New Bracing Study

[LindaRacine]

http://www.ncbi.nlm.nih.gov/pubmed/21119579
Med Sci Monit. 2010 Nov 30;16(12):CR606-615.
Personality characteristics of females with adolescent idiopathic scoliosis after brace or surgical treatment compared to healthy controls.

Misterska E, Glowacki M, Harasymczuk J.

Department of Pediatric Orthopaedics, Poznan University of Medical Sciences, Poland.
Abstract

Background: The goal of this research was to determine whether short-term differences exist in psychopathological symptoms between adolescents with scoliosis treated operatively or conservatively. We analyzed the personality characteristics of scoliosis patients compared with controls.<br /> Material/Methods: The study group consisted of 35 scoliosis patients treated conservatively; 35 patients treated surgical¬ly with posterior (27 cases) or anterior (7 cases) correction and fusion combined with thoraco¬plasty who then, after surgery, went on to use a brace; and a group of 35 healthy con-trols. Psychopathological symptoms were assessed with the Erich Mittenecker and Walter Toman Personality Test.<br /> Results: In comparison with healthy individuals, the entire group of patients, including patients treated conservatively, expressed more self-criticism, whereas the patients treated surgically expressed more self-criticism, neurotism, and depressiveness. The daily length of brace use and age of patients in conservatively treated patients had a significant effect on the outcomes, in patients treated operatively degree of apical translation after surgery played a similarly significant role.<br /> Conclusions: Patients with scoliosis fell in the range average for the personality test. The prevalence of self-reported psychopathological symptoms is higher in patients with scoliosis in the short-term after brace or surgical treatment compared with healthy controls.<br /> There are differences in personality characteristics between adolescents with scoliosis after conservative or surgical treatment. Patients treated conservatively show more symptoms of maniacality, and the longer the brace was applied during the day, the higher the level of depression reported by the patients themselves. Patients treated operatively manifest more symptoms of neurotism.

[mamamax]

http://www.ncbi.nlm.nih.gov/pubmed/21119579
Med Sci Monit. 2010 Nov 30;16(12):CR606-615.
Personality characteristics of females with adolescent idiopathic scoliosis after brace or surgical treatment compared to healthy controls.

Misterska E, Glowacki M, Harasymczuk J.

Department of Pediatric Orthopaedics, Poznan University of Medical Sciences, Poland.

Results: In comparison with healthy individuals, the entire group of patients, including patients treated conservatively, expressed more self-criticism, whereas the patients treated surgically expressed more self-criticism, neurotism, and depressiveness.

• The prevalence of self-reported psychopathological symptoms is higher in patients with scoliosis in the short-term after brace or surgical treatment compared with healthy controls.
  
• Patients treated conservatively show more symptoms of maniacality, and the longer the brace was applied during the day, the higher the level of depression reported by the patients themselves.
  
• Patients treated operatively manifest more symptoms of neurotism.

Interesting offering. My first thought is: comparing any group of people who have a serious medical condition, against a control group of perfectly healthy individuals; may produce very similar findings.

My second thought: what were the brace types?

How many of the surgical subjects (if any) were previously braced and how many (if any) experienced post surgical complications?

Where did the control group come from? A similar personality test given to a healthy group divided between affluent and poverty level, may again give similar results.

Having survived childhood without either treatment, I have had short term bouts of all of the above which makes me wonder if life itself (generally speaking) is something that produces psychopathological symptoms (among groups not perfectly healthy and affluent).

[Pooka1]

Psych is not a hard science.

The rest is commentary.

[mamamax]

Possibly the most important thing to note in this study is, that psychopathological symptoms exist in the course of any treatment. This could be important since it is well understood that emotional stress can affect the immune system (raising the risk for infection in surgical patients) and emotional stress can affect a vulnerable (or weakened) body system. Maybe one day we will see a similar study comparing outcomes of those who participated in something like a cognitive behavioral therapy program against those who did not. Diagnosis alone can be traumatic for the patient and the "psychology" of any individual is part and parcel of the body package. It will be interesting to see what future studies combining Medicine and Psychology may reveal in terms of treatment outcomes.

[jrnyc]

"maniacality"...??
in all my years as a social worker, being required to put a DSM 4 diagnsois down on a treatment plan, that's one i never heard...or used!

i am gonna' have to look "maniacality" up in the social work/psych books!

jess

[Pooka1]

We know there is a mind-body connection from placebo evidence. So the brain, expressing itself through the mind, can produce some measurable physical effects.

They seem to have two treatment groups, one braced and one fused plus braced. I wonder why they didn't have a group who were fused only who never wore a brace at any point (pre- or post-op).

Maybe I'm missing something but it is a penetrating glimpse into the obvious that bracing is a hard treatment. Also, concluding that surgical cases exhibit more neuroticism is likely confusing cause and effect. If you have a big enough curve to need surgery it's probably noticeable and that would tend to make folks shy and not interactive.

I don't understand why some things are publishable. Psych is not a science. The only hope for psych in my opinion is the fMRI work trying to map reproducible brain activity to various subjective claims. But I really don't know enough about psych to be saying even that I suspect.

[hdugger]

Unfortunately, the major measure of "successful" treatment for scoliosis are all psychological measures: are you in pain? are you able to go about your life normally? and are you happy about how you look?

No precise reproducible measurement, like cobb angle or degree of rotation, will tell you anything as important as those three psychological measures.

So, either we focus on the measurable but insignificant, or we focus on the difficult-to-measure but critically important.

[Pooka1]

Fine but that doesn't excuse publishing the umpteenth treatment of a penetrating glimpse into the obvious.

[hdugger]

It was a response to " Psych is not a science."

It may not be a science, but it's the thing that matters most. So, either we find some other way to get a handle on it, or we tolerate its inherent ambiguity.

But, yeah, I agree, this study doesn't look so good.

[mamamax]

Sometimes, I wonder if some studies are done with the intent to justify adding something to the treatment plan. This study would have been a good one if the plan was to justify counseling in the course of treatment?