predicted larger future curves: first available Cobb angle, Cobb angle on other previous X-ray, and time (with Time2 and Time3) to the target prediction. Larger values on the following variables predicted a smaller future Cobb angle: Risser and age at the first available X-ray, time*Risser and time*female sex interactions. Cross-validation found a median error of 4.5o with 84% predicted within 10°. Similarly, the model using only data from the first specialist consult had a median error of 5.5o with 80% of cases within 10° and included: maximum Cobb angle at first specialist consult, Time, Time2, age, curve type, and both interactions. Conclusions: The models can help clinicians predict how much curves would progress without treatment at future timepoints of their choice using simple variables. Predictions can inform treatment prescription or show families why no treatment is recommended. The nonlinear effects of time account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. These validated models predicted future Cobb angle with good accuracy in untreated idiopathic scoliosis over the full growth spectrum. [ABSTRACT FROM AUTHOR]

Background Context: Currently, there are no published studies that compare non-pharmacological, pharmacological and invasive treatments for chronic low back pain in adults and provide summary statistics for benefits and harms.Purpose: The aim of this review was to compare the benefits and harms of treatments for the management of chronic low back pain without radiculopathy and to report the findings in a format that facilitates direct comparison (Benefit-Harm Scale: level 1 to 7).Design: Systematic review and meta-analysis of randomized controlled trials, including trial registries, from electronic databases up to 23rd May 2022.Patient Sample: Adults with non-specific chronic low back pain, excluding radicular pain in any clinical setting.Outcome Measures: Comparison of pain at immediate-term (≤2 weeks) and short-term (>2 weeks to ≤12 weeks) and serious adverse events using the Benefit-Harm Scale (level 1 to 7).Methods: This was a registered systematic review and meta-analysis of randomized controlled trials. Interventions included non-pharmacological (acupuncture, spinal manipulation only), pharmacological and invasive treatments compared to placebo. Best evidence criteria was used. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal.Results: The search retrieved 17,362 records. Three studies provided data on the benefits of interventions, and 30 provided data on harms. Studies included interventions of acupuncture (n = 8); manipulation (n = 2); pharmacological therapies (n = 9), including NSAIDs and opioid analgesics; surgery (n = 8); and epidural corticosteroid injections (n = 3). Acupuncture (standardized mean difference (SMD) -0.51, 95%CI -0.88 to -0.14, n = 1 trial, moderate quality of evidence, benefit rating of 3) and manipulation (SMD -0.39 (96%CI -0.56 to -0.21, n = 2 trials, moderate quality of evidence, benefit rating of 5) were effective in reducing pain intensity compared to sham. The benefit of the other interventions was scored as uncertain due to not being effective, statistical heterogeneity preventing pooling of effect sizes, or the absence of relevant trials. The harms level warnings were at the lowest (e.g. indicating rarer risk of events) for acupuncture, spinal manipulation, NSAIDs, combination ingredient opioids, and steroid injections, while they were higher for single ingredient opioid analgesics (level 4) and surgery (level 6).Conclusions: There is uncertainty about the benefits and harms of all the interventions reviewed due to the lack of trials conducted in patients with chronic non-specific low back pain without radiculopathy. From the limited trials conducted, non-pharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions. However, more research is needed. There were high harms ratings for opioids and surgery.Registration: This review was registered on the International Prospective Register of Systematic Reviews. [ABSTRACT FROM AUTHOR]

Purpose: Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS. Methods: A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis. Results: Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = − 0.245), %FVC (r = − 0.302), FEV1 (r = − 0.232), %FEV1 (r = − 0.348), FEV1/FVC ratio (r = − 0.166), TLC (r = − 0.302), %TLC (r = − 0.183), and percent predicted vital capacity (r = − 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = − 0.215) and %TLC (r = − 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05). Conclusion: Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results. [ABSTRACT FROM AUTHOR]

