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Wear your brace - It usually works if you wear it properly!

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  • Wear your brace - It usually works if you wear it properly!

    For those who may believe that bracing doesn't work, this study below shows the difference between those who were compliant with bracing and those who weren't.

    In my mind, this proves that bracing does work because if bracing had no effect there would be no difference between these two groups of brace wearers!!

    i.e. In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075).

    Now, if they just did a big enough study (Braist perhaps) and showed these kinds of results, even without a control group...you could certainly say that bracing was effective if used properly and with a good correction.



    Journal of Pediatric Orthopaedics:
    July/August 2005 - Volume 25 - Issue 4 - pp 420-422
    doi: 10.1097/01.bpo.0000161097.61586.bb
    Spine: Original Article

    The Association Between Brace Compliance and Outcome for Patients With Idiopathic Scoliosis

    Rahman, Tariq PhD; Bowen, J Richard MD; Takemitsu, Masakazu MD; Scott, Claude MD

    Abstract
    This was a prospective study on the association of brace compliance and curve progression in idiopathic scoliosis. Compliance was measured electronically by embedding a temperature sensor and logger in the Wilmington scoliosis brace. To date there have been no studies that relate objective measures of compliance in a scoliosis brace to treatment outcomes.

    Thirty-four subjects with idiopathic scoliosis were monitored over the duration of their brace wear. Compliance data were downloaded and analyzed.

    The compliance rate for the patients whose curve progressed (>5 degrees) was 62%; the compliance rate for the patients who did not progress was 85% (P = 0.004).

    In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075).

    Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome.

  • #2
    Hmmm,

    Maybe this should actually be in the Research section?

    Comment


    • #3
      Originally posted by Ballet Mom View Post
      Hmmm,

      Maybe this should actually be in the Research section?
      I don't know where it should be. Maybe a new area titled "My Interpretation of the Research".

      BalletMom, I'm not going to digress into this whole thing again, but:

      "Wear your brace - It usually works if you wear it properly!" <> "Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome."

      There's a logic flaw there.
      Fusion is NOT the end of the world.
      AIDS Walk Houston 2008 5K @ 33 days post op!


      41, dx'd JIS & Boston braced @ 10
      Pre-op ±53°, Post-op < 20°
      Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


      VIEW MY X-RAYS
      EMAIL ME

      Comment


      • #4
        Originally posted by txmarinemom View Post
        I don't know where it should be. Maybe a new area titled "My Interpretation of the Research".

        BalletMom, I'm not going to digress into this whole thing again, but:

        "Wear your brace - It usually works if you wear it properly!" <> "Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome."

        There's a logic flaw there.

        And what flaw would that be? I don't see any flaw there at all.

        Comment


        • #5
          Originally posted by Ballet Mom View Post
          And what flaw would that be? I don't see any flaw there at all.
          I hope you aren't serious. Let's try a variation of one of Sharon's recent analogies ...

          What you effectively stated in your comparison is something like:

          "Ride in cars and you'll usually crash!"

          =

          "The more you ride in a car, the more likely you are to be involved in a crash".


          See it yet?
          Fusion is NOT the end of the world.
          AIDS Walk Houston 2008 5K @ 33 days post op!


          41, dx'd JIS & Boston braced @ 10
          Pre-op ±53°, Post-op < 20°
          Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


          VIEW MY X-RAYS
          EMAIL ME

          Comment


          • #6
            Please explain this result:

            "In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075)."

            Those who wore their brace compliantly had a rate of 11% who progressed. Those who did not, 56% progressed. Do you see the advantage in wearing a brace compliantly?

            I think this absolutely shows that braces worn as directed do make a difference.
            Last edited by Ballet Mom; 12-18-2009, 05:29 PM.

            Comment


            • #7
              This is all in brace and that is clearly stated.

              Thirty-four subjects with idiopathic scoliosis were monitored over the duration of their brace wear.
              I hope they follow ALL these kids to see where their curves are 2 years after all brace wear stops.

              I won't hold my breath.

              The other thing is I want to see if the T curves ended up being stacked in the non-compliant group. It if turns out most of the compliant group had L curves and most of the non-compliant group had T curves they the study is not useful. And I want to see the distribution of curve magnitude in each group before I agree the bracing did a thing.

              I continue to question the peer review. If I tried to publish interim results that likely have no correlation to the final results in my field, I would be edified if not ti-edified in no time flat. The paper probably wouldn't even be sent out for review by the editor absent final results or some rigorous correlation between interim and final results which is not the case with brace wear, in-brace correction, compliance, etc. etc..

              In my opinion, this is noisy enough that no clear result will ever emerge, similar to the PT situation. And we have enough people in this sandbox who said their were very compliant, told their curve was stable, only to show up in the surgical section. If anything turns out to be the master variable it will be esoteric about particular brace fit to particular kids by chance, not by skill of the orthotist. And even then it will be a very small minority of the population who wears the brace. Just my opinion.
              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."

              Comment


              • #8
                Originally posted by Ballet Mom View Post
                Please explain this result:

                "In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075)."

