The effect of stretching exercises before orthotic treatment on the immediate in-orthosis correction of the patients with adolescent idiopathic scoliosis: A pilot study.

BACKGROUND: Stretching exercise is generally used for improving flexibility. However, its application to promote orthotic treatment for patients with adolescent idiopathic scoliosis (AIS) remains unknown. OBJECTIVE: This study was to explore the effect of pre-orthosis stretching exercises on spinal flexibility and initial in-orthosis correction for the patients with AIS. STUDY DESIGN: A pilot-controlled study. METHODS: An experimental group (EG) of 13 subjects (10 girls and 3 boys) with AIS allocating to self-stretching exercises and a control group (CG) of 19 AIS subjects (14 girls and 5 boys) with no stretching before orthosis fitting were recruited. The spinal flexibility of the EG was evaluated with an ultrasound imaging system and physical measurements. The initial in-orthosis correction rates between the 2 groups were compared with the independent t test, and the correlation analysis between the spinal flexibility measured from ultrasound images and physical measurement was performed with the Pearson correlation test. RESULTS: The initial Cobb angle of EG and CG were 25.70° ± 7.30° and 28.09° ± 5.58°, respectively. No significant difference was observed between the initial in-orthosis Cobb angle of EG (11.13° ± 6.80°) and CG (15.65° ± 9.10°) (p = 0.06). However, the spinal flexibility after stretching exercises was improved (p < 0.001), and the spinal flexibility changes measured with ultrasound and physical forward-bending method were significantly correlated (r = 0.57, p < 0.05). CONCLUSION: Stretching exercises before orthotic treatment could improve the spinal flexibility but did not cause a better in-orthosis correction. A study with a larger sample size and longer follow-up period should be conducted to investigate the long-term effect of stretching exercises.

Reliability and validity of assessing lower-limb muscle architecture of patients with cerebral palsy (CP) using ultrasound: A systematic review.

AIMS: To investigate the reliability, validity, and level of evidence of applying ultrasound in assessing the lower-limb muscles of patients with cerebral palsy (CP). METHOD: Publications in Medline, PubMed, Web of Science, and Embase were searched on May 10, 2023, to identify and examine relevant studies investigating the reliability/validity of ultrasound in evaluating the architecture of CP lower-limb muscles systematically, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. RESULTS: Out of 897 records, 9 publications with 111 CP participants aged 3.8-17.0 years were included (8 focused on intra-rater and inter-rater reliability, 2 focused on validity, and 4 were with high quality). The ultrasound-based measurements of muscle thickness (intra-rater only), muscle length, cross-sectional area, muscle volume, fascicle length, and pennation angle showed high reliability, with the majority of intraclass correlation coefficient (ICC) values being larger than 0.9. Moderate-to-good correlations between ultrasound and magnetic resonance imaging measurements existed in muscle thickness and cross-sectional area (0.62 ≤ ICC ≤ 0.82). INTERPRETATION: Generally, ultrasound has high reliability and validity in evaluating the CP muscle architecture, but this is mainly supported by moderate and limited levels of evidence. More high-quality future studies are needed.

Fostering integration among students with different backgrounds using an orthotic community service program.

BACKGROUND: In this globalization era, institutions are developing strategies including international service-learning pedagogies to integrate global perspectives and dimensions into the learning and teaching processes to develop students' capacity in intercultural competence. OBJECTIVE: This study aimed to assess the students' intercultural learning outcome through provision of orthotic community service to the less-privileged children. METHODS: A Hong Kong-based university collaborated with 2 American universities to conduct an orthotic community service program for the children with cerebral palsy in mainland China. In the process of service delivery, the students with different backgrounds worked closely and students' professional knowledge, intercultural understanding, and communication skills were evaluated. A mixed-method approach was adopted to investigate on how this international program could facilitate meaningful interactions in clinical practices. Preprogram and postprogram surveys and focus group interviews were conducted. Statistical analyses were performed on the quantitative data, while interview data were analyzed thematically. RESULTS: A comparison of preprogram and postprogram surveys showed that the students perceived this community service program important for enhancement of their capabilities to communicate with people from other cultures (n = 39, p < 0.05). It also showed an increase in local students' willingness to work with people from other cultures. Some themes related to intercultural competences were identified from the interview: "intercultural awareness, understanding, and communication" as well as openness to work/socialize with people from other cultures." CONCLUSIONS: This study demonstrated that an international community service program could initiate positive changes in students' intercultural communication capability and interest to work with culturally different people.