Purpose: In-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient's ability to maintain the correction. We aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph). Design: Retrospective cohort study of a prospective dataset. Methods: The population was selected based on the following inclusion criteria: AIS, age 10–18 years; Risser score 0–2; Cobb angle 25–40°; brace treatment; availability of all radiographs. Statistics: Pearson correlations provide a first exploration of data. The univariate and multivariate logistic regression model tested the predictors. Finally ROC curve provided a check of model accuracy. Results: A total of 131 patients were included (mean age 13.0 ± 1.3, Cobb angle 33.2 ± 5.5°; 78% females). At the end of treatment, 56% had stabilised, 9% had progressed, and 44% had improved. The difference between the in-brace and final radiographs was 8.0 ± 6.0°, while the difference between the first out-of-brace and final radiographs was 1.8 ± 5.2°. The best predictor of final outcome was the first out-of-brace radiograph (0.80), compared to in-brace (0.68) and baseline (0.59) radiographs. The best cut-offs to predict avoidance of progression were 30% and 10% of the correction rates for the in-brace and first out-of-brace radiographs, respectively. Conclusion: The first out-of-brace radiograph predicts end results better than the in-brace radiograph. It offers an excellent clinical reference for clinicians and patients. The first out-of-brace radiograph should be considered an essential element of future predictive models. Level of Evidence 1: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding. [ABSTRACT FROM AUTHOR]

• Aesthetics is a main outcome for idiopathic scoliosis, but there is no criterion standard. • TRACE is an easy 12-point clinical scale to quantify symmetry as a proxy of aesthetics. • TRACE can be administered in 20 s and learned in a couple of hours of training. • TRACE has been validated and converted into a Rasch-consistent, interval measure. • TRACE can now be used as an interval outcome measure in the clinic and in research. Aesthetics is recognized as a main outcome in idiopathic scoliosis (IS) treatment, but to date, there is no criterion standard for physicians' evaluation. Trunk Aesthetic Clinical Evaluation (TRACE) is a simple 12-point ordinal scale to quantify symmetry as a proxy of aesthetics. TRACE is already diffused worldwide and has been used in clinical research. We aimed to validate TRACE and improve it with Rasch analysis. This study involved an observational Rasch analysis validation of an evaluation tool in outpatient rehabilitation centres. From a clinical database, we randomly selected patients who had IS, were age 10 to 18, had brace prescription at first evaluation, and had at least 2 consultations. Rasch analysis (partial credit model) was used. Differential item functioning (DIF) was assessed for age, sex, disease severity, bracing and treatment. The median was chosen to dichotomize disease severity and bracing. We removed 64 outlier participants (4%). We included 1553 participants (1334 females; mean [SD] age 13 [1.7] years old). TRACE items showed ordered thresholds and proper fit to the Rasch model. The score-to-measure conversion table showed proper length (range −4.55 to 4.79 logit) with a mean (SE) measure of −0.52 (0.04) logit. The principal component analysis supported the TRACE unidimensionality. The TRACE was free from DIF for age, sex and bracing. The TRACE ordinal scale has been converted into a Rasch-consistent, interval-level measure of trunk aesthetics in IS patients and can be used to compare different populations. Its main flaw is low reliability, likely because of the small number of items. TRACE can be used as an outcome measure and in everyday clinical evaluation of IS, even if new developments of the scale are advised. [ABSTRACT FROM AUTHOR]

Background Plumb line distances (PDs) are widely used in conservative clinical practice to evaluate the sagittal shape of the spine. Objective The objective was to assess the normative values of PDs in a large, healthy population in an age range representative of the adolescent population with spinal deformities, and to correlate it with x-ray measurements. Design This was a cross-sectional study. Methods Participants were 584 healthy individuals (341 females) with x-rays showing no spine deformities. The whole sample (OVERALL) was divided into 5 groups: 6 to 9 years old (n = 106); >10 years, Risser 0 with triradiate cartilage open (n = 129) or closed (n = 104); Risser 1 to 2 (n = 126); and Risser 3 to 5 (n = 119). PDs were taken by maintaining a tangent to the thoracic kyphosis apex at C7, T12, L3, and S2. Sagittal index (C7 + L3), and sagittal and coronal balances (C7 related to S2) were calculated. Results In OVERALL, PDs at C7, T12, L3, and S2 were 39.9 ± 16.7, 21.4 ± 15.3, 39.9 ± 15, 20.6 ± 17.0 mm, respectively. Sagittal index was 79.8 ± 26.8, sagittal balance was 19.3 ± 17 mm anterior to S2 plumb line; 13.5% had a coronal imbalance of 11.4 ± 5.4 mm to the right and 24.7% of 13.2 ± 6.0 mm to the left. C7 and L3 PDs, sagittal index, and sagittal balance were significantly lower in ages 6 to 9 compared to older patients in Risser 1 to 2 group. C7 and S2 PDs and sagittal index were significantly larger in males. Sagittal index correlated with thoracic kyphosis Cobb degrees (r = 0.47). Limitations The participants were not randomly chosen from the general population; and they had an x-ray because of spine pathology suspicion. Conclusions This study shows normative data to be used in clinical practice. Sagittal spinopelvic alignment has gained more and more importance in the last decades because of its high correlation to Health-Related Quality of Life scores in adults. 1 [ABSTRACT FROM AUTHOR]

