Originally posted by Pooka1
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TSRH research shows that bracing IS effective!
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Originally posted by flerc View PostOf course I was not talking about something so obvious. I referred to cases when degrees increased in some months or years after the remotion.
If brace wear was easy we would never be discussing this. I hope it is shown to be effective some day just so kids who wore them can know there was a chance.Last edited by Pooka1; 07-15-2010, 11:50 AM.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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Originally posted by Pooka1 View PostIt is reasonable to conclude from the data in hand that braces may only delay surgery as opposed to avoid it.
Originally posted by Pooka1 View PostThat is proven but it certainly hasn't been disproven at this point because of the huge backdrop of unnecessarily treated kids that we know are out there based on the few controlled studies. It is also impossible to say if any particular case of brace usage stopped a curve given that most curves do not progress and that there are at least 3 people on this little group who got into the 50s and their curve stopped (without brace in at least one case).
Originally posted by Pooka1 View PostIf brace wear was easy we would never be discussing this. I hope it is shown to be effective some day just so kids who wore them can know there was a chance.
Hopefully, the new tests that are out will be able to pinpoint those kids who will progress but that's a very new technology and will probably be some time before it's used mainstream as a screening tool. I think most surgeons would err on the side of caution and brace at this time.
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Originally posted by Pooka1 View PostIt is reasonable to conclude from the data in hand that braces may only delay surgery as opposed to avoid it. It is impossible to say. That is not proven but it certainly hasn't been disproven at this point because of the huge backdrop of unnecessarily treated kids that we know are out there based on the few controlled studies. It is also impossible to say if any particular case of brace usage stopped a curve given that most curves do not progress and that there are at least 3 people on this little group who got into the 50s and their curve stopped (without brace in at least one case). Once you know those things, it's very hard to make definitive statements about bracing efficacy.
If brace wear was easy we would never be discussing this. I hope it is shown to be effective some day just so kids who wore them can know there was a chance.
Any way, in other cases when, after skeletal maturity, the curve increase again over time, how could it be explained in a scientifical way?
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As an afterthought, I remembered that I emailed Dr. Mooney about his study to see if there were any locations in Houston participating. He did reply back (they were not). My point is these people are not out of our reach, you just have to make an effort to reach them. If there is a question about the legitimacy of this study, you should make an effort to contact these researchers and get the true facts and post them here.
In reference to Dr. Mooney, he was a retired scoliosis surgeon trying to find a better way to treat this condition before it progressed to surgery. He sounded very compassionate in his response to me. Don't assume all these physicians and researchers are conducting these studies for personal gain, I believe many if not most of them are a truly dedicated group looking for answers just like us.
Perhaps the research was flawed, but the intentions are not.
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Originally posted by Sherie View PostThis study is not the same. They're only looking at compliance. In the TSRH study, they've actually concluded that compliant bracing has resulted in stopping curve progression.
And, so you don't have to look back:
http://early-onset-scoliosis.com/Doc...Compliance.pdf
And, here's another one:
http://www.srs.org/professionals/bra...s/section3.pdfLast edited by LindaRacine; 07-15-2010, 02:31 PM.Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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Originally posted by LindaRacine View PostSorry, my copy/paste apparently didn't work correctly. I've posted the correct URL above.
And, so you don't have to look back:
http://early-onset-scoliosis.com/Doc...Compliance.pdf
And, here's another one:
http://www.srs.org/professionals/bra...s/section3.pdf
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Originally posted by Sherie View PostThanks Linda. So basically, these previous studies concur that bracing IS effective.
ETA: The article you posted is June 2010. Why hasn't the BRAIST study been halted immediately on ethical grounds?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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Originally posted by Sherie View PostWhy don't you guys write to the researchers with your concerns let us know what they say.
It's like if I do a time course study with 10 time points and publish at the point where I have only collected data on the first two time points. That's assuming this is another in-brace study.Last edited by Pooka1; 07-16-2010, 05:54 AM.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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Originally posted by Sherie View PostWhy don't these details matter? That's the whole point of research, it's in the details. I didn't see what she was referring to and simply wanted to know what she was looking at.
Why do you keep quoting the Mooney study? That has no relevance here and is way off topic.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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Originally posted by Sherie View PostNo, I don't think it's premature if they are only publishing the facts as they have developed. If they've been bracing for 18 months or whatever time, and they didn't see any progression during that time in the compliant bracers, then they're drawing a factual, observable conclusion from their data. Now if they go on to say somewhere that this will hold forever, then that's a false statement.
