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Thread: General figure question for Dr. McIntire

  1. #16
    Join Date
    Mar 2009
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    Quote Originally Posted by Pooka1 View Post
    Do you think BrAIST is big enough to change the approach of any surgeon if the results don't support bracing over watching/waiting to avoid surgery?
    Quote Originally Posted by skevimc View Post
    Considering the number of sites, I'd definitely think that would be large enough to make a serious impact on standard of care. This is the size of study that I think is needed. Certainly, no matter what the outcome, some people will disagree. But overall, I'd imagine that whatever the basic finding of the study ends up being will become the standard of care. Personally, I'm excited either way. I hope they've done a good job collecting the data.
    With your quotes above, you're admitting that the Braist study will most likely change the kind of medical care used as standard practice in scoliosis. With the exclusion of those using methods to increase the flexibility of the spine while bracing, you are likely influencing those results to end up at a more negative outcome for bracing. Do you think if doctors stop bracing wholesale that suddenly a study will appear just like Braist, but with stretching and exercise during bracing included?

    Quote Originally Posted by Pooka1 View Post
    And rightly so. I think we have enough evidence in hand to show that PT can temporarily slow or halt curves such that including it in a bracing study would completely confound the results in the short term at least.
    This comment proves my point. The point of bracing is to slow or halt the curves during the growth spurt until physical maturity. If PT or any exercise with stretching, such as ballet, is able to greatly increase the odds of the success of bracing during that timeframe, generally a couple of years, it should be recommended when bracing is commenced...not throwing bracing away wholesale. It doesn't need to continue after physical maturity as most patients under 40-50 degrees at maturity won't continue to increase during adulthood.

  2. #17
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    Jan 2010
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    San Bruno, CA
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    271
    Quote Originally Posted by Ballet Mom View Post
    With your quotes above, you're admitting that the Braist study will most likely change the kind of medical care used as standard practice in scoliosis. With the exclusion of those using methods to increase the flexibility of the spine while bracing, you are likely influencing those results to end up at a more negative outcome for bracing. Do you think if doctors stop bracing wholesale that suddenly a study will appear just like Braist, but with stretching and exercise during bracing included?
    If bracing alone shows absolutely no promise at slowing or halting the progression of a curve during adolescence then I have no problem with it being stopped. Given that there are already some fairly positive studies on the effectiveness of bracing, the results that would cause the full stop of all bracing would have to be unbelievably convincing. I think the Braist study will likely better define what type of brace and how long a brace should be worn for particular types of curves. (I forget what the study is measuring).


    Quote Originally Posted by Ballet Mom View Post
    This comment proves my point. The point of bracing is to slow or halt the curves during the growth spurt until physical maturity. If PT or any exercise with stretching, such as ballet, is able to greatly increase the odds of the success of bracing during that timeframe, generally a couple of years, it should be recommended when bracing is commenced...not throwing bracing away wholesale. It doesn't need to continue after physical maturity as most patients under 40-50 degrees at maturity won't continue to increase during adulthood.
    It's very important to understand exactly what each component of a particular therapy protocol does. Right now I study the effects of strength training and whey protein on muscle. When we set up the experiment we design a control group with no treatment, one group gets strength training, one group gets whey protein and one group gets both. This gives us infinitely more information about the effectiveness of the two treatments. Do they work fine as a stand alone or are they additive, etc...

    If bracing is shown to be effective I have little doubt that adding exercise would improve outcomes. But starting from there would not be good from a scientific point of view.

  3. #18
    Join Date
    Jan 2008
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    NC
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    8,901
    Originally Posted by Pooka1:
    Here's something that is conspicuous by its absence... the starting curve magnitude of the progressive and non-progressive patients.
    Quote Originally Posted by skevimc View Post
    That is kind of silly that they didn't include this info.
    I'm on travel but had to respond.

    I wouldn't use the word "silly." I would tentatively use another word which I won't mention until I get more info.

    Given that this is one of the prime variables in predicting curve progression, I would be shocked if they didn't determine it. Now I am wondering if it undermined or at least further muddied or otherwise confounded the major result of dose response given that it wasn't mentioned.

    It is conspicuous by its absence.
    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."

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