• Left side dominance has a prevalence for trunk asymmetry. • Embryology factors could justify the development of left-right side dominance. • It is unclear how neuro-abnormality is common in trunk asymmetry with left convexity. In some studies, an association has been reported between laterality of the curve in scoliotic adolescents and hand dominance; however, additional studies have to be performed to confirm these findings. The objective of this study is to evaluate the prevalence between trunk asymmetry and side dominance in hand, foot and visual laterality in adolescents. This was a cross-sectional study secondary analysis. In total, 1029 children (491 females) were enrolled from the Secondary School of Brescia, Italy, with a mean age of 12 (SD = 0.9 years). All subjects underwent a screening program divided into three phases: Phase 1, collection of demographic and clinical characteristics; Phase 2, spine evaluation with a plumb line and Bunnell Scoliometer; and Phase 3, evaluation of side dominance of the eye, hand and foot with a 4-item survey. Our data showed a prevalence of 0.43%, 1.01% and 0.87% for thoracic, thoracolumbar and lumbar curves, respectively, with a right-side dominance and a prevalence of 2.72%, 2.54% and 0.65% for thoracic, thoracolumbar and lumbar curves, respectively, with a left-side dominance. The left-side dominance could have a prevalence on trunk asymmetry in thoracic and thoraco-lumbar curves. Our study suggests that the clinical evaluation of trunk asymmetry should be associated with the evaluation of laterality. [ABSTRACT FROM AUTHOR]

Highlights • Physiotherapeutic scoliosis-specific exercises (PSSE) have been found effective in avoiding bracing in adolescents with idiopathic scoliosis (AIS). • One hundred and forty-five patients performed the SEAS (Scientific Exercise Approach to Scoliosis) PSSE program, based on active self-correction and stabilization. • The control groups included 53 patients who were not prescribed exercises (observation) or who did not regularly exercise, and 95 who performed usual physiotherapy. • SEAS reduced the bracing rate in AIS and was more effective than usual physiotherapy or control treatment. Abstract Background In an ideal experimental setting, 2 randomized controlled trials recently showed the efficacy of physiotherapeutic scoliosis-specific exercises (PSSEs) for adolescents with idiopathic scoliosis (AIS). Now large observational studies are needed to check the generalizability of these results to everyday clinical life. Objective To explore the effectiveness of PSSEs for avoiding bracing or progression of AIS in everyday clinics. Methods This was a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients. Inclusion criteria were AIS, age ≥ 10 years old at first evaluation, Risser sign 0–2, and 11–20°Cobb angle. Exclusion criteria were consultations only and brace prescription at baseline. Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle > 29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design. Results We included 293 eligible subjects after propensity score matching (SEAS, n = 145; UP, n = 95; controls, n = 53). The risk of success was increased 1.7-fold (P = 0.007) and 1.5-fold (P = 0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2–3.7) and 1.8 (95% CI 1.5–2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis. Conclusions SEAS reduced the bracing rate in AIS and was more effective than UP. PSSEs are additional tools that can be included in the therapeutic toolbox for AIS treatment. [ABSTRACT FROM AUTHOR]

Background Context: Spinal deformities are commonly associated with poor health-related quality of life (HRQOL). Several questionnaires (eg, Scoliosis Research Society-24 [SRS-24] and Scoliosis Research Society-22 [SRS-22]) have been developed to evaluate HRQOL in these conditions. In adults as well as during growth, the HRQOL is considered one of the most relevant outcomes of both conservative and surgical treatments. Rasch analysis is a powerful statistical technique for developing high-quality and valid questionnaires. The SRS-24 and SRS-22 have been evaluated using the Rasch analysis but showed poor measurement properties. Thus, a proper measure of HRQOL in people with a spine condition is still missing.Purpose: This study aimed to develop a new