Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace Effectiveness Analysis of BrAIST and ISICO Cohorts
Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace Effectiveness Analysis of BrAIST and ISICO Cohorts
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DOI：
10.1097/brs.0000000000003506
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发表时间：
2020-09-01
期刊：
影响因子：
3
通讯作者：
Negrini, Stefano
中科院分区：
文献类型：
--
作者：
Dolan, Lori A.;Donzelli, Sabrina;Negrini, Stefano
研究设计。比较效果研究目的。评估导致北美青少年特发性脊柱侧凸患者中支架失败率高于意大利同龄人的因素。背景资料摘要。在美国进行的支具研究显示出比欧洲研究中心更差的结果，可能是由于样本特征或治疗方法。方法：样本：支架患者，年龄10 ~ 15岁，Risser = 40°和/或>= Risser 4，从前瞻性数据库中选择。比较：青少年特发性脊柱侧凸试验（brist） （TLSO）和意大利脊柱科学研究所（ISICO）方案（运动牙套加或不加SEAS练习）中每个牙套的支撑。基线特征（性别、年龄、BMI、Risser、Cobb、曲线类型）和支具每天佩戴的平均时间。程序中的差异（例如，SEAS，支架类型，断奶协议）由一个名为“SITE”的变量捕获。结果：治疗失败（Risser 4前Cobb >= 40）。统计学：使用逻辑回归比较基线特征、分析危险因素、治疗成分和队列内部和队列之间的结果。结果：共纳入157例brist和81例ISICO受试者。各组在基线时相似，但在支具佩戴的平均小时数方面存在显著差异：ISICO组为18.31小时，而BrAIST组为11.76小时。12%的ISICO组和39%的brist组治疗失败。年龄、Risser、Cobb和胸椎尖顶预测两组衰竭。SITE与手术失败相关（比值比[OR] = 0.19），表明ISICO与brist入路的失败几率较低。同时具有SITE和穿搭时间的模型，SITE松动具有重要意义。在最终模型中，调整后的失败几率在男孩（OR = 3.34）和最低BMI （OR = 9.83）中较高；随Cobb角增加（OR = 1.23），随年龄（OR = 0.41）和磨损时间（OR = 0.86）而降低。结论：在ISICO治疗导致较低的失败率，主要原因是支架磨损的平均时间更长。
Study Design. Comparative effectiveness studyObjective. 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 = 40 degrees 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.