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Thread: TSRH research shows that bracing IS effective!

  1. #31
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    Quote Originally Posted by Pooka1 View Post
    The brace is holding the curve. Remove the brace and there is nothing to hold the curve.
    Of course I was not talking about something so obvious. I referred to cases when degrees increased in some months or years after the remotion.

  2. #32
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    Quote Originally Posted by flerc View Post
    Of course I was not talking about something so obvious. I referred to cases when degrees increased in some months or years after the remotion.
    It is reasonable to conclude from the data in hand that braces may only delay surgery as opposed to avoid it. It is impossible to say. That is not proven but it certainly hasn't been disproven at this point because of the huge backdrop of unnecessarily treated kids that we know are out there based on the few controlled studies. It is also impossible to say if any particular case of brace usage stopped a curve given that most curves do not progress and that there are at least 3 people on this little group who got into the 50s and their curve stopped (without brace in at least one case). Once you know those things, it's very hard to make definitive statements about bracing efficacy.

    If brace wear was easy we would never be discussing this. I hope it is shown to be effective some day just so kids who wore them can know there was a chance.
    Last edited by Pooka1; 07-15-2010 at 11:50 AM.
    Sharon, mother of identical twin girls with scoliosis

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  3. #33
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    Quote Originally Posted by Pooka1 View Post
    It is reasonable to conclude from the data in hand that braces may only delay surgery as opposed to avoid it.
    So, you are able to draw this conclusion based on the study I posted? Please explain based on the facts given.


    Quote Originally Posted by Pooka1 View Post
    That is proven but it certainly hasn't been disproven at this point because of the huge backdrop of unnecessarily treated kids that we know are out there based on the few controlled studies. It is also impossible to say if any particular case of brace usage stopped a curve given that most curves do not progress and that there are at least 3 people on this little group who got into the 50s and their curve stopped (without brace in at least one case).
    the publication specifically states the 70% who wore their brace <7 hrs/day demonstrated curve progression and 82% who wore it >12 hrs/day did not have curve progression. Can we then conclude that 30% would not have curve progression anyways regardless of bracing and 18% would have progressed regardless of bracing? Seems obvious to draw those conclusions but I'm sure it's more complicated than that.

    Quote Originally Posted by Pooka1 View Post
    If brace wear was easy we would never be discussing this. I hope it is shown to be effective some day just so kids who wore them can know there was a chance.
    Agreed, but there are not many treatments for ANY medical condition that doesn't have some sort of side effects, including scoliosis surgery.

    Hopefully, the new tests that are out will be able to pinpoint those kids who will progress but that's a very new technology and will probably be some time before it's used mainstream as a screening tool. I think most surgeons would err on the side of caution and brace at this time.

  4. #34
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    Quote Originally Posted by Pooka1 View Post
    It is reasonable to conclude from the data in hand that braces may only delay surgery as opposed to avoid it. It is impossible to say. That is not proven but it certainly hasn't been disproven at this point because of the huge backdrop of unnecessarily treated kids that we know are out there based on the few controlled studies. It is also impossible to say if any particular case of brace usage stopped a curve given that most curves do not progress and that there are at least 3 people on this little group who got into the 50s and their curve stopped (without brace in at least one case). Once you know those things, it's very hard to make definitive statements about bracing efficacy.

    If brace wear was easy we would never be discussing this. I hope it is shown to be effective some day just so kids who wore them can know there was a chance.
    I know in some cases the delay remains over 10 years. This people could die tommorrow in an accident or never increase degrees any more, who knows..
    Any way, in other cases when, after skeletal maturity, the curve increase again over time, how could it be explained in a scientifical way?

  5. #35
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    As an afterthought, I remembered that I emailed Dr. Mooney about his study to see if there were any locations in Houston participating. He did reply back (they were not). My point is these people are not out of our reach, you just have to make an effort to reach them. If there is a question about the legitimacy of this study, you should make an effort to contact these researchers and get the true facts and post them here.