questionnaire that is totally Rasch consistent for measuring the HRQOL in young people with a spine condition.Study Design: This is a cross-sectional study for developing a new HRQOL measure.Patient Sample: A total of 402 participants with adolescent idiopathic scoliosis or Scheuermann juvenile kyphosis were included in the study.Outcome Measure: The outcome measure used was the Italian Spine Youth Quality of Life (ISYQOL) questionnaire.Materials and Methods: The study consisted of different stages: a conventional approach content analysis, an opinion poll among clinicians trained in spine deformities, and the Rasch analysis (partial credit model).Results: The Rasch analysis showed that all items of the ISYQOL questionnaire had ordered thresholds and a good fit to the model. Differential item functioning was present for Item 1, with bracing only, and was solved with a conventional items splitting procedure. The ISYQOL item map spans an adequate range of HRQOL. The principal component analysis for Rasch residuals showed, in practical terms, the ISYQOL unidimensionality. The reliability of ISYQOL was high enough so that approximately three significantly different levels of HRQOL could be discerned. Two questionnaire versions were provided for patients with and without the brace, respectively.Conclusions: ISYQOL is the first HRQOL questionnaire developed according to the Rasch analysis. It was developed in a conservative treatment setting for all types of spinal deformities, including also patients with surgical curves. Validation in many languages is already under way. [ABSTRACT FROM AUTHOR]

Study Design: A Cochrane systematic review.Objective: To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, psychological, and cosmetic issues.Summary Of Background Data: Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. Although adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic.Methods: We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015. We also checked reference lists and hand searched grey literature. Randomized controlled trials (RCTs) and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. We used standard methodological procedures expected by the Cochrane Collaboration.Results: We included seven studies. Five were planned as RCTs, two as prospective controlled clinical trials. One RCT failed completely, another was continued as an observational study. There was very low quality evidence from one small RCT that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation.Conclusion: Two studies showed that bracing did not change QoL during treatment, and QoL, back pain psychological and cosmetic issues in the long term (16 years.) All articles showed that bracing prevented curve progression. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children.Level Of Evidence: 1. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the association between scoliosis and sagittal balance parameters in Parkinson disease patients. Design: This is a cross-sectional study. Results: Fifty percent of the cohort presented a scoliosis larger than 11 degrees; 84% of the patients with scoliosis presented a thoracolumbar curve, 10% presented a thoracic one, and 6% presented a lumbar one. The group with scoliosis curves presented a lower spinosacral angle (111.6 [21.9] degrees vs. 121.7 [9.8] degrees, PG 0.05), whereas thoracic kyphosis, lumbar lordosis, and spinopelvic angle were similar. Pelvic incidence, pelvic tilt, and sacral slope were not statistically different. In the scoliosis group, the authors found negative correlations for lumbar lordosis/spinopelvic angle, sacral slope/spinosacral angle, and lumbar lordosis/pelvic tilt. Moreover, the sacral slope/pelvic tilt correlation was positive in patients without scoliosis and negative in others. The two groups did not present differences regarding age, years of disease, Hoehn-Yahr score, and Unified Parkinson Disease Rating Scale-motor section. Conclusions: Pelvic parameters were similar in the two groups, whereas spinosacral angle was lower in patients with scoliosis. The prevalence of scoliosis in Parkinson disease was higher than what was previously described and the thoracolumbar spine was the mostly affected. [ABSTRACT FROM AUTHOR]

