MJB, Although Dr. Rivard may feel that there isn't a need for an out of brace xray, he is in agreement with the other doctors that when an out of brace xray is taken, that the child should be out of brace for at least 24 hours prior. Well, caveat - he hasn't told me that directly, because we haven't had the out of brace xray discussion yet, but he had told others who had posted that here.
Sharon, I believe you are right...they have been gathering data and they have to decide on a protocol. They would say that the data they have (that looks very promising) is based upon not being out of brace for more than 2 hours at any one time (although to clarify, 2 out of brace periods are allowed per day as long as the brace is worn in between...i.e. a couple hours out of brace in the morning and a couple hours out of brace in the late afternoon for a total of 4 hours out of brace). I imagine they'd say that at this point they don't have any data to indicate whether the brace has the same success rates if somebody goes 4 straight hours out of brace on a REGULAR basis or spends 6 hours out of brace or whatever. I saw a similar evolution with the TLSOs....while people have been wearing them for decades, it was more recently (relatively) that studies were done to see whether wearing a tlso for 18 hours a day was really any worse than 23 hours a day. First they have to come up with a baseline, and then when the results of the baseline are well established they can start to tweak various controls (i.e. time in brace). Nonetheless, I'd be shocked if they said occasional exceptions are likely to be harmful.
Sharon, I believe you are right...they have been gathering data and they have to decide on a protocol. They would say that the data they have (that looks very promising) is based upon not being out of brace for more than 2 hours at any one time (although to clarify, 2 out of brace periods are allowed per day as long as the brace is worn in between...i.e. a couple hours out of brace in the morning and a couple hours out of brace in the late afternoon for a total of 4 hours out of brace). I imagine they'd say that at this point they don't have any data to indicate whether the brace has the same success rates if somebody goes 4 straight hours out of brace on a REGULAR basis or spends 6 hours out of brace or whatever. I saw a similar evolution with the TLSOs....while people have been wearing them for decades, it was more recently (relatively) that studies were done to see whether wearing a tlso for 18 hours a day was really any worse than 23 hours a day. First they have to come up with a baseline, and then when the results of the baseline are well established they can start to tweak various controls (i.e. time in brace). Nonetheless, I'd be shocked if they said occasional exceptions are likely to be harmful.
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