    In reference to Dr. Mooney, he was a retired scoliosis surgeon trying to find a better way to treat this condition before it progressed to surgery. He sounded very compassionate in his response to me. Don't assume all these physicians and researchers are conducting these studies for personal gain, I believe many if not most of them are a truly dedicated group looking for answers just like us.
    Perhaps the research was flawed, but the intentions are not.

  6. #36
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    Quote Originally Posted by Sherie View Post
    This study is not the same. They're only looking at compliance. In the TSRH study, they've actually concluded that compliant bracing has resulted in stopping curve progression.
    Sorry, my copy/paste apparently didn't work correctly. I've posted the correct URL above.

    And, so you don't have to look back:

    http://early-onset-scoliosis.com/Doc...Compliance.pdf

    And, here's another one:

    http://www.srs.org/professionals/bra...s/section3.pdf
    Last edited by LindaRacine; 07-15-2010 at 02:31 PM.

  7. #37
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    Quote Originally Posted by LindaRacine View Post
    Sorry, my copy/paste apparently didn't work correctly. I've posted the correct URL above.

    And, so you don't have to look back:

    http://early-onset-scoliosis.com/Doc...Compliance.pdf

    And, here's another one:

    http://www.srs.org/professionals/bra...s/section3.pdf
    Thanks Linda. So basically, these previous studies concur that bracing IS effective.

  8. #38
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    Quote Originally Posted by Sherie View Post
    Thanks Linda. So basically, these previous studies concur that bracing IS effective.
    If all these studies allow the conclusion that bracing works as you seem to think, and if all of these studies PREDATE BRAIST and the ethics panel that okayed that study then how do you square that?

    ETA: The article you posted is June 2010. Why hasn't the BRAIST study been halted immediately on ethical grounds?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #39
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    Quote Originally Posted by Sherie View Post
    Why don't you guys write to the researchers with your concerns let us know what they say.
    There is no need. They understand the limitations of their studies.

    It's like if I do a time course study with 10 time points and publish at the point where I have only collected data on the first two time points. That's assuming this is another in-brace study.
    Last edited by Pooka1; 07-16-2010 at 05:54 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #40
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    Quote Originally Posted by Sherie View Post
    Why don't these details matter? That's the whole point of research, it's in the details. I didn't see what she was referring to and simply wanted to know what she was looking at.
    There are limitations of what you can do with any data set. And there are Achilles heels. I've mentioned this before but once my adviser's adviser found out he didn't adequately control one of his studies after reading the methods section, the paper was literally tossed in the garbage can in front of my adviser. That was correct. My adviser took that to heart and started designing well controlled studies that took him to the top of his field. Maybe he only got there because of the experience of having his paper tossed in the garbage, who knows. Just hearing that story made a huge impression on me. Science is hard.

    Why do you keep quoting the Mooney study? That has no relevance here and is way off topic.
    It is directly relevant if chose to start with a new group instead of following up with the first group. Then we have to ask why. There are legitimate answers to that.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  11. #41
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    Quote Originally Posted by Sherie View Post
    No, I don't think it's premature if they are only publishing the facts as they have developed. If they've been bracing for 18 months or whatever time, and they didn't see any progression during that time in the compliant bracers, then they're drawing a factual, observable conclusion from their data. Now if they go on to say somewhere that this will hold forever, then that's a false statement.
    What is the evidence that the last in-brace reading (if that is what this is) has any bearing whatsoever to a reading a week out or a month out or a year out or ... etc.?

    If anyone has seen a paper no this I would like to be edified.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #42
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    As I read the article, it seems to be a new study i.e. patient population. However, the patients were recruited between 1998 and 2000. If this group published on the same data I can't find it and they don't refer to that in the introduction. The whole group published a paper in 1997 comparing Boston to Charleston and the lead author (Katz) published something in 2001 but that was a retrospective study.

    All patients were risser 2 or less and between 25 and 45. X-rays taken every 4 months out of brace. All patients were followed until skeletal maturity. Failure was >6 progression or progression to surgery.