Scoliosis is a complex three dimensional (3D) deformity: the current lack of a 3D classification could hide something fundamental for scoliosis prognosis and treatment. A clear picture of the actually existing 3D classifications lacks. The aim of this systematic review was to identify all the 3D classification systems proposed until now in the literature with the aim to identify similarities and differences mainly in a clinical perspective.After a MEDLINE Data Base review, done in November 2013 using the search terms "Scoliosis/classification" [Mesh] and "scoliosis/classification and Imaging, three dimensional" [Mesh], 8 papers were included with a total of 1164 scoliosis patients, 23 hyperkyphosis and 25 controls, aged between 8 and 20 years, with curves from 10° to 81° Cobb, and various curve patterns. Six studies looked at the whole 3D spine and found classificatory parameters according to planes, angles and rotations, including: Plane of Maximal Curvature (PMC), Best Fit Plane, Cobb angles in bodily plane and PMC, Axial rotation of the apical vertebra and of the PMC, and geometric 3D torsion. Two studies used the regional (spinal) Top View of the spine and found classificatory parameters according to its geometrical properties (area, direction and barycenter) including: Ratio of the frontal and the sagittal size, Phase, Directions (total, thoracic and lumbar), and Shift. It was possible to find similarities among 10 out of the 16 the sub-groups identified by different authors with different methods in different populations.In summation, the state of the art of 3D classification systems include 8 studies which showed some comparability, even though of low level. The most useful one in clinical everyday practice, is far from being defined. More than 20 years passed since the definition of the third dimension of the scoliosis deformity, now the time has come for clinicians and bioengineers to start some real clinical application, and develop means to make this approach an everyday tool. [ABSTRACT FROM AUTHOR]

Background context Recently, positive results in bracing patients with idiopathic scoliosis (IS) above 45° who refused surgery have been presented in a retrospective study. Obviously, this can give only an efficacy (EA) analysis, as there is neither a control group, nor it is possible to know failures because of dropouts. Purpose To present the prospective results of bracing patients affected by IS above 45° and still growing. Study design Prospective study including all IS patients with 45° or more, Risser stage 0 to 4, who had their first evaluation in our institute, an outpatient clinic specialized in scoliosis evaluation and conservative treatment, from March 1, 2003 to December 21, 2010 and utterly denied any surgical intervention. Patient sample Of 59 patients, we excluded 2 patients still in treatment and 57 (11 males) patients were included. At the beginning of the study, they were 15 years 3±22 months of age, had 52.5° Cobb (range, 45°-93°), and Risser 2 (0-4). Thirty-nine accepted a full-time brace treatment (BG) to try avoiding surgery, 18 refused any treatment and served as controls (CG). Outcome measures Physiological measures: radiographic and clinical data. Methods Treatment: A year of full-time Sforzesco brace (23 hours/day) or Risser cast (8-12 months) and gradual weaning after Risser 3; all patients performed exercises; and International Society on Scoliosis Orthopaedic and Rehabilitation Treatment management criteria were respected. Analyses: EA in patients who completed treatment/observation (34 in BG and 10 in CG) and intent-to-treat (ITT) with worst case analysis in the whole population. Relative risk (RR) and 95% confidence interval (CI) have been computed. Results Efficacy: failures were 23.5% in BG and 100% in CG. Intent-to-treat: failures were 20.5% in BG and 55.6% in CG. Relative risks of failure in CG were 4.3 (95% CI, 3.6-4.9) in EA and 2.7 (95% CI, 2.0-3.5) in ITT (p<.05). Percentage of patients (53.8%) improved: RRs of improvement in BG were 1.6 (95% CI, 1.46-1.9) in EA and 1.9 (95% CI, 1.6-2.2) in ITT (p<.05). Patients who joined the treatment achieved a 10.4°±10.7° Cobb improvement, an ATR reduction of 4.2°±4.3°, and an esthetic improvement of 2.8±1.9 of 12 points (TRACE). At the end, in BG, 24 patients were below 45° and 6 patients below 35°. Conclusions Through this study we can conclude that the conservative brace plus exercises treatment (if correctly performed and managed) is a suitable alternative for those patients who reject any surgical intervention for IS above 45°. But we could also conclude that a good brace treatment should be considered as the first choice to try avoiding fusion because of the high sanitary and social costs of surgery. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Objectives: 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., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: Adolescent idiopathic scoliosis (AIS) is a pathology that changes the three-dimensional shape of the spine and trunk. While AIS can progress during growth and cause cosmetic issues, it is usually asymptomatic. However, a final spinal curvature above the critical threshold of 30° increases the risk of health problems and curve progression in adulthood. The use of therapeutic exercises (TEs) to reduce the progression of AIS and delay or avoid other, more invasive treatments is still controversial., Objectives: To evaluate the effectiveness of TE, including generic therapeutic exercises (GTE) and physiotherapeutic scoliosis-specific exercises (PSSE) in treating AIS, compared to no