The Efficacy of Night Bracing in the Treatment of Adolescent Idiopathic Scoliosis: A Systematic Review.

Background/Objectives: The effectiveness of night braces alone or in combination with other treatments for adolescent idiopathic scoliosis remains unclear. This systematic review study aimed to review and analyze the available literature to determine whether night braces are an effective treatment for idiopathic scoliosis. Methods: A total of 162 databases, including Cochrane Library (reviews, protocols, trials), Web of Science, PubMed, Medline, Scopus, PEDro, CINAHL (EBSCO), Ovid and Google Scholar, were searched for published articles from inception to February 2024. The available literature was screened by the following terms: "scoliosis and night-time brace", "scoliosis and night brace", "scoliosis and part-time bracing", "scoliosis and Providence" and "scoliosis and Charleston". Results: Twenty studies were included; only one study was a randomized controlled trial, and most of the studies were retrospectively designed. Providence, Charleston and Boston braces were used as night braces. The Cobb angle was evaluated in all studies, and Cobb angle change after treatment and surgical treatment rates were the parameters that were evaluated the most. In one study, the angle of trunk rotation, quality of life, perception of spinal appearance, and physical activity level were measured. In one study, sagittal plane assessments were performed in addition to the Cobb angle. Conclusions: The results of this review suggest that there is no evidence to support the use of night braces in the treatment of adolescent idiopathic scoliosis. Randomized controlled trials with a well-designed methodology are needed to determine the efficacy of night braces.

The Immediate Effect of Hanging Exercise and Muscle Cylinder Exercise on the Angle of Trunk Rotation in Adolescent Idiopathic Scoliosis.

(1) Background: Semi-hanging and muscle cylinder exercises have been defined as scoliosis-specific corrective exercises. The aim of this study was to evaluate the immediate effect of muscle cylinder and semi-hanging exercises on the angle of trunk rotation in patients with adolescent idiopathic scoliosis (AIS). (2) Methods: Twenty-seven patients with AIS with a mean age of 18.6 years were retrospectively analyzed. The angle of trunk rotation (ATR) values were measured before and after performing semi-hanging and standing muscle cylinder exercises. Both exercises were performed for three to five respiratory cycles. The semi-hanging exercise was performed first, followed by the muscle cylinder exercise, in this order, in all participants. For statistical analysis, the Wilcoxon signed-rank test was used to analyze ATR changes after the exercises, and the Kruskal-Wallis test was used to compare ATR changes according to the main curve location. (3) Results: The thoracic, thoracolumbar and lumbar maximum ATR values were significantly increased after the semi-hanging exercise (p < 0.001) and decreased after the muscle cylinder exercise (p < 0.001). The ATR change was greater in the lumbar region than in the thoracic and thoracolumbar regions. (4) Conclusion: The results of this study of a small group of patients emphasized that one of the scoliosis-specific corrective exercises, the standing muscle cylinder exercise, improved ATR, while the other, the semi-hanging exercise, worsened ATR in patients with AIS. It is recommended that each scoliosis-specific corrective exercise be evaluated and redesigned to maximize the three-dimensional corrective effect, considering the biomechanics of the spine and the pathomechanics of scoliosis.

Results of Gensingen Bracing in Patients With Adolescent Idiopathic Scoliosis: Retrospective Cross-Sectional Feasibility Study.

BACKGROUND: Bracing is an essential part of scoliosis treatment. The standard of brace treatment for patients with scoliosis today is still very variable in terms of brace quality and outcome. The Gensingen brace is a further developed Chêneau brace derivative with individual design, which can be adapted through computer-aided design. OBJECTIVE: This study aims to generate a template to obtain a database for prospective multicenter studies study to analyze the results of high-corrective asymmetric Gensingen brace treatment for patients with adolescent idiopathic scoliosis (AIS). METHODS: A template for the database was created, which contains the patients' basic data (age, menarcheal status, Risser Sign, curve pattern, and daily brace wearing time), the Cobb angles of curvature, and the cosmetically relevant angles of trunk rotation (ATR). A retrospective review of medical records of patients with AIS, who met the Scoliosis Research Society's inclusion criteria for brace studies, was performed to test the feasibility of the template. Template items were filled in by the researchers. RESULTS: Out of 115 patients between 2014 and 2018, the complete data of 33 patients followed up at least 3 months after complete Gensingen brace weaning could be analyzed. The mean age was 12 years, the mean Cobb angle was 33.6°, and the mean Risser value was 0.7 at the beginning of the treatment. The mean improvement in the Cobb angle on in-brace x-ray imaging was -26.1० (80% of in-brace correction). The Cobb angle of the major curvature changed as follows: curve stabilization was achieved in 7 (21.2%) cases, and curve improvement was achieved in 26 (78.8%) cases. None of the patients showed a curve progression. The Cobb angle was significantly reduced in the brace at the end of treatment and at follow-up evaluation (P<.001). ATR improved significantly for thoracic (P<.001) and lumbar curves (P<.001). CONCLUSIONS: The database proved to be informative in the assessment of radiological and clinical outcome parameters. The example data set we have generated can be a helpful tool for professionals who work in clinics but do not store regular patient data. Especially with regard to different patient collectives worldwide, different results may be achieved with the same standards of care. In addition, the results of this study suggest that above-average correction effects with a full-time brace application lead to significant improvements in the Cobb angle after brace treatment has been completed.

