Wear your brace - It usually works if you wear it properly!

[Ballet Mom]

For those who may believe that bracing doesn't work, this study below shows the difference between those who were compliant with bracing and those who weren't.

In my mind, this proves that bracing does work because if bracing had no effect there would be no difference between these two groups of brace wearers!!

i.e. In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075).

Now, if they just did a big enough study (Braist perhaps) and showed these kinds of results, even without a control group...you could certainly say that bracing was effective if used properly and with a good correction.




Journal of Pediatric Orthopaedics:
July/August 2005 - Volume 25 - Issue 4 - pp 420-422
doi: 10.1097/01.bpo.0000161097.61586.bb
Spine: Original Article

The Association Between Brace Compliance and Outcome for Patients With Idiopathic Scoliosis

Rahman, Tariq PhD; Bowen, J Richard MD; Takemitsu, Masakazu MD; Scott, Claude MD

Abstract
This was a prospective study on the association of brace compliance and curve progression in idiopathic scoliosis. Compliance was measured electronically by embedding a temperature sensor and logger in the Wilmington scoliosis brace. To date there have been no studies that relate objective measures of compliance in a scoliosis brace to treatment outcomes.

Thirty-four subjects with idiopathic scoliosis were monitored over the duration of their brace wear. Compliance data were downloaded and analyzed.

The compliance rate for the patients whose curve progressed (>5 degrees) was 62%; the compliance rate for the patients who did not progress was 85% (P = 0.004).

In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075).

Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome.

[Ballet Mom]

Hmmm,

Maybe this should actually be in the Research section?

[txmarinemom]

Hmmm,

Maybe this should actually be in the Research section?

I don't know where it should be. Maybe a new area titled "My Interpretation of the Research".

BalletMom, I'm not going to digress into this whole thing again, but:

"Wear your brace - It usually works if you wear it properly!" <> "Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome."

There's a logic flaw there.

[Ballet Mom]

I don't know where it should be. Maybe a new area titled "My Interpretation of the Research".

BalletMom, I'm not going to digress into this whole thing again, but:

"Wear your brace - It usually works if you wear it properly!" <> "Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome."

There's a logic flaw there.


And what flaw would that be? I don't see any flaw there at all.

[txmarinemom]

And what flaw would that be? I don't see any flaw there at all.

I hope you aren't serious. Let's try a variation of one of Sharon's recent analogies ...

What you effectively stated in your comparison is something like:



"Ride in cars and you'll usually crash!"

=

"The more you ride in a car, the more likely you are to be involved in a crash".


See it yet?

[Ballet Mom]

Please explain this result:

"In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075)."

Those who wore their brace compliantly had a rate of 11% who progressed. Those who did not, 56% progressed. Do you see the advantage in wearing a brace compliantly?

I think this absolutely shows that braces worn as directed do make a difference.

[Pooka1]

This is all in brace and that is clearly stated.


Thirty-four subjects with idiopathic scoliosis were monitored over the duration of their brace wear.

I hope they follow ALL these kids to see where their curves are 2 years after all brace wear stops.

I won't hold my breath.

The other thing is I want to see if the T curves ended up being stacked in the non-compliant group. It if turns out most of the compliant group had L curves and most of the non-compliant group had T curves they the study is not useful. And I want to see the distribution of curve magnitude in each group before I agree the bracing did a thing.

I continue to question the peer review. If I tried to publish interim results that likely have no correlation to the final results in my field, I would be edified if not ti-edified in no time flat. The paper probably wouldn't even be sent out for review by the editor absent final results or some rigorous correlation between interim and final results which is not the case with brace wear, in-brace correction, compliance, etc. etc..

In my opinion, this is noisy enough that no clear result will ever emerge, similar to the PT situation. And we have enough people in this sandbox who said their were very compliant, told their curve was stable, only to show up in the surgical section. If anything turns out to be the master variable it will be esoteric about particular brace fit to particular kids by chance, not by skill of the orthotist. And even then it will be a very small minority of the population who wears the brace. Just my opinion.

[txmarinemom]

Please explain this result:

"In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075)."

Those who wore their brace compliantly had a rate of 11% who progressed. Those who did not, 56% progressed. Do you see the advantage in wearing a brace compliantly?

I think this absolutely shows that braces worn as directed do make a difference.

I think if your claim were the intended conclusion of the study, it would have been stated as such.

It was not.

What the stated conclusion proves is IF you're in the group that may benefit from a brace, it's more likely it will be effective if it's ON your body.

It doesn't even come close to saying "braces are usually effective".