treatment, other non-surgical treatments, or between treatments., Search Methods: We searched CENTRAL, MEDLINE, Embase, four other databases, and two clinical trials registers to 17 November 2022. We also screened reference lists of articles., Selection Criteria: Randomised controlled trials (RCTs) comparing TE with no treatment, other non-surgical treatments (braces, electrical stimulation, manual therapy), and different types of exercises. In the previous version of the review, we also included observational studies. We did not include observational studies in this update since we found sufficient RCTs to address our study aims., Data Collection and Analysis: We used standard Cochrane methodology. Our major outcomes were progression of scoliosis (measured by Cobb angle, trunk rotation, progression, bracing, surgery), cosmetic issues (measured by surface measurements and perception), and quality of life (QoL). Our minor outcomes were back pain, mental health, and adverse effects., Main Results: We included 13 RCTs (583 participants). The percentage of females ranged from 50% to 100%; mean age ranged from 12 to 15 years. Studies included participants with Cobb angles from low to severe. We judged 61% of the studies at low risk for random sequence generation and 46% at low risk for allocation concealment. None of the studies could blind participants and personnel. We judged the subjective outcomes at high risk of performance and detection bias, and the objective outcomes at high risk of detection bias in six studies and at low risk of bias in the other six studies. One study did not assess any objective outcomes. Comparing TE versus no treatment, we are very uncertain whether TE reduces the Cobb angle (mean difference (MD) -3.6°, 95% confidence interval (CI) -5.6 to -1.7; 2 studies, 52 participants). Low-certainty evidence indicates PSSE makes little or no difference in the angle of trunk rotation (ATR) (MD -0.8°, 95% CI -3.8 to 2.1; 1 study, 45 participants), may reduce the waist asymmetry slightly (MD -0.5 cm, 95% CI -0.8 to -0.3; 1 study, 45 participants), and may result in little to no difference in the score of cosmetic issues measured by the Spinal Appearance Questionnaire (SAQ) General (MD 0.7 points, 95% CI -0.1 to 1.4; 1 study, 16 participants). PSSE may result in little to no difference in self-image measured by the Scoliosis Research Society - 22 Patient Questionnaire (SRS-22) (MD 0.3 points, 95% CI -0.3 to 0.9; 1 study, 16 participants) and improve QoL slightly measured by SRS-22 Total score (MD 0.3 points, 95% CI 0.1 to 0.4; 2 studies, 61 participants). Only Cobb angle results were clinically meaningful. Comparing PSSE plus bracing versus bracing, low-certainty evidence indicates PSSE plus bracing may reduce Cobb angle (-2.2°, 95% CI -3.8 to -0.7; 2 studies, 84 participants). Comparing GTE plus other non-surgical interventions versus other non-surgical interventions, low-certainty evidence indicates GTE plus other non-surgical interventions may reduce Cobb angle (MD -8.0°, 95% CI -11.5 to -4.5; 1 study, 80 participants). We are uncertain whether PSSE plus other non-surgical interventions versus other non-surgical interventions reduces Cobb angle (MD -7.8°, 95% CI -12.5 to -3.1; 1 study, 18 participants) and ATR (MD -8.0°, 95% CI -12.7 to -3.3; 1 study, 18 participants). PSSE plus bracing versus bracing alone may make little to no difference in subjective measurement of cosmetic issues as measured by SAQ General (-0.2 points, 95% CI -0.9 to 0.5; 1 study, 34 participants), self-image score as measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -0.3 to 0.5; 1 study, 34 participants), and QoL measured by SRS-22 Total score (MD 0.2 points, 95% CI -0.1 to 0.5; 1 study, 34 participants). None of these results were clinically meaningful. Comparing TE versus bracing, we are very uncertain whether PSSE allows progression of Cobb angle (MD 2.7°, 95% CI 0.3 to 5.0; 1 study, 60 participants), changes self-image measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -1.0 to 1.1; 1 study, 60 participants), and QoL measured by SRS-22 Total score (MD 3.2 points, 95% CI 2.1 to 4.2; 1 study, 60 participants). None of these results were clinically meaningful. Comparing PSSE with GTE, we are uncertain whether PSSE makes little or no difference in Cobb angle (MD -3.0°, 95% CI -8.2 to 2.1; 4 studies, 192 participants; very low-certainty evidence). PSSE probably reduces ATR (clinically meaningful) (MD -3.0°, 95% CI -3.4 to -2.5; 2 studies, 138 participants). We are uncertain about the effect of PSSE on QoL measured by SRS-22 Total score (MD 0.26 points, 95% CI 0.11 to 0.62; 3 studies, 168 participants) and on self-image measured by SRS-22 Self-Image and Walter Reed Visual Assessment Scale (standardised mean difference (SMD) 0.77, 95% CI -0.61 to 2.14; 3 studies, 168 participants). Further, low-certainty evidence indicates that 38/100 people receiving GTE may progress