    They do a fairly complex analysis linking brace wear to progression and stratifying by tri-radiate cartilage, risser, time of day the brace is worn, compliance and total number of hours of brace wear.

    Of the 100 patients, 50 progressed and 50 did not. Of the 50 that did progress, 28 had surgery. The non-sugical group had a significantly higher number of daily brace wear (10.6 v 7.2), total number of braced hours (5002 v 2552), and percent compliance (42.4 v 24.4). These numbers include the non-progression group as well, i.e. 28 had surgery and 72 did not and 22 of the 72 with no surgery had progression. It would be interesting to see the analysis of the surgical v non-surgical in the progressing group.

    The group that had the highest number of progressions was the risser 0 group. The risser 0 non-progressive group had a significantly higher number of daily brace wear than the progressive group (9.9 v 5.2).

    The article goes on and on. Lots of statistics but the data seems to be fairly clearly presented, that is, they don't seem to be massaging the data too much. There are a lot of more detailed results in the text, but requires careful reading. Of interest.

    Brace treatment is traditionally compared with the natural history study by Lonstein and Carlson, in which 68% of curves between 20 and 29 in patients at Risser 0 or 1 progressed. Only one of our thirteen patients at Risser 0 who wore the brace for more than twelve hours per day experienced curve progression. This benefit continued between the completion of brace wear and the latest follow-up. Those wearing the brace for seven to twelve hours per day had progression 39% of the time, whereas those who wore the brace fewer than seven hours per day had progression 68% of the time, which is the same as the natural history
    The latest follow-up date isn't mentioned, but the patients were recruited at least 10 years ago. So it's not a huge jump to say these have remained stable after brace treatment. However, I do wish they would present that data. But it's possible they didn't have IRB approval for that.

  13. #43
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    All of that was quite interesting. Thanks for crunching it. I would like to read the paper.

    Quote Originally Posted by skevimc View Post
    The latest follow-up date isn't mentioned, but the patients were recruited at least 10 years ago. So it's not a huge jump to say these have remained stable after brace treatment. However, I do wish they would present that data. But it's possible they didn't have IRB approval for that.
    That's the make or break aspect of it, though.

    And if these patients go back 10 years, how did they choose a mere 100 out of all of them? They have to worry about data selection which I'm guessing can be inadvertent also. That is, they inadvertently used a criterion that was correlated with a certain outcome... something like the inadvertent stacking of T curves in the non-braced group versus L curves in the braced group of that other study which I'm blanking on the name of.

    And speaking of T versus L curves, I hope they indicated which compliance group had which curve types. It would invalidate the results to some extent if the L group was over-represented in the compliant group and(or) the T group was over-represented in the less compliant group.

    I also question the 68% figure for chance of progression between 20* and 29* at low Risser. I think that comes from a table where there are no errors bars if I'm remembering correctly. If they showed the error bars, that number might appear less hard let's say than it appears.

    Anywho, thanks again for the synopsis.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #44
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    Quote Originally Posted by Sherie View Post
    Thanks Linda. So basically, these previous studies concur that bracing IS effective.
    Hi Sherie...

    The studies found that bracing works. However, since that time many specialists have agreed with Sharon, that since there is no control, they cannot tell for certain whether the braced kids might not have progressed without any treatment.

    With that said, if I had a skeletally immature child with a curve between 25-40 degrees, I'd push them to wear a brace as much as possible.

    Regards,
    Linda

  15. #45
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    Hi Kevin...

    The real natural history of the cohort won't be known until they reach at least the age of 35, when a lot of curves seem to start causing trouble. If bracing doesn't keep most of the patients out of the O.R., then it's going to be judged pretty worthless, because there's a big cost, both monetarily and in terms of the additional pain and disability of adult scoliosis surgery vs. adolescent scoliosis surgery.

    At this point, it would be reasonable to say that bracing might work, but no one yet knows for certain.

    Regards,
    Linda

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