[Pooka1]

I think if your claim were the intended conclusion of the study, it would have been stated as such.

It was not.

What the stated conclusion proves is IF you're in the group that may benefit from a brace, it's more likely it will be effective if it's ON your body.

It doesn't even come close to saying "braces are usually effective".

Concur.

This abstract in uninterpretable without specifics on T versus L, curve magnitude, etc. etc.

The number of patients in this study is not expected to yield robust results given the variability of this condition. If you ran this EXACT study with another set of 34 kids you would NOT expect the results to look the same except by chance. That's what variability means.

[Ballet Mom]

I think if your claim were the intended conclusion of the study, it would have been stated as such.

It was not.

What the stated conclusion proves is IF you're in the group that may benefit from a brace, it's more likely it will be effective if it's ON your body.

It doesn't even come close to saying "braces are usually effective".


So you're saying that it just happens that all the kids that would benefit from a brace, just happened to be in the compliant group. Sure.


Anyhow, must run, busy this weekend. Will take this up later.

[Pooka1]

So you're saying that it just happens that all the kids that would benefit from a brace, just happened to be in the compliant group. Sure.


Do you have the paper?

What is the distribution of T versus L curves in each group? Also what are the Cobb angles in each group.

The smaller L curves will appear to respond at a higher rate than the larger T curves. The compliance was determined NOT by curve location or magnitude by by the patients themselves. And we can't say much with only 34 patients even if we knew these things.

[txmarinemom]

So you're saying that it just happens that all the kids that would benefit from a brace, just happened to be in the compliant group. Sure.

You still aren't getting it, but I don't think continuing to point out the gaps in your theory is going to make that happen.

Until you can show that any child in EITHER group wouldn't have stopped progressing - brace or not - you don't have DATA to back up your claim.

[Pooka1]

You still aren't getting it, but I don't think continuing to point out the gaps in your theory is going to make that happen.

Until you can show that any child in EITHER group wouldn't have stopped progressing - brace or not - you don't have DATA to back up your claim.

Concur.

This will always be the Achilles heel of bracing and PT studies. ALWAYS. We know too much about large curves occasionally halting on their own for decades.

It truly is intractable in my opinion when the condition is so variable.

[AILEA]

Pooka, if you don’t may me asking.....
What would you do today (knowing what you know), if another hypothetical- imaginary daughter with Risser 0 is told to have a curve between 20º or 35º? Would you let her curve without trying anything until surgery level? And what if the curve is lumbar?

[Pooka1]

Pooka, if you don’t may me asking.....
What would you do today (knowing what you know), if another hypothetical- imaginary daughter with Risser 0 is told to have a curve between 20º or 35º?

What I know about this wouldn't fill a thimble... it's easy to get the wrong idea around here about how much effort is involved in actually getting your arms around a subject.

W.R.T. the hypo daughter, I would let her try any brace she wanted if she wanted.


Would you let her curve without trying anything until surgery level? And what if the curve is lumbar?

"Let" her curve? Doesn't that imply I necessarily have some way to stop it?

Lumbars don't tend to progress as much as thoracic making bracing less likely in my mind. If she wanted to wear a Charleston (or any brace) I would get it for her.

[Pooka1]

http://early-onset-scoliosis.com/Documents/BraceCompliance.pdf

Apparently, the important variables (type of curve, magnitude of curve, etc.) for each group is in another paper:

Takemitsu M, Bowen RJ, Rahman T, et al. Compliance monitoring of brace treatment for patients with idiopathic scoliosis. Spine. 2004;29: 2070–2074.)

making it impossible to assess this paper on its own. It's interesting that not even one sentence about the key variables in this article. Looking at the data the way they did assumes compliance is a master variable which is something they are trying to prove. Circular.

I'll try to find the other paper online.

There is a WILD variation in prescribed wear time among these 34 patients:

Prescribed regimens for the bracewearing schedule were 8 (nighttime) or 12 hours per day in the brace for patients with curves 30 degrees or less and 16, 20, or 23 hours per day for those with curves greater than 30 degrees.

I am predicting the most compliant group were the ones wearing the brace only 8 hours at night and those wearing it only 12 hours during the day (as opposed to 16, 20, or 23 hours). And since it is highly likely that people with smaller curves were told to wear the brace less than people with larger curves, what prescribed wear time might reduce to is being a proxy for Cobb angle. I will be looking specifically for that in the other paper. And I question how they can relate any of this to outcome when the treatments are so wildly variant (among 34 patients no less).

