Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Impact of a physical rehabilitation program on the respiratory function of adolescents with idiopathic scoliosis. Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients Braces for Idiopathic Scoliosis in Adolescents Objective Assessment of the Cardiorespiratory Function of Adolescents With Idiopathic Scoliosis Through the Six-Minute Walk Test Spinal Range of Motion, Muscle Endurance, and Back Pain and Function at Least 20 Years After Fusion or Brace Treatment for Adolescent Idiopathic Scoliosis: A Case-Control Study The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study
BACKGROUND The feasibility of conducting a definitive r and omised controlled trial ( RCT ) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises ( SSEs ) for adolescent idiopathic scoliosis ( AIS ) is uncertain . OBJECTIVES The aim of this study was to assess the feasibility of conducting a large , multicentre trial of SSE treatment for patients with AIS , in comparison with st and ard care , and to refine elements of the study design . The objectives were to ( 1 ) up date a systematic review of controlled trials evaluating the efficacy of SSE in AIS ; ( 2 ) survey UK orthopaedic surgeons and physiotherapists to determine current practice , patient population s and equipoise ; ( 3 ) r and omise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites ; ( 4 ) develop , document and assess acceptability and adherence of interventions ; ( 5 ) assess and describe training requirements of physiotherapists ; and ( 6 ) gain user input in all relevant stages of treatment and protocol design . DESIGN Multicomponent feasibility study including UK clinician survey , systematic literature review and a r and omised feasibility trial . SETTING The r and omised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS . PARTICIPANTS The r and omised feasibility study recruited people aged 10 - 16 years with mild AIS ( Cobb angle of < 50 ° ) . INTERVENTIONS The r and omised study allocated participants to st and ard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan . Our choice of intervention was informed by a systematic review of exercise interventions for AIS . MAIN OUTCOME MEASURES The main outcome was feasibility of recruitment to the r and omised study . Other elements were to inform choice of outcomes for a definitive trial and included curve severity , quality of life , requirement for surgery/brace , adverse events , psychological symptoms , costs and health utilities . RESULTS A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services . It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study . A systematic review up date found five new studies that were generally of low quality but showed some promise of effectiveness of SSE . The r and omised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month , with acceptable 6-month follow-up ( currently 73 % ) . Adherence to treatment was variable ( 56 % of participants completed treatment offered ) . The qualitative study found the exercise programme to be highly acceptable . We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation , as well as practical elements such as scheduling of intervention sessions . CONCLUSIONS A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible . Such a RCT is a priority for future work in the area . There is a sufficiently large patient base , combined with willingness to be r and omised within specialist UK centres . Interventions developed during the feasibility study were acceptable to patients , families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning . TRIAL REGISTRATION Current Controlled Trials IS RCT N90480705 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 55 . See the NIHR Journals Library website for further project information BACKGROUND CONTEXT Three-dimensional ( 3D ) deformations of the spine are predominantly characterized by two-dimensional ( 2D ) angulation measurements in coronal and sagittal planes , using anteroposterior and lateral X-ray images . For coronal curves , a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice , and these methods have been shown to exhibit good-to-excellent reliability and reproducibility , carried out either manually or by computer-based tools . Recently , an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column . PURPOSE Comparison of accuracy , correlation of measurement values , intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting . STUDY DESIGN / SETTING Retrospective nonr and omized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009 . PATIENT SAMPLE In total , 201 individuals ( 170 females , 31 males ; mean age , 19.88 years ) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis ( 175 cases ) , adult degenerative scoliosis ( 11 cases ) , and Scheuermann hyperkyphosis ( 5 cases ) .  Overall range of coronal curves was between 2.4 ° and 117.5 ° . Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation : 0 ° to 10 ° ( Group 1 , n=36 ) , 10 ° to 25 ° ( Group 2 , n=25 ) , 25 ° to 50 ° ( Group 3 , n=69 ) , 50 ° to 75 ° ( Group 4 , n=49 ) , and more than 75 ° ( Group 5 , n=22 ) . METHODS Coronal and sagittal curvature measurements were determined by three experienced examiners , using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions . Manual measurements were performed three times , and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner . Means comparison t test , Pearson bivariate correlation analysis , reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software ( IBM Corp. , Armonk , NY , USA ) . No funds were received in support of this work . No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article . RESULTS In comparison with manual 2D methods , only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data . Intraobserver reliability was excellent for both methods , and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations . CONCLUSIONS This is the first clinical report on EOS 2D/3D system ( EOS Imaging , Paris , France ) and its sterEOS 3D software , documenting an excellent capability for accurate , reliable , and reproducible spinal curvature measurements BACKGROUND Idiopathic adolescent scoliosis ( AIS ) causes not only spinal deformities but rib cage abnormalities that lead to abnormal volumes and pulmonary capacity on pulmonary function testing ( PFT ) . The objective of this study was to analyze the impact of a physical rehabilitation program on respiratory function in surgical patients with AIS . METHODS From October 2003 to October 2004 , a total of 34 patients ( age range , 10 to 18 years ) presenting with AIS and a thoracic curvature between 45 degrees and 88 degrees were studied prospect ively at a tertiary academic hospital . The patients underwent clinical and radiographic evaluations of the  vertebral deformity , chest radiographs , PFT , evaluation of peak expiratory flow , and 6-min walk tests ( 6MWTs ) before and after joining a physical rehabilitation program for 4 months . RESULTS An improvement in FVC , inspiratory capacity , FEV(1 ) , expiratory reserve volume , and performance assessed by 6MWT were observed after rehabilitation . CONCLUSIONS Global conditioning improved after the rehabilitation program . This was expressed by both PFT and 6MWT results The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis ( AIS ) was investigated . Sixteen ( 16 ) AIS patients with progressing or high-risk curves ( Cobb 's angle between 25 ° and 35 ° at start and reducible by lateral bending ) were fitted with a device with tone alarm for poor posture . In the first 18 months of application , 3 patients defaulted and 4 showed curve progression > 10 ° ( 2 changed to rigid spinal orthoses and 2 underwent surgery ) . The curves for the other 9 patients were kept under control ( within ±5 ° of Cobb 's angle ) and 5 of them have reached skeletal maturity and terminated the application . The remaining 4 patients were still using the devices until skeletal maturity or curve progression . The curve control rate was 69 % . A long-lasting active spinal control could be achieved through the patient 's own spinal muscles . Nevertheless , before the postural training device could become a treatment modality , a long-term study for more AIS patients was necessary . This project is ongoing in the Duchess of Kent Children 's Hospital , S and y Bay , Hong Kong Study Design . A Cochrane systematic review . Objective . To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments , on quality of life , disability , pulmonary disorders , progression of the curve , psychological , and cosmetic issues . Summary of Background Data . Idiopathic scoliosis is a three-dimensional deformity of the spine . The most common form is diagnosed in adolescence . Although adolescent idiopathic scoliosis ( AIS ) can progress during growth and cause a surface deformity , it is usually not symptomatic . Methods . We search ed CENTRAL , MEDLINE , EMBASE , five other data bases , and two trials registers up to February 2015 . We also checked reference lists and h and search ed grey literature . R and omized controlled trials ( RCTs ) and prospect i ve controlled cohort studies comparing braces with no treatment , other treatment , surgery , and different types of braces for adolescent with AIS . We used st and ard method ological procedures expected by the Cochrane Collaboration . Results . We included seven studies . Five were planned as RCTs , two as prospect i ve controlled clinical trials . One RCT failed completely , another was continued as an observational study . There was very low quality evidence from one small RCT that quality of life ( QoL ) during treatment did not differ significantly between rigid bracing and observation . Conclusion . Two studies showed that bracing did not change QoL during treatment , and QoL , back pain psychological and cosmetic issues in the long term ( 16 years . ) All articles showed that bracing prevented curve progression . The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject r and omization of their children . Level of Evidence : Study Design . Clinical prospect i ve , r and om study . Objective . Analyze the results of the six-minute walk test ( 6MWT ) in patients with adolescent idiopathic scoliosis . Summary of Background Data . Although it is widely believed that Adolescent Idiopathic Scoliosis ( AIS ) causes cardiorespiratory dysfunctions , there is no report in literature of objective measurements of this restriction in the ventilatory performance during physical exertion . Methods . One hundred twenty-six adolescents matched by gender and age were prospect ively studied at a tertiary teaching institution : 40 patients without spine deformities ( group I – controls ) , and 86 patients with AIS with a spine curve ranging from 45 ° to 138 ° ( group II ) . All patients underwent radiographic evaluations and the 6MWT . Results . Normal controls presented