                Those who wore their brace compliantly had a rate of 11% who progressed. Those who did not, 56% progressed. Do you see the advantage in wearing a brace compliantly?

                I think this absolutely shows that braces worn as directed do make a difference.
                I think if your claim were the intended conclusion of the study, it would have been stated as such.

                It was not.

                What the stated conclusion proves is IF you're in the group that may benefit from a brace, it's more likely it will be effective if it's ON your body.

                It doesn't even come close to saying "braces are usually effective".
                Fusion is NOT the end of the world.
                AIDS Walk Houston 2008 5K @ 33 days post op!


                41, dx'd JIS & Boston braced @ 10
                Pre-op ±53°, Post-op < 20°
                Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


                VIEW MY X-RAYS
                EMAIL ME

                Comment


                • #9
                  Originally posted by txmarinemom View Post
                  I think if your claim were the intended conclusion of the study, it would have been stated as such.

                  It was not.

                  What the stated conclusion proves is IF you're in the group that may benefit from a brace, it's more likely it will be effective if it's ON your body.

                  It doesn't even come close to saying "braces are usually effective".
                  Concur.

                  This abstract in uninterpretable without specifics on T versus L, curve magnitude, etc. etc.

                  The number of patients in this study is not expected to yield robust results given the variability of this condition. If you ran this EXACT study with another set of 34 kids you would NOT expect the results to look the same except by chance. That's what variability means.
                  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."

                  Comment


                  • #10
                    Originally posted by txmarinemom View Post
                    I think if your claim were the intended conclusion of the study, it would have been stated as such.

                    It was not.

                    What the stated conclusion proves is IF you're in the group that may benefit from a brace, it's more likely it will be effective if it's ON your body.

                    It doesn't even come close to saying "braces are usually effective".

                    So you're saying that it just happens that all the kids that would benefit from a brace, just happened to be in the compliant group. Sure.


                    Anyhow, must run, busy this weekend. Will take this up later.

                    Comment


                    • #11
                      Originally posted by Ballet Mom View Post
                      So you're saying that it just happens that all the kids that would benefit from a brace, just happened to be in the compliant group. Sure.
                      Do you have the paper?

                      What is the distribution of T versus L curves in each group? Also what are the Cobb angles in each group.

                      The smaller L curves will appear to respond at a higher rate than the larger T curves. The compliance was determined NOT by curve location or magnitude by by the patients themselves. And we can't say much with only 34 patients even if we knew these things.
                      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."

                      Comment


                      • #12
                        Originally posted by Ballet Mom View Post
                        So you're saying that it just happens that all the kids that would benefit from a brace, just happened to be in the compliant group. Sure.
                        You still aren't getting it, but I don't think continuing to point out the gaps in your theory is going to make that happen.

                        Until you can show that any child in EITHER group wouldn't have stopped progressing - brace or not - you don't have DATA to back up your claim.
                        Fusion is NOT the end of the world.
                        AIDS Walk Houston 2008 5K @ 33 days post op!


                        41, dx'd JIS & Boston braced @ 10
                        Pre-op ±53°, Post-op < 20°
                        Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


                        VIEW MY X-RAYS
                        EMAIL ME

                        Comment


                        • #13
                          Originally posted by txmarinemom View Post
                          You still aren't getting it, but I don't think continuing to point out the gaps in your theory is going to make that happen.

                          Until you can show that any child in EITHER group wouldn't have stopped progressing - brace or not - you don't have DATA to back up your claim.
                          Concur.

                          This will always be the Achilles heel of bracing and PT studies. ALWAYS. We know too much about large curves occasionally halting on their own for decades.

                          It truly is intractable in my opinion when the condition is so variable.
                          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."

                          Comment


                          • #14
                            Question for Pooka

                            Pooka, if you don’t may me asking.....
                            What would you do today (knowing what you know), if another hypothetical- imaginary daughter with Risser 0 is told to have a curve between 20º or 35º? Would you let her curve without trying anything until surgery level? And what if the curve is lumbar?
                            2004: Daughter diagnosed at 13 L38º. Risser 0.
                            Treatment: Cheneau brace
                            2009: Brace free, 18 years old, Risser 5, L25º

                            Comment


                            • #15
                              Originally posted by AILEA View Post
                              Pooka, if you don’t may me asking.....
                              What would you do today (knowing what you know), if another hypothetical- imaginary daughter with Risser 0 is told to have a curve between 20º or 35º?
                              What I know about this wouldn't fill a thimble... it's easy to get the wrong idea around here about how much effort is involved in actually getting your arms around a subject.

                              W.R.T. the hypo daughter, I would let her try any brace she wanted if she wanted.

                              Would you let her curve without trying anything until surgery level? And what if the curve is lumbar?
                              "Let" her curve? Doesn't that imply I necessarily have some way to stop it?

                              Lumbars don't tend to progress as much as thoracic making bracing less likely in my mind. If she wanted to wear a Charleston (or any brace) I would get it for her.
                              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."

                              Comment

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