Importantly, ~21% of the 34 subjects went on to have fusion. There is not one word about how compliant they were. It would be an important result if some or most came from the compliant group. That would make sense if they had larger curves and suspected they might be moving into surgery territory. It would also be a confounder if the people most worried were most compliant--- it would skew the results. But one wonders why not even one sentence on which group they were in.

This is a VERY short paper. Unless the journal set length constraints, I don't understand why this wasn't simply folded into the other paper with the "rubber-meets-the -road" results. If these results paint a different picture compared to the larger paper then I'm going to have some questions (as usual!).

Last, they confirm the last measurements in this study were final "brace use." That is, ALL these numbers are in brace and they admit up front in the intro that no rigorous correlation between compliance and final outcome has been shown. Also, there is a penetrating glimpse into the obvious aspect of folks who wear the brace more have less IN BRACE progression. That is another reason why this paper should have been folded into the other in my opinion.

As always, just a bunny opinion from the field as this is not my field.

[Pooka1]

Okay I found the abstract for the main article on this work and note that their conclusions deal ENTIRELY with brace compliance per se and they don't even try to relate the compliance to long term outcome because this is a prospective study.

http://journals.lww.com/spinejournal/Abstract/2004/09150/Compliance_Monitoring_of_Brace_Treatment_for.19.as px

Conclusions. Patients with idiopathic scoliosis complied with 75% of prescribed regimen on average and overreported their hours of brace wear to their physician. Age affected compliance. There was no statistical difference in compliance among patients with different prescribed regimens. The present study confirms the need for a compliance monitor to accurately evaluate use and outcome of brace treatment.


In other words, Pam was correct that the title of this thread bears no resemblance to the actual research objective or final conclusion.

Last, apparently I was wrong about compliance correlating with number of hours or time of day/night the brace is worn. But that may be due to the other point I made... people who thought they were edging into surgery territory might be more compliant and be more willing to wear the brace for long hours.

[Pooka1]

It is now almost 5 years after this prospective study was published. The final results are in on outcome of compliance versus bracing efficicay among this cozy little group of 34. We know 7 of them were already fused so the question is what happened with the remaining 24 patients.

Have the final outcome results been published?

[Pooka1]

By the way, the word "outcome" used in the title of the 2005 paper is very misleading as most people, including to OP here, would assume it meant final outcome, NOT final IN BRACE measurement as is the case.

[txmarinemom]

For some reason, links aren't posting correctly. Sharon, the link you posted to the quoted "compliance study" was truncated and broken.

At any rate, I was able to find the article by going to www.early-onset-scoliosis.com. After seeing who started that website, I'm not even remotely surprised that study is purported to have significance despite any real data.

Ballet Mom, something rang familiar about your recent posts, comments to me, and the odd reference to a ca. 2007 thread a few weeks back: Up until now, I couldn't *quite* explain the sense of deja vu.

Thanks for the missing puzzle piece.

[Pooka1]

Pam, I can't get to the article from the web site but the link should be clickable...

http://early-onset-scoliosis.com/Documents/BraceCompliance.pdf

For some reason, I can't find the article from the top level directory but google finds it.

[Pooka1]

I just clicked on the link I just posted and it came up correctly. Can you try this link?

[Pooka1]

At any rate, I was able to find the article by going to www.early-onset-scoliosis.com. After seeing who started that website, I'm not even remotely surprised that study is purported to have significance despite any real data.


I'm sure she's trying her best. She just doesn't have the training or tools to approach the literature.

[txmarinemom]

I just clicked on the link I just posted and it came up correctly. Can you try this link?

Yep ... that one works. It could be on my end, but I'm not having problems with other sites ... and didn't have an issue here until the last few days. :confused:

[Ballet Mom]

At any rate, I was able to find the article by going to www.early-onset-scoliosis.com. After seeing who started that website, I'm not even remotely surprised that study is purported to have significance despite any real data.

Ballet Mom, something rang familiar about your recent posts, comments to me, and the odd reference to a ca. 2007 thread a few weeks back: Up until now, I couldn't *quite* explain the sense of deja vu.

Thanks for the missing puzzle piece.

Oh my GOD!!!

I come home from a weekend of Nutcracker performances by my ADVANCED ballet dancer daughter, and you're apparently accusing me of being the mother of what must be an eight or nine year old girl? Crazy stuff. (She's very cute, by the way)

Amazingly enough, I used my own fingers and search engine to find that abstract on my own. I know it's hard to believe that more than one person could actually find information on something they're both interested in. I actually had to click every link on that site you linked to in order to finally find, with great difficulty, the entire research paper, but thanks for providing the entire paper for me...I had been looking for it without much luck.