If anyone has seen a paper no this I would like to be edified.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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As I read the article, it seems to be a new study i.e. patient population. However, the patients were recruited between 1998 and 2000. If this group published on the same data I can't find it and they don't refer to that in the introduction. The whole group published a paper in 1997 comparing Boston to Charleston and the lead author (Katz) published something in 2001 but that was a retrospective study.
All patients were risser 2 or less and between 25° and 45°. X-rays taken every 4 months out of brace. All patients were followed until skeletal maturity. Failure was >6° progression or progression to surgery.
They do a fairly complex analysis linking brace wear to progression and stratifying by tri-radiate cartilage, risser, time of day the brace is worn, compliance and total number of hours of brace wear.
Of the 100 patients, 50 progressed and 50 did not. Of the 50 that did progress, 28 had surgery. The non-sugical group had a significantly higher number of daily brace wear (10.6 v 7.2), total number of braced hours (5002 v 2552), and percent compliance (42.4 v 24.4). These numbers include the non-progression group as well, i.e. 28 had surgery and 72 did not and 22 of the 72 with no surgery had progression. It would be interesting to see the analysis of the surgical v non-surgical in the progressing group.
The group that had the highest number of progressions was the risser 0 group. The risser 0 non-progressive group had a significantly higher number of daily brace wear than the progressive group (9.9 v 5.2).
The article goes on and on. Lots of statistics but the data seems to be fairly clearly presented, that is, they don't seem to be massaging the data too much. There are a lot of more detailed results in the text, but requires careful reading. Of interest.
Brace treatment is traditionally compared with the natural history study by Lonstein and Carlson, in which 68% of curves between 20° and 29° in patients at Risser 0 or 1 progressed. Only one of our thirteen patients at Risser 0 who wore the brace for more than twelve hours per day experienced curve progression. This benefit continued between the completion of brace wear and the latest follow-up. Those wearing the brace for seven to twelve hours per day had progression 39% of the time, whereas those who wore the brace fewer than seven hours per day had progression 68% of the time, which is the same as the natural history
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All of that was quite interesting. Thanks for crunching it. I would like to read the paper.
Originally posted by skevimc View PostThe latest follow-up date isn't mentioned, but the patients were recruited at least 10 years ago. So it's not a huge jump to say these have remained stable after brace treatment. However, I do wish they would present that data. But it's possible they didn't have IRB approval for that.
And if these patients go back 10 years, how did they choose a mere 100 out of all of them? They have to worry about data selection which I'm guessing can be inadvertent also. That is, they inadvertently used a criterion that was correlated with a certain outcome... something like the inadvertent stacking of T curves in the non-braced group versus L curves in the braced group of that other study which I'm blanking on the name of.
And speaking of T versus L curves, I hope they indicated which compliance group had which curve types. It would invalidate the results to some extent if the L group was over-represented in the compliant group and(or) the T group was over-represented in the less compliant group.
I also question the 68% figure for chance of progression between 20* and 29* at low Risser. I think that comes from a table where there are no errors bars if I'm remembering correctly. If they showed the error bars, that number might appear less hard let's say than it appears.
Anywho, thanks again for the synopsis.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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Originally posted by Sherie View PostThanks Linda. So basically, these previous studies concur that bracing IS effective.
The studies found that bracing works. However, since that time many specialists have agreed with Sharon, that since there is no control, they cannot tell for certain whether the braced kids might not have progressed without any treatment.
With that said, if I had a skeletally immature child with a curve between 25-40 degrees, I'd push them to wear a brace as much as possible.
Regards,
LindaNever argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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Hi Kevin...
The real natural history of the cohort won't be known until they reach at least the age of 35, when a lot of curves seem to start causing trouble. If bracing doesn't keep most of the patients out of the O.R., then it's going to be judged pretty worthless, because there's a big cost, both monetarily and in terms of the additional pain and disability of adult scoliosis surgery vs. adolescent scoliosis surgery.
At this point, it would be reasonable to say that bracing might work, but no one yet knows for certain.
Regards,
LindaNever argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
---------------------------------------------------------------------------------------------------------------------------------------------------
Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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