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Whether Orthotic Management and Exercise are Equally Effective to the Patients With Adolescent Idiopathic Scoliosis in Mainland China?

A Randomized Controlled Trial Study

Zheng, Yu MD∗,†,‡,¶; Dang, Yini MD§; Yang, Yan MD; Li, Huabo BS; Zhang, Lijie BS; Lou, Edmond H. M. PhD||; He, Chengqi MD†,‡; Wong, Mansang PhD

doi: 10.1097/BRS.0000000000002412
RANDOMIZED TRIAL
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Study Design. A prospective randomized controlled trial.

Objective. The aim of this study was to investigate the effectiveness of orthotic management versus exercise on spinal curvature, body symmetry, and quality of life.

Summary of Background Data. A number of well-designed studies comparing conservative treatment of adolescent idiopathic scoliosis (AIS) have been conducted and the evidence becomes stronger. However, there is a lack of the information on the effectiveness of orthotic management versus exercise.

Methods. The inclusion criteria recommended by the Scoliosis Research Society (SRS) and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) were used during enrollment. Eligible patients were randomly assigned to either bracing group or exercise group. Patients in the bracing group were prescribed with a rigid thoracolumbosacral orthosis and requested to wear 23 h/day, while patients in the exercise group were treated with the protocol of the Scientific Exercise Approach to Scoliosis. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, and quality of life (QoL) were collected every 6 months.

Results. Twenty-four patients in the bracing group and 29 patients in the exercise group participated in this study. For the intergroup comparison, the bracing group showed better results about the correction of spinal curvature (Cobb angle at the first 12 months of intervention, P = 0.039), scores concerning QoL, especially function (P < 0.001), mental health (P < 0.001), and total score (P < 0.001), were higher than that of the exercise group. The results of body symmetry evaluation did not differ significantly between the two groups. For the intragroup comparison, parameters of spinal curvature (baseline vs. 12-month, P < 0.03 in the exercise group and P < 0.001 in the bracing group), QoL (baseline vs. 12-month, P < 0.001), and TAPS (baseline vs. 12-month, P < 0.033) significantly improved over the studied period. Shoulder balance (baseline vs. 12-month, P < 0.005) showed significant improvement only in the bracing group.

Conclusion. Both interventions of bracing and exercise showed significant treatment effectiveness on the patients with AIS. Bracing was superior to capture corrections in parameters of spinal curvature and body symmetry, while the QoL, especially in aspect of the functional and psychological status, was significantly better in the exercise group.

Level of Evidence: 1

Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China

Center of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, Sichuan Province, China

§Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, Wuxi, Jiangsu Province, China

||Department of Surgery, Glenrose Rehabilitation Research Centre, University of Alberta, Alberta, Edmonton, Canada.

Address correspondence and reprint requests to Mansang Wong, PhD, Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; E-mail: m.s.wong@polyu.edu.hk; Chengqi He, MD, Center of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, China; E-mail: hxkfhcq2015@126.com

Received 5 April, 2017

Revised 30 June, 2017

Accepted 28 August, 2017

Wuxi Science and Technology Program (WSTP), China (Grant number: ZD201408) funds were received in support of this work.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No relevant financial activities outside the submitted work.

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