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Thread: Efficacy of Exercise for AIS

  1. #1
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    Efficacy of Exercise for AIS

    Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature.
    Mordecai SC, Dabke HV.

    Department of Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ, UK, Simon_mordecai@yahoo.com.

    Abstract
    PURPOSE:
    Current evidence regarding the use of exercise therapy in the treatment of adolescent idiopathic scoliosis (AIS) was assessed with a review of published literature.

    METHODS:
    An extensive literature search was carried out with commonly used medical databases. A total of 155 papers were identified out of which only 12 papers were deemed to be relevant.

    RESULTS:
    There were nine prospective cohort studies, two retrospective studies and one case series. All studies endorsed the role of exercise therapy in AIS but several shortcomings were identified-lack of clarity of patient recruitment and in the method of assessment of curve magnitude, poor record of compliance, and lack of outcome scores. Many studies reported "significant" changes in the Cobb angle after treatment, which were actually of small magnitude and did not take into account the reported inter or intra-observer error rate. All studies had poor statistical analysis and did not report whether the small improvements noted were maintained in the long term.

    CONCLUSIONS:
    This unbiased literature review has revealed poor quality evidence supporting the use of exercise therapy in the treatment of AIS. Well-designed randomised controlled studies are required to assess the role of exercise therapy in AIS.
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  2. #2
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    Thus the need for a really good study! It needs to categorize kids by risser, curve magnitude, curve type, scoliscore, exercise modalities used, compliance and long term follow-up. That's really hard to do.

  3. #3
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    DR. McINTIRE ES MAS MACHO DE LOS MEDICOS!!!!!!

    Dr. McIntire is viewed as the only one of the 12 first authors of the included studies to be neutral and not pro PT.

    I'm ordering the velvet ropes to organize the autograph seekers...
    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."

  4. #4
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    "2 papers represented the same data published in different journals"

    Gee, I wonder who that could be??? <cough... cough... Mooney... cough... cough>
    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."

  5. #5
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    Weiss was first author on 5 of the 12 papers.
    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."

  6. #6
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    That doesn't change the fact that the conclusion was no conclusion. Dr. McIntire was in there? Yay! We need more good papers. Keep 'em coming doc. :-)

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    Quote Originally Posted by rohrer01 View Post
    That doesn't change the fact that the conclusion was no conclusion. Dr. McIntire was in there? Yay! We need more good papers. Keep 'em coming doc. :-)
    Right. But here is one comment they had about the McIntire study...

    This was a well-designed study with a substantial followup period and clearly defined step-by-step treatment protocols.
    I hope he gets tenure somewhere.
    Last edited by Pooka1; 12-04-2011 at 10:01 PM.
    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."

  8. #8
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    He will. Unfortunately, as you know it takes time, and is somewhat "political" within the universities. My friend got tenure a couple of years ago and she started working for the university, I believe, in 2000. But, on the other hand, with a published paper that good, maybe it will happen sooner for Dr. McIntire!
    Last edited by rohrer01; 12-05-2011 at 10:53 PM. Reason: changed date from 2003 to 2000 oops!

  9. #9
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    Yeah, I came across this article the other day as well. Was happy to see our study actually get chosen. I think they missed one study though. The den Boer paper about side-shift. They have a nice long follow up. I don't think it's randomized. But do think it was MD blinded, i.e. the doctor didn't know what treatment the patient received (might be wrong about that though). They also had a brace control group. Plus a really nice discussion.


    Quote Originally Posted by rohrer01 View Post
    Thus the need for a really good study! It needs to categorize kids by risser, curve magnitude, curve type, scoliscore, exercise modalities used, compliance and long term follow-up. That's really hard to do.
    Yep. Hard, but necessary. At the very least, this data needs to be included. If you don't have the group size to stratify in that way, at least include it. I was a little upset when Dr. Asher wanted to include all of what we included at first. But then, as I learned more, it was obvious why this was needed.

    Quote Originally Posted by Pooka1 View Post
    DR. McINTIRE ES MAS MACHO DE LOS MEDICOS

    Dr. McIntire is viewed as the only one of the 12 first authors of the included studies to be neutral and not pro PT.

    I'm ordering the velvet ropes to organize the autograph seekers...
    LOL! I noticed that table as well. Our study sticks out in that column pretty well. Kind of funny I think.

    Quote Originally Posted by rohrer01 View Post
    That doesn't change the fact that the conclusion was no conclusion. Dr. McIntire was in there? Yay! We need more good papers. Keep 'em coming doc. :-)
    Quote Originally Posted by Pooka1 View Post
    Right. But here is one comment they had about the McIntire study...