The effect of Schroth Best Practice exercises and Cheneau brace treatment on perceptual and cognitive asymmetry in adolescent idiopathic scoliosis with thoracic major curve.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) patients have been found to exhibit cortical asymmetry. Although asymmetries in cortical structures have been found in patients with AIS, there has been no research on how conservative treatments affect cerebellar functional organization. AIMS: This study aimed to examine the impact of conservative treatments on perceptual and cognitive asymmetry in the auditory system assessed by dichotic listening in AIS patients with thoracic major curves. METHOD: This study involved 30 AIS patients and 21 healthy subjects. The intervention group used a Cheneau brace and performed 18 Schroth Best Practice (SBP) exercise sessions. Auditory lateralization was assessed using the Dichotic Listening Paradigm (DLP) in both groups before and after the intervention. RESULTS: The 6-week intervention resulted in a significant increase in left ear responses in the force-left condition in the AIS (p < 0.05). Left ear responses were lower in AIS at baseline (p < 0.05). The results at week 6 were similar in all conditions (p > 0.05). CONCLUSION: The results of this study demonstrated that SBP exercises and Cheneau brace treatment can improve perceptual and cognitive asymmetry in the auditory system in AIS patients with thoracic major curve. Scoliosis-associated changes in the spine and postural control may affect auditory perception by causing adaptations in sensory and motor networks. Future studies are needed to examine the connectivity in brain regions related to motor control and auditory processing after conservative treatment. TRIAL REGISTRATION: Clinical trials number: NCT06141759.

Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study.

BACKGROUND: Kinesio taping (KT) is one of the treatment methods used on patients with shoulder impingement syndrome (SIS). There are different results regarding its effectiveness in the literature. OBJECTIVE: To investigate the effects of scapular KT combined with a conventional physiotherapy program on scapular dyskinesia, shoulder pain, upper extremity function, and well-being in patients with SIS. METHODS: The study was conducted with 60 outpatients diagnosed with SIS, aged 40-65 years. The patients were divided into two groups: KT [conventional physiotherapy program + scapular KT (targets scapular retraction and is applied along the inferior-medial edge of the scapula, starting from the processus coracoids), n= 30] and control [conventional physiotherapy program, n= 30]. In before- and after-treatment evaluations, the Lateral Scapular Slide Test (LSST) for scapular dyskinesia, a Visual Analogue Scale (VAS) for shoulder pain, and the Disabilities of the Arm, Shoulder, and Hand (DASH) for upper extremity function were used. In addition, at the end of treatment, a Kinesio taping Satisfaction Survey, created by the researchers, was filled out by the KT group for the assessment of well-being. RESULTS: The interaction effect of Group*Time was not statistically significant in all outcome measures (p> 0.05). However, the main effect of both group and time was statistically significant in the DASH-Function/Symptom, VAS-Rest, VAS-Activity, and VAS-Night (p< 0.05). Moreover, only the main effect of time was statistically significant in LSST-1 and LSST-3 (p< 0.05). In the KT group, the satisfaction level was 8.50 ± 1.69 and the recommendation level was 8.72 ± 1.81. CONCLUSION: Both conventional physiotherapy programs and additional scapular KT improved scapular dyskinesia, reduced pain, and increased the upper extremity function. Adding scapular KT to treatment did not change the results, but it had positive psychological effects and yielded a high satisfaction rate.

Translation, reliability and validity of the Turkish version of Scoliosis Japanese Questionnaire-27 in adolescent idiopathic scoliosis.