Effect of different undergarment designs on the compliance and acceptance of the patients with adolescent idiopathic scoliosis under orthotic treatment.

BACKGROUND: Patient's acceptance and compliance to spinal orthosis could influence the outcome of orthotic treatment in adolescent idiopathic scoliosis. Two innovative undergarments (thin and thick designs) were designed to improve the patient's orthosis wearing experience and acceptance. OBJECTIVE: This study aimed to evaluate the effects of patients' self-provided undergarment and 2 newly designed undergarments with respect to the orthosis wearing compliance and quality of life (QoL) measures. METHODS: A prospective randomized-controlled study was conducted to compare the effect of three types of undergarments. Thirty-eight subjects with adolescent idiopathic scoliosis were randomly assigned to one of the three groups: self-provided, thin-design, or thick-design undergarment. Wearing compliance logbook, Scoliosis Research Society questionnaire, and Brace Questionnaire were used to document the orthosis wearing period and quantify the health-related and orthosis-related QoL measures. Kruskal-Wallis one-way analysis of variance (ANOVA) and Friedman two-way ANOVA by ranks tests were conducted for intergroup and intragroup comparisons, respectively. RESULTS: The compliance and QoL domains of the subjects in the thin-design undergarment group were significantly higher than those of the other two undergarment groups (P < .05). The intragroup compliance and QoL scores varied significantly in the 4 visits throughout the study period (P < .05). CONCLUSIONS: It was observed that an adaptation period toward the prescribed spinal orthosis is required to help patients gradually achieve a more stable acceptance. The thin-design undergarment was ranked higher than the other two tested undergarments in compliance and QoL measures.

Compliance study of hip protector users for prevention of fragility fracture: A pilot randomized trial.

BACKGROUND: Hip protectors have been widely used for hip fracture prevention in the elderly, but its efficacy remains controversial. Users' compliance to hip protector is an important factor for its efficacy. However, the assessment of users' compliance tended to be subjective and unreliable in the past. OBJECTIVES: To quantify the elderly's compliance to hip protectors and investigate the effect of different underpant designs on the elderly's compliance. STUDY DESIGN: A pilot randomized trial. METHODS: Thirty-one participants were recruited and provided with hip protectors in which compliance monitors were installed and delivered with three pairs of either the conventional underpants or the purpose-design underpants randomly. Participants were encouraged to use the hip protectors with the assigned underpants for whole day. After 4 weeks, compliance data were downloaded from the compliance monitors. Participants were also asked to fill a survey form for acceptance analysis. The Spearman correlation coefficient and the Wilcoxon signed-rank test/2 independent samples t test/Mann-Whitney U test were used for the corresponding statistical analyses. RESULTS: Thirty-one participants were recruited initially. Eighteen participants were excluded from instrumented compliance analysis because of limited or no data collection. The data of the resting 13 participants (six in the conventional underpants group and seven in purpose-design underpants group) were analyzed and showed an average instrumented compliance of 77.5% which was lower than the average self-reporting compliance (83.3%) of all the available 23 participants (eight of 31 became wheelchair-bounded). Participants' compliance was positively correlated with their acceptance to the hip protectors and significantly higher in the purpose-design underpants group than in the conventional underpants group ( P < 0.05). CONCLUSIONS: This pilot study demonstrated a feasible protocol for compliance quantification of the elderly to the hip protectors, the importance to have an objective compliance measure to assess users' actual compliance, and purpose-design underpants could improve the users' compliance. Future studies with long-term observation and large sample size deserve further proof of the current findings.

Estimation of plane of maximum curvature for the patients with adolescent idiopathic scoliosis via a purpose-design computational method.

PURPOSE: The coronal Cobb angle is commonly used for assessing the adolescent idiopathic scoliosis (AIS); however, it may underestimate the severity of AIS while the plane of maximum curvature (PMC) could be a promising descriptor for three-dimensional assessment of AIS. This study aimed to develop a computational method (CM) for estimating the PMC based on the coronal and sagittal images of the spine, and to verify the results with computed tomography (CT). METHODS: Twenty-eight thoracic and 24 lumbar curves from 30 subjects with AIS were analysed. For the CM, PMC was estimated via identifying the two corner points at the superior endplate of upper-end vertebra and the inferior endplate of lower-end vertebra in the coronal and sagittal CT images separately (eight corner points in total). For the CT, PMC was determined through rotating the spine images axially until the maximum Cobb angle was found. Intraclass correlation coefficient (ICC), Bland-Altman method and linear regression analysis were used for the statistical analyses. RESULTS: The high ICC values (intra- > 0.91; inter- > 0.84) suggested very good intra- and inter-rater reliability of the CM in PMC estimation. The high ICC values (> 0.91) and assessment of Bland-Altman method demonstrated a good agreement between the PMC acquired using the CM and CT. The generated linear regression equations (R2 > 0.69) could allow to estimate the PMC (originally measured through the CT) via the CM. CONCLUSION: The developed computational method could estimate reliable and valid PMC for the patients with AIS, and become feasible for three-dimensional assessment of AIS. LEVEL OF EVIDENCE: III.