    This was a well-designed study with a substantial followup period and clearly defined step-by-step treatment protocols.
    I'm more proud of this critique than anything else. It's always why I was disappointed when our study wasn't included in any past articles. We took A LOT of effort to make sure these things were covered. Long(er) follow-up, lots of patient data, well defined and described, etc...

    Quote Originally Posted by Pooka1 View Post
    I hope he gets tenure somewhere.
    Quote Originally Posted by rohrer01 View Post
    He will. Unfortunately, as you know it takes time, and is somewhat "political" within the universities. My friend got tenure a couple of years ago and she started working for the university, I believe, in 2003. But, on the other hand, with a published paper that good, maybe it will happen sooner for Dr. McIntire!

    I think I'll print this post out and include it in my tenure packet when the time comes. :> Or at least bookmark it so I can re-read it when my ego has been damaged when I get my next grant review back.

  10. #10
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    What is your opinion of the quality of this artilce?

    Quote Originally Posted by LindaRacine View Post
    Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature.
    Mordecai SC, Dabke HV.

    Department of Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ, UK, Simon_mordecai@yahoo.com.
    Will you please share your opinion of the quality of this article located in ncbi.nlm.nih.gov? Thanks.

    Physiother Theory Pract. 2011 Jan;27(1):80-114.
    Physical exercises in the treatment of adolescent idiopathic scoliosis: an updated systematic review.
    Fusco C, Zaina F, Atanasio S, Romano M, Negrini A, Negrini S.
    SourceISICO (Italian Spine Scientific Institute), Milano, Italy.

    Abstract
    Two years ago we published an update of another of our previous systematic reviews about the effectiveness of physical exercises (PEs), and we found that the evidence on exercises for AIS was of level 1b. Now we have updated these results in the field of exercises for AIS with the final aim to find the strongest evidence as possible about PEs. Our goal was to verify if treatment with specific exercises for AIS has changed in these years. The study design was a systematic review. A bibliographic search with strict inclusion criteria (patients treated exclusively with exercises, outcome Cobb degrees, all study designs) has been performed on the main electronic databases. We found a new paper about active autocorrection (Negrini et al, 2008 b), a prospective controlled cohort observational study on patients never treated before so the number of manuscripts considered in the systematic review was 20. The highest quality study (RCT) compared 2 groups of 40 patients, showing an improvement of the curve in all treated patients after 6 months. All studies confirmed the efficacy of exercises in reducing the progression rate (mainly in early puberty) and/or improving the Cobb angles (around the end of growth). Exercises were also shown to be effective in reducing brace prescription. Appendices of the popular exercise protocols that have been used in the research studies that are examined are included with detailed description and illustrations. This study (like the previously published systematic reviews) showed that PEs can improve the Cobb angles of individuals with AIS and can improve strength, mobility, and balance. The level of evidence remains 1b according to the Oxford Centre for Evidence-based Medicine, as previously documented.

    PMID:21198407[PubMed - indexed for MEDLINE]

  11. #11
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    Quote Originally Posted by AMom View Post
    Will you please share your opinion of the quality of this article located in ncbi.nlm.nih.gov? Thanks.

    Physiother Theory Pract. 2011 Jan;27(1):80-114.
    Physical exercises in the treatment of adolescent idiopathic scoliosis: an updated systematic review.
    Fusco C, Zaina F, Atanasio S, Romano M, Negrini A, Negrini S.
    SourceISICO (Italian Spine Scientific Institute), Milano, Italy.
    Here's the .pdf.

    http://www.bamt.be/nieuwsbrief/art%204.pdf
    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. #12
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    From the study...

    Asymmetric exercises
    This subgroup includes three studies in which authors did not use autocorrection principles but used asymmetric exercises for trunk mobilization according to different theories. These are two pilot studies performed with the aid of a rehabilitation device: the MedX Rotatory Torso Machine for trunk rotation strength training.
    The patients underwent two training sessions per week until equal strength was achieved between sides
    I think that's an oops. Torso rotation is performed symmetrically and just a few sentences later they write that the goal was equal strength on both sides.
    Last edited by Dingo; 12-05-2011 at 10:39 PM.

  13. #13
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    Quote Originally Posted by Kevin_Mc View Post



    I think I'll print this post out and include it in my tenure packet when the time comes. :> Or at least bookmark it so I can re-read it when my ego has been damaged when I get my next grant review back.
    Sorry, I had to change a date. I believe it was 2000. She started when I transferred to that university. I graduated in 2003.

    Oh, and I'm sure if you are as meticulous as you are, you won't have too much trouble getting grant money. I did undergrad research and got just a little "taste" of writing a grant proposal. Mine got accepted, but I don't envy you guys. You can't leave out a petri dish or why you need it!
    Last edited by rohrer01; 12-05-2011 at 11:00 PM.

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