PDA

View Full Version : Boston Brace Long-Term Follow-Up



LindaRacine
09-05-2011, 04:36 PM
Scoliosis. 2011 Aug 31;6(1):18. [Epub ahead of print]
Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis.
Lange JE, Steen H, Gunderson RB, Brox JI.
Abstract
ABSTRACT:

BACKGROUND:
It is recommended that research in patients with idiopathic scoliosis should focus on short- and long-term patient-centred outcome. The aim of the present study was to evaluate outcome in patients with late-onset juvenile or adolescent idiopathic scoliosis 16 years or more after Boston brace treatment.

METHODS:
272 (78%) of 360 patients, 251 (92%) women, responded to follow-up examination at a mean of 24.7 (range 16 - 32) years after Boston brace treatment. Fifty-eight (21%) patients had late-onset juvenile and 214 had adolescent idiopathic scoliosis. All patients had clinical and radiological examination and answered a standardised questionnaire including work status, demographics, General Function Score (GFS) (100 - worst possible) and Oswestry Disability Index (ODI) (100 - worst possible), EuroQol (EQ-5D) (1 - best possible), EQ-VAS (100 - best possible), and Scoliosis Research Society - 22 (SRS - 22) (5 - best possible).

RESULTS:
The mean age at follow-up was 40.4 (31-48) years. The prebrace major curve was in average 33.2 (20 - 57)o. At weaning and at the last follow-up the corresponding values were 28.3 (1 - 58)o and 32.5 (7 - 80)o, respectively. Curve development was similar in patients with late-onset juvenile and adolescent start. The prebrace curve increased > 5o in 31% and decreased > 5o in 26%. Twenty-five patients had surgery. Those who did not attend follow-up (n=88) had a lower mean curve at weaning: 25.4 (6-53)o. Work status was 76% full-time and 10% part-time. Eighty-seven percent had delivered a baby, 50% had pain in pregnancy. The mean (SD) GFS was 7.4 (10.8), ODI 9.3 (11.0), EQ-5D 0.82 (0.2), EQ-VAS 77.6 (17.8), SRS-22: pain 4.1 (0.8), mental health 4.1 (0.6), self-image 3.7 (0.7), function 4.0 (0.6), satisfaction with treatment 3.7 (1.0). Surgical patients had significantly reduced scores for SRS-physical function and self-image, and patients with curves [greater than or equal to] 45degrees had reduced self-image.

CONCLUSION:
Long-term results were satisfactory in most braced patients and similar in late-onset juvenile and idiopathic adolescent scoliosis.

jrnyc
09-05-2011, 05:30 PM
i do not understand what "satisfactory" means in this study...
does that mean the patients were glad they wore the brace...
or does it mean some didn't need surgery because they wore the brace..?

i do not mean to ask a stupid question...but i do not get the
conclusion...?

jess

Pooka1
09-05-2011, 05:54 PM
I agree with Jess.

The only relevant issue is did brace wear beat natural history in terms of avoiding surgery.

LindaRacine
09-05-2011, 06:35 PM
Satisfaction is in the eye of the beholder. I'm guessing that the question was simply something like "Are you satisfied with the results of your treatment."

jrnyc
09-05-2011, 07:04 PM
thanks for the explanation, Linda...

i just thought scientific studies weren't supposed to be subjective...
i didn't think they used words that are so open to interpretation...
thought they were supposed to measure things in an objective way....

jess...& Sparky
http://i1085.photobucket.com/albums/j439/jrrnyc/Sparky-Quilt.jpg

LindaRacine
09-05-2011, 07:12 PM
thanks for the explanation, Linda...

i just thought scientific studies weren't supposed to be subjective...
i didn't think they used words that are so open to interpretation...
thought they were supposed to measure things in an objective way....

jess...& Sparky
http://i1085.photobucket.com/albums/j439/jrrnyc/Sparky-Quilt.jpg


If the question was worded something like "How satisfied are you with the results of your brace treatment?" And the possible answers are Very Satisfied, Satisfied, Neither Satisfied nor Dissatisfied, Dissatisfied, or Very Dissatisfied, the result would be subjective, no?

--Linda

jrnyc
09-05-2011, 07:17 PM
is the measure of a "successful"brace treatment the permanent reduction of curve size?...
or is it never needing fusion surgery....?
or both?

jess

Pooka1
09-05-2011, 07:23 PM
Braces don't claim to permanently reduce curve size. That has never been documented to my knowledge.

If the curve went down it is far more likely that it resolved on its own which has been documented to occur.

LindaRacine
09-05-2011, 07:31 PM
is the measure of a "successful"brace treatment the permanent reduction of curve size?...
or is it never needing fusion surgery....?
or both?

jess

It's not the authors' measure. They're simply reporting on how the patients in the study responded to a questionnaire.