PURPOSE: Disease-specific scales which evaluate QoL are needed to evaluate treatment outcomes, and to compare the effects of different treatments. The outcome measures evaluating quality of life in adolescent idiopathic scoliosis are limited. The purpose of this study was to examine the validity and reliability of the Turkish version of the Scoliosis Japanese Questionnaire-27 (SJ-27) in adolescent idiopathic scoliosis. METHODS: The SJ-27 questionnaire was translated into Turkish and 61 female patients filled out the translated version (TRv.SJ-27) twice to measure the test-retest reliability of the scale. Internal reliability of the questionnaire was estimated using Cronbach's α coefficient. The intraclass correlation coefficient was analysed for each item. Discriminant validity and convergent validity were determined by correlations with Cobb angle, ATR and the SRS-22r scale. RESULTS: The mean Cobb angle was 25.8° and the ATR angle was 8.8°. Cronbach's α value was estimated as 0.935. The test-retest correlation coefficient for the item-total score was 0.877 (p = 0.000). Validity analysis showed a significantly positive correlation between the TRv.SJ-27 total score and Cobb and ATR angles, and a significantly negative relationship was found between the TRv.SJ-27 and SRS-22r scores. CONCLUSIONS: It would be useful to use different outcome measures to assess the scoliosis-specific quality of life in clinical practice and research. The findings suggest that the Turkish version of Scoliosis Japanese Questionnaire-27 is a valid and reliable measure to assess Turkish patients with AIS.

The Effectiveness of the Schroth Best Practice Program and Chêneau-Type Brace Treatment in Adolescent Idiopathic Scoliosis: Long-Term Follow-Up Evaluation Results.

BACKGROUND: Although the number of studies showing the efficacy of conservative treatment in adolescent idiopathic scoliosis has increased, studies with long-term follow-up are very limited. The aim of this study was to present the long-term effects of a conservative management method including exercise and brace in adolescent idiopathic scoliosis patients. METHODS: This retrospective cohort study included patients with idiopathic scoliosis who presented at our department and were followed up for at least 2 years after completing the treatment. The main outcome measurements were the Cobb angle and angle of trunk rotation (ATR). RESULTS: The cohort participants were 90.4% female, with a mean age of 11 years and the maximum Cobb angle was mean 32.1°. The mean post-treatment follow-up period was 27.8 months (range 24-71 months). The improvements after treatment in mean maximum Cobb angle (p < 0.001) and ATR (p = 0.001) were statistically significant. At the end of treatment, the maximum Cobb angle was improved in 88.1% of the patients and worsened in 11.9% compared to baseline. In the long-term follow-up evaluations, 83.3% of the curvatures remained stable. CONCLUSIONS: The results of this study showed that moderate idiopathic scoliosis in growing adolescents can be successfully halted with appropriate conservative treatment and that long-term improvement is largely maintained.

Effects of Pilates exercises on idiopathic scoliosis: a scoping review of the literature.

PURPOSE: Scoliosis is a deformity involving changes in three planes. These changes include lateral curvature in the frontal plane, changes in physiological thoracic kyphosis and lumbar lordosis angles in the sagittal plane, and rotation of the vertebrae in the transverse plane. The aim of this scoping review was to review and summarize the available literature to determine whether Pilates exercises are an effective treatment for scoliosis. METHODS: The Cochrane Library (reviews, protocols, trials), PubMed, Web of Science, Ovid, Scopus, PEDro, Medline, CINAHL (EBSCO), ProQuest, and Google Scholar electronic databases were used to search for published articles from inception to February 2022. All the searches included English language studies. Keywords were determined as "scoliosis and Pilates" or "idiopathic scoliosis and Pilates", "curve and Pilates", "spinal deformity and Pilates." RESULTS: Seven studies were included; one study was a meta-analysis study, three studies compared Pilates and Schroth exercises, and three applied Pilates exercises in combined therapy. The studies included in this review used outcome measurements of Cobb angle, ATR, chest expansion, SRS-22r, posture assessment, weight distribution, and psychological factors such as depression. CONCLUSIONS: The results of this review suggest that the level of evidence regarding the effect of Pilates exercises on scoliosis-related deformity is very limited. Pilates exercises can be applied to reduce asymmetrical posture in individuals with mild scoliosis with reduced growth potential and progression risk.

Adaptation, reliability, and validation of the Turkish version of the Bad Sobernheim Stress Questionnaire-Deformity in patients with adolescent idiopathic scoliosis.