The reason I brought up the "odd reference" to the 2007 string, was not because I am the person you're accusing me of being, but because you were trying to mislead people into believing that your curve did not progress even though you weren't wearing your brace compliantly, by your own admission.

I simply remembered from reading in the archives, that you had stated that you were diagnosed at 35 degrees and went back to find that statement in order to clarify your misleading comment.

It is useless to get into the technicalities of the paper with you and Pooka, other than by saying that I did state that a much larger study, probably Braist, needed to be done to verify those results.

Let me think, would I be more likely to believe the lead author of this study, a PhD in Mechanical Engineering who is striving to help children through the study and design of medical devices and the Head of the Pediatric Engineering Research Lab at A.I. duPont Hospital for Children and Associate Professor at Drexel University, or a programmer training to be a masseuse and her virtual friend, a wannabe PhD apparently trained in the so-called "scientific" methods of environmental "science".

Or perhaps, the second doctor listed on this study, James Richard Bowen, Chairman of the Department of Pediatric Orthopaedics at the Alfred I. duPont Institute and Professor of Orthopaedics, Jefferson Medical College of Thomas Jefferson University.

Hmmmmmm, not even a close call. You gals need to get a grip on your egos.

[Ballet Mom]

I'm sure she's trying her best. She just doesn't have the training or tools to approach the literature.


That from a wannabe PhD who quite clearly isn't one.

[hdugger]

Ballet Mom,

Given the state of the literature, you might try the same thing that I'm trying - collecting data points of those who have actually reduced their curve. The standard I'm applying for exercise is adolescent and adult scoliosis only (juvenile has too odd a course), a greater than 10 degree reduction, held for months or (preferrably) years, in a "significant" curve, which I'm counting as anything over 35 degrees.

I suspect you'll find data points for bracing, as I have for exercise.

[AILEA]

"Let" her curve? Doesn't that imply I necessarily have some way to stop it?


Ups!!! I didn’t choose the correct word; English is not my main language.
I only wanted to make you that question because reading your post, sometimes I have the impression that you wouldn’t give bracing a try, and new parents who come here, could make decisions basing on "your fact”, that bracing doesn’t work.

[Pooka1]

Ups!!!

I expect it will win handily. :)

[Kid_15]

i think it is easier said than done wear your brace all the pain yes it should be better for you but its really harder than it sounds

[brace4impact]

Yeah and my doctor said that a brace does not stop the scoliosis but it keeps it from getting worse. So yeah i guess if you wear the brace like one should then your scoliosis shouldn't have changed or if your degree has been reduced by it

[Balletgirl77]

This thread has me all confused when I tried to read it haha. Anyways I have been pretty worried that my spine will go back now that I'm off the brace. I was braced 3 years and he told me I could stop wearing it for good when he was positive I was finished growing, but could it still go back? I'm terrified of surgery. The only advice I'd give to kids with the brace though would be to wear it faithfully even though it's awful, because well I know it doesn't help everybody, but in my case it even provided some correction, and it's definitely worth a chance.

[brace4impact]

I couldn't have said it better myself, BalletGirl77 :) what you said was so true. the only advice i can give is to wear your brace no matter how bad it may hurt or be uncomfortable. In the end, it will all be worth it. That's keeping me motivated to wear it and I have it to wear it 23 hours a day but most of the time I wear it all day because I don't like going through the long hassle of taking it off and changing into my non-brace clothes.

[LindaRacine]

Thread moved to Parents forum. Adults, please stop posting to the Kid's forum.

[scoliodancer]

i was very disappointed when i read this thread. the arguing on it is absolutely ridiculous. this is supposed to be a place for advice or support, not petty arguments that over-analyze the specifics of a simple statement that may or may not be perfectly correct. i am sure that Ballet Mom's original intent was to encourage people to wear their brace and show that it helps, not start an argument. i was glad to see that this was moved to the adult section. adults, if you want to argue about things like this no one can stop you, but please keep it out of the adolescent section.

[Pooka1]

You're correct, this was posted in the wrong section. Several of us were operating under the assumption that posts about bracing should be in this section. It only became clear very recently, at least to me, that adults shouldn't start threads threads on bracing in this bracing section.

Hopefully, this won't happen again. I'm sorry.

[Pooka1]

By the way, if you are mainly interested in support, these two fora are very good in my opinion:

http://www.scoliosis-support.org/index.php

http://www.spinekids.com/boards/

You also mention advice. I strongly suggest you do NOT look for any advice on line in any forum and only get advice from your surgeon.