significantly lower mean heart rate and Borg scores , as well as higher oxygen saturation and walked longer distances on the 6MWT . Conclusion . The 6MWT effectively demonstrated the cardiorespiratory restrictions presented by patients with AIS Study Design . A consecutive series of patients with adolescent idiopathic scoliosis ( AIS ) , treated between 1968 and 1977 before 21 years of age with either distraction and fusion using Harrington rods ( ST , n = 156 ; 145 females and 11 males ) or with brace ( BT , n = 127 ; 122 females and 5 males ) , were followed at least 20 years after completion of the treatment . Objectives . To determine the long-term outcome in terms of spinal mobility and muscle strength and its possible correlations to present back pain and function in patients surgically or brace treated for AIS . Summary of Background Data . Few reports on long-term outcome on these variables have previously been presented for this group of patients . Methods . A total of 135 ( 87 % ) of ST and 102 ( 80 % ) of BT patients underwent a complete examination by two unbiased observers incl . evaluation of lumbar muscle endurance and spinal mobility , curve size ( Cobb method ) , vali date d question naires in terms of general and disease-specific quality of life aspects , as well as present back function and pain . An age- and sex-matched control group of 100 persons was r and omly selected and subjected to the same examinations . Results . For both ST and BT groups , lumbar spinal motion as well as muscle endurance were significantly decreased compared with controls . For ST patients , better lumbar extensor and flexor muscle endurance or lumbar spinal mobility correlated with a better physical function . The length of fusion into the lumbar spine correlated inversely with lumbar range of motion , but the finger-floor distance was not affected . BT patients with reduced lumbar spinal mobility experienced lumbar back pain more often than controls . Conclusions . For both brace treated and surgically treated AIS patients , spinal mobility and muscle endurance were reduced more than 20 years after completed treatment . The physical function was not severely restricted Background Recently an RCT confirmed brace efficacy in adolescent idiopathic scoliosis ( AIS ) patients . Previously , a Cochrane review suggested also producing studies according to the Scoliosis Research Society ( SRS ) criteria on the effectiveness of bracing for AIS . Even if the SRS criteria propose a prospect i ve design , until now only one out of 6 published studies was prospect i ve . Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment ( SOSORT ) criteria for AIS conservative treatment . Methods Study design / setting : prospect i ve cohort study nested in a clinical data base of all out patients of a clinic specialized in scoliosis conservative treatment . Patient sample : seventy-three patients ( 60 females ) , age 12 years 10 months ±17 months , 34.4±4.4 Cobb degrees , who satisfied SRS criteria were included out of 3,883 patients at first evaluation . Outcome measures : Cobb angle at the end of treatment according to SRS criteria : ( unchanged ; worsened 6 ° or more , over 45 ° and surgically treated , and rate of improvement of 6 ° or more).Braces were prescribed for 18–23 hours/day according to curves magnitude and actual international guidelines . Weaning was gradual after Risser 3 . All patients performed exercises and were managed according to SOSORT criteria . Results in all patients were analyzed according to intent-to-treat at the end of the treatment . Funding and Conflict of Interest : no. Results Overall 34 patients ( 52.3 % ) improved . Seven patients ( 9.6 % ) worsened , of which 1 patient progressed beyond 45 ° and was fused . Referred compliance was assessed during a mean period of 3 years 4 months ±20 months ; the median adherence was 99.1 % ( range 22.2 - 109.2 % ) . Employing intent-to-treat analysis , there were failures in 11 patients ( 15.1 % ) . At start , these patients had statistically significant low BMI and kyphosis , high thoracic rotation and higher Cobb angles . Drop-outs showed reduced compliance and years of treatment ; their average scoliosis at discontinuation was low : 22.7 ° ( range 16 - 35 ° ) at Risser 1.3 ± 1 . Conclusions Bracing in patients with AIS who satisfy SRS criteria is effective . Combining bracing with exercise according to SOSORT criteria shows better results than the current literature
iPhone measurements correlated well with scoliometer measurements .
2D photography results had a moderate to high correlation with 3D topography results .
Conclusions Overall , strong levels of evidence exist for iPhone and scoliometer measurements , with a high to very high reliability and moderate to very high validity .
Limited evidence exists for aesthetic tools TRACE and AI and 2D photography .
These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy setting s to assess postural asymmetry ; however , these only exist for measurement in the transverse plane , despite 3D characteristics of AIS .
Abstract Purpose As accurate and reproducible measurements of spinal curvature are crucial in the examination of patients with adolescent idiopathic scoliosis ( AIS ) , this systematic review aims to report on the reliability and validity of a range of inexpensive and easily administered anthropometric methods of postural asymmetry measurement in an AIS population , to inform practice in a clinical setting .