Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner
Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner
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DOI：
10.1186/1748-7161-9-6
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发表时间：
2014-01-01
影响因子：
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通讯作者：
Guzzanti, Vincenzo
中科院分区：
文献类型：
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作者：
Aulisa, Angelo G.;Giordano, Marco;Guzzanti, Vincenzo
背景资料：在过去的几年里，越来越多的证据支持支具作为特发性脊柱侧凸患者的有效治疗选择。然而，关于脊柱侧凸受试者保守治疗的依从性对结果的影响的信息很少。本研究的目的是前瞻性地评估特发性青少年（AIS）或青少年脊柱侧凸（JIS）患者对支具治疗的依从性与脊柱侧凸曲线进展之间的关系。方法：在1.424例特发性脊柱侧凸患者中，645例符合纳入标准。根据SRS标准区分了三种结局：弯曲矫正、弯曲稳定和弯曲进展。由一名骨科医生（LA）评估支具佩戴情况，并在标准化表格上进行评分。对治疗的依从性分为完全（按规定佩戴支具）、不完全A（取出支具1个月）、不完全B（取出支具2个月）、不完全C（在上学时间取出支具）和不完全D（仅在夜间佩戴支具）。结果：随访结果显示：完全依从性为61.1%，不完全A为5.2%，不完全B为10.7%，不完全C为14.2%，不完全D为8.8%。完全型301/319例，不完全型A型19/27例，不完全型B型25/56例，不完全型C型52/74例，不完全型D型27/46例。开始时Cobb平均值为29.8 ± 7.5 SD，随访时为17.1 ± 10.9 SD。完全依从性患者的Cobb和Perdriolle程度改善显著高于所有其他组，无论是青少年还是青少年脊柱侧凸。在意向治疗分析中，手术治疗率在有明确结果的患者中为2.1%，在脱落患者中为12.1%。治疗依从性表现出显着的相互作用与time.Conclusion：曲线进展和转诊手术的患者高支具依从性较低。停用支具1个月不影响治疗结果。相反，仅在夜间佩戴支具与曲线进展的高速率相关。
Background: Over the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. Yet, little information is available on the impact of compliance on the outcome of conservative treatment in scoliotic subjects. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS).Methods: Among 1.424 patients treated for idiopathic scoliosis, 645 were eligible for inclusion criteria. Three outcomes were distinguished in agreement with the SRS criteria: curve correction, curve stabilization and curve progression. Brace wearing was assessed by one orthopaedic surgeon (LA) and scored on a standardized form. Compliance to treatment was categorized as complete (brace worn as prescribed), incomplete A (brace removed for 1 month), incomplete B (brace removed for 2 months), incomplete C (brace removed during school hours), and incomplete D (brace worn overnight only). Chi square test, T test or ANOVA and ANOVA for repeated measures tests were used as statistical tests.Results: The results from our study showed that at follow-up the compliance was: Complete 61.1%; Incomplete A 5.2%; Incomplete B 10.7%; Incomplete C 14.2%; Incomplete D 8.8%. Curve correction was accomplished in 301/319 of Complete, 19/27 Incomplete A, 25/56 Incomplete B, 52/74 Incomplete C, 27/46 Incomplete D. Cobb mean value was 29.8 +/- 7.5 SD at beginning and 17.1 +/- 10.9 SD at follow-up. Both Cobb and Perdriolle degree amelioration was significantly higher in patients with complete compliance over all other groups, both in juvenile, both in adolescent scoliosis. In the intention-to-treat analysis, the rate of surgical treatment was 2.1% among patients with definite outcome and 12.1% among those with drop-out. Treatment compliance showed significant interactions with time.Conclusion: Curve progression and referral to surgery are lower in patients with high brace compliance. Bracing discontinuation up to 1 month does not impact on the treatment outcome. Conversely, wearing the brace only overnight is associated with a high rate of curve progression.