more than 5° Cobb versus 7/100 receiving PSSE (risk ratio (RR) 0.19, 95% CI -0.67 to 0.52; 1 study, 110 participants). None of the included studies assessed adverse effects., Authors' Conclusions: The evidence on the efficacy of TE is currently sparse due to heterogeneity, small sample size, and many different comparisons. We found only one study following participants to the end of growth showing the efficacy of PSSE over TE. This result was weakened by adding studies with short-term results and unclear preparation of treating physiotherapists. More RCTs are needed to strengthen the current evidence and study other highly clinically relevant outcomes such as QoL, psychological and cosmetic issues, and back pain., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine and trunk deformity. Bracing is an effective treatment for medium-degree curves. Thermal sensors help monitor patients' adherence (compliance), a critical issue in bracing treatment. Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts. We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We performed a cross-sectional study of patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year. To ensure high adherence, for years, we have provided specific support to brace treatment through a series of cognitive-behavioural interventions for patients and parents. We used iButton thermal sensor systematic data collection to precisely analyse the real brace-wearing time. We included 514 adolescents, age 13.8 ± 1.6, with the worst scoliosis curve of 34.5 ± 10.3° Cobb. We found a 95% (95CI 60-101%) adherence to the brace prescription of 21.9 ± 1.7 h per day. Determinants included gender (91% vs. 84%; females vs. males) and age < 14 years (92% vs. 88%). Brace hours prescription, BMI, and all clinical variables (worst curve Cobb degrees, angle of trunk rotation, and TRACE index for aesthetics) did not influence adherence.

Objective: To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations from high-quality clinical practice guidelines (CPGs) to inform the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR)., Data Source: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, National Health Services Economic Evaluation Database, Health Technology Assessment Database, PEDro, the Trip Database, the Index to Chiropractic Literature and the gray literature., Study Selection: Eligible guidelines were (1) published between 2009 and 2019 in English, French, Italian, or Swedish; (2) included adults or children with non-specific LBP with or without radiculopathy; and (3) assessed the benefits of rehabilitation interventions on functioning. Pairs of independent reviewers assessed the quality of the CPGs using AGREE II., Data Synthesis: We identified 4 high-quality CPGs. Recommended interventions included (1) education about recovery expectations, self-management strategies, and maintenance of usual activities; (2) multimodal approaches incorporating education, exercise, and spinal manipulation; (3) nonsteroidal anti-inflammatory drugs combined with education in the acute stage; and (4) intensive interdisciplinary rehabilitation that includes exercise and cognitive/behavioral interventions for persistent pain. We did not identify high-quality CPGs for people younger than 16 years of age., Conclusion: We developed evidence-based recommendations from high-quality CPGs to inform the WHO PIR for people with LBP with and without radiculopathy. These recommendations emphasize the potential benefits of education, exercise, manual therapy, and cognitive/behavioral interventions., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Patients with scoliosis have a high prevalence of back pain (BP). It is possible that scoliosis patients present with specific features when experiencing back or leg pain pathology. The aim of this systematic review is to report the signs, symptoms and associated features of BP in patients with scoliosis compared to adults without scoliosis during adulthood. From inception to 15 May 2023, we searched the following databases: PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. We found 10,452 titles, selected 25 papers for full-text evaluation and included 8 in the study. We found that scoliosis presents with asymmetrical pain, most often at the curve's apex, eventually radiating to one leg. Radiating symptoms are usually localised on the front side of the thigh (cruralgia) in scoliosis, while sciatica is more frequent in non-scoliosis subjects. These radiating symptoms relate to rotational olisthesis. The type and localization of the curve have an impact, with lumbar and thoracolumbar curves being more painful than thoracic. Pain in adults with scoliosis presents specific features: asymmetrical localization and cruralgia. These were the most specific features. It remains unclear whether pain intensity and duration can differentiate scoliosis and non-scoliosis-related pain in adults.