Assessment of the plane of maximum curvature for patients with adolescent idiopathic scoliosis via computed tomography.

BACKGROUND: In the assessment of three-dimensional features of adolescent idiopathic scoliosis, the plane of maximum curvature was compared with the coronal Cobb angle. OBJECTIVES: To investigate the intrarater reliability, variability, and difference of the prone plane of maximum curvature measurements taken from computed tomography using the constrained and unconstrained Cobb methods; to assess the difference and correlation between the prone plane of maximum curvature measurements obtained using the constrained and unconstrained Cobb methods; and to examine differences and correlation between the prone plane of maximum curvature Cobb angle and coronal Cobb angle measurements. STUDY DESIGN: Retrospective study. METHODS: Records of 29 subjects with adolescent idiopathic scoliosis aged 15.8 ± 3.5 years were reviewed (25 thoracic and 24 thoracolumbar/lumbar curves). An experienced rater measured the plane of maximum curvature using the constrained and unconstrained Cobb methods, and the coronal Cobb angles using the conventional Cobb method on computed tomography images 3 times each with 1-week interval. The intraclass correlation coefficient (2,1), Pearson correlation coefficient (r), one-way repeated measures analysis of variance, and paired t test were applied for various analyses. RESULTS: The intraclass correlation coefficients for all intrarater reliability assessments were greater than 0.87. The plane of maximum curvature measurements of the two Cobb methods were excellently correlated (r ⩾ 0.97) with no significant difference (P > 0.05). The mean plane of maximum curvature Cobb angle was moderately correlated with (r > 0.72) but significantly greater (P < 0.001) than the mean coronal Cobb angle. CONCLUSION: The plane of maximum curvature measurements obtained from computed tomography were found to be reliable while the plane of maximum curvature measurements of the two Cobb methods were comparable. The mean plane of maximum curvature Cobb angle was moderately correlated with but significantly greater than the mean coronal Cobb angle. CLINICAL RELEVANCE: The plane of maximum curvature measurements taken from computed tomography was found to be reliable, hence it could be used as a supplement to the coronal Cobb angle in the assessment and management of adolescent idiopathic scoliosis. With technological advancement, the radiation dose of computed tomography can be further reduced to a safer level for a broader range of cases.

Reliability and validity of lateral curvature assessments using clinical ultrasound for the patients with scoliosis: a systematic review.

PURPOSE: Clinical ultrasound is radiation-free, low cost and user friendly, which makes it probable in assessment of scoliosis. Numerous studies have been conducted about the feasibility of using clinical ultrasound to assess scoliosis; thus, an inclusive review of the literature would be beneficial for researchers, clinicians and patients. This study aimed to systematically review the reliability and validity of coronal curvature assessments obtained from different clinical ultrasound imaging methods. METHODS: A comprehensive search of 6 databases and Google Scholar search engine was performed for retrieving articles assessing reliability and/or validity of spinal curvature measurements obtained from clinical ultrasound. Two reviewers assessed the methodological quality of selected articles independently using criteria appraisal instrument. The results were analysed and synthesized qualitatively using level of evidence method. RESULTS: Fourteen articles were included. Thirteen articles investigated both the reliability and validity, of which nine were of high quality; and one article evaluated only the reliability and was of high quality. Totally five ultrasound methods were evaluated. Very high reliability (intra-class correlation coefficient = 0.80-1.00) but limited levels of evidence were found for the majority of the studied ultrasound methods. Almost all the methods showed good to excellent validity (correlation coefficient = 0.76-1.00) but limited to moderate levels of evidence. CONCLUSION: A high level of evidence was found in support of the reliability and validity of the COL (centre of lamina) ultrasound method. Further reliability and validity studies should be conducted to strengthen the level of evidence for those ultrasound methods with moderate, limited or conflicting level of evidence. These slides can be retrieved under Electronic Supplementary Material.