"troublingly inconsistent or inconclusive studies of any level."

[concerned dad]

Thanks for the replies Emily, Gayle and Sharon.

Sharon, you make some very good points. There is still much to learn. Time is not on my side though. This whole thing reminds me of a Mark Twain Quote: There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.

Gayle, Thank you for the link to the BRAist Study. I guess I've heard it referred to but never saw the actual information. It is interesting to read that there seems to be an independent panel evaluating preliminary results. I may be reading more into this than I should, but since this study has been going on for 2 years, I assume that had there been a clear preference for bracing they would have stopped the study and offered it to all.

The last large study (Nachemson) took about 10 years between the start of the study (1985) and publishing the data (1995).

We are going to give the SpineCor a try with Dr. Rivard.

[Pooka1]

Well, even if there is a clear result to date, if the number of subjects is too small, nobody should be halting anything. Large numbers are needed... this is a very variable condition (even between identical twins ).

[concerned dad]

Well, even if there is a clear result to date, if the number of subjects is too small, nobody should be halting anything. Large numbers are needed... this is a very variable condition (even between identical twins ).

The "clearer" the result, the fewer the patients needed to demonstrate it. Nachemson has a table where they compare the different rates of curve progression with the number of patients required to detect a difference at the 5 percent significance level. Purely a statistical argument.
The extreme limit on the table shows that if the difference between observation and bracing where 30% curve progression (observation) and 5% (bracing) they could detect the difference with only 47 patients.
But, if the difference were only 30% curve progression (observation) and 20% (bracing) they would need almost 400 patients to detect it.

I was also interested to see in the link Gayle shared that the braces are fitted with temperature sensors to measure actual compliance.

And, Gayle offered a perspective on bracing that few parents can appreciate having actually worn a brace herself. Thank you for sharing.

[Pooka1]

Well, I have my doubts.

I am of the (admittedly small) school of thought that if you need fancy statistics to interpret your data then you should consider a better experimental design. It takes lots of training and experience be able to design a good study in my opinion.

You can flip a coin 30 times and get 25 heads some (small) percentage of the time. In fact you can calculate what percentage of time you would get 25 of 30 being heads. Doesn't mean the true frequency isn't 0.5 heads.

There was an article discussing this very thing within the context of scientific studies in my field several years ago.

[concerned dad]

Well, I have my doubts.

I am of the (admittedly small) school of thought .....

Well, it's not that small of a school, I would have to agree with you. I feel like quoting smart people today, and here's another one (somewhat related but not directed at any particular study).

'He uses statistics as a drunken man uses lamp-posts- for support rather than illumination.' A. Lang sometime in the 1800's

But, I dont think Nachemson was using fancy statistics. They were just trying to determine how many people they needed for their study to come up with a result that was statistically significant. It was part of their attempt to design a good study.

And my "reading between the lines" of this current ongoing study guesses that perhaps, if the preliminary results were dramatic, they would have halted the study and braced (or unbraced) all the kids.

[Pooka1]

Concerned Dad, you have some pertinent quotes.

It is not out of the question to suggest that bracing efficacy might never be nailed down in my opinion. The problem with people agreeing to randomized trials combined with improvements in non-fusion and fusion surgery may make bracing obsolete before it can be a proven modality.

[concerned dad]

Table 2 from Dolan in Spine 2007 was bothering me. I mentioned it earlier in this thread. I was going to post a question on the other (UK) forum asking her to clarify it.
I took a better look at the issue and I think it is either a typo or a problem with my PDF.
Table 2 is a 2 page table. On my PDF it has a different total row height on page 1 of the table than on page 2 of the table. I think their comment that I interpreted to be about the Puerto Rico paper was really meant to summarize the Ireland paper. I edited my post above in this thread and figured I would also make a post here (in case it was bothering anyone like it bothered me.... ) just to set the record straight.

[Pooka1]

Thanks for correcting that.

Always remember that despite your best efforts and the best efforts of the researchers, most research results are still false.

[FixScoliosis]

...most research results are still false.

Hi Sharon.
I know that you have experience in research, so could you please explain a bit more in detail, how it is that most result/conclusions are false?
I know that many things can be twisted with statistics, is that what you are referring to?

I'm just want keen to learn something new.

will

[Pooka1]

most results are false

Why Most Published Research Findings Are False

John P. A. Ioannidis

John P. A. Ioannidis is in the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America. E-mail: jioannid@cc.uoi.gr

Abstract

Summary

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.

[FixScoliosis]

Sharon, Thank you!

This is very good, I will read it all.