BACKGROUND: There is a limited number of disease-specific outcome measurement scales in Turkish, which can be used for individuals with adolescent idiopathic scoliosis (AIS). The aim of this study was to translate, adapt, and evaluate the validity and reliability of the Turkish version of the Bad Sobernheim Stress Questionnaire-Deformity (TRv.BSSQD) questionnaire in Turkish patients with AIS. OBJECTIVES: After the translation and back-translation process, the TRv.BSSQD and Scoliosis Research Society-22 questionnaires were completed in face-to-face interviews with 49 patients with AIS. The TRv.BSSQD questionnaire was readministered to the same patients 2 weeks later to assess test-retest reliability. RESULTS: The Cronbach alpha value calculated for internal reliability was 0.806. The intraclass correlation coefficient values of the items of the TRv.BSSQD ranged from 0.809 ( P < 0.001) (question 8) to 0.955 ( P < 0.001) (question 7). The test-retest correlation coefficient for the item-total score was 0.960 ( P < 0.001). Validity analysis showed a significantly positive correlation between the TRv.BSSQD total score and pain, self-image, and mental subgroup and the total scores of the SRS-22r scale ( P < 0.05). CONCLUSIONS: This patient-reported outcome instrument, the TRv.BSSQD, showed good internal consistency, good reliability with test-retest analysis, and construct validity, suggesting that it is an appropriate assessment instrument for Turkish patients with AIS.

The reliability of the augmented Lehnert-Schroth and Rigo classification in scoliosis management.

BACKGROUND: In pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems. OBJECTIVE: To test the reliability of the augmented Lehnert-Schroth (ALS) classification and the Rigo classification. METHODS: X-rays and posterior photographs of 45 patients with scoliosis were sent by the first author to three clinicians twice at 1-week intervals. The clinicians classified images according to the ALS and Rigo classifications, and the data were analysed using SPSS V-16. Intraclass correlation coefficients (ICCs) and standard error measurement (SEM) were calculated to evaluate the inter- and intra-observer reliability. RESULTS: The inter-observer ICC values were 0.552 (ALS), 0.452 (Rigo) for X-ray images and 0.494 (ALS), 0.518 (Rigo) for the photographs. The average intra-observer ICC value was 0.720 (ALS), 0.581 (Rigo) for the X-ray images and 0.726 (ALS) and 0.467 (Rigo) for the photographs. CONCLUSIONS: The results of our study indicate moderate inter-observer reliability for X-ray images using the ALS classification and clinical photographs using the Rigo classification. Intra-observer reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification. CLINICAL IMPLICATIONS: Pattern classifications assist in creating a plan and indication of correction in specific scoliosis physiotherapy and pattern-specific brace applications and surgical treatment. More sub-types are needed to address the individual patterns of curvature. The optimisation of curve classification will likely reduce failures in diagnosis and treatment.

Investigation of the perceptual and cognitive asymmetry in the auditory system in patients with adolescent idiopathic scoliosis.

BACKGROUND: Studies have shown that perceptual and cognitive asymmetries are present in the auditory system in patients with adolescent idiopathic scoliosis (AIS). The Dichotic Listening (DL) paradigm was formerly performed in non-forced (NF) conditions only, and no study has examined the conditions of attention to one ear. OBJECTIVE: To investigate the perceptual and cognitive asymmetry in the auditory system in patients with AIS as well as the asymmetry changes according to the curvature characteristics of patients with AIS. METHOD: The DL paradigm was performed on 38 patients with AIS and 10 healthy individuals in all conditions (NF, Forced Right [FR], Forced Left [FL]). RESULTS: In the NF and FL conditions, the mean number of correct responses for the left ear was significantly lower in patients with AIS than in healthy individuals (p < 0.05). The correct responses for the right ear in the NF condition, right and left ear in the FR condition, and right ear in the FL condition did not show a significant difference between the groups (p > 0.05). Also, there was no difference between patients with AIS with both functional 3-curve and 4-curve (p > 0.05). CONCLUSION: Our study indicates perceptual and cognitive asymmetry or lateralisation in the auditory system in patients with AIS. The asymmetry might be caused by the inability to direct their attention to the left ear, which is not affected by their curvature type. Further studies are needed to investigate perceptual and cognitive asymmetry behaviour models in the auditory system in patients with AIS. CLINICAL IMPLICATIONS: Determination of perceptual and cognitive asymmetry in the auditory system may offer a new perspective on conservative treatment protocols for AIS patients. Besides, the DL paradigm can be easily used in patients with AIS as a non-invasive evaluation method in clinics.