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Thread: Are Some Canadian Doctors from the Dark Ages?

  1. #31
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    How about this one?

    Spine. 2003 Sep 15;28(18):2078-85; discussion 2086. Related Articles, Links

    Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: a case-control study-part I.

    Danielsson AJ, Nachemson AL.

    Department of Orthopaedics, Sahlgrenska University Hospital, Goteborg University, Sweden. danielsson.aina@telia.com

    STUDY DESIGN: A consecutive series of patients with adolescent idiopathic scoliosis and brace-treated (BT) between 1968 and 1977 before age 21 years (BT: n = 127; 122 females and 5 males) were followed-up at least 20 years after completion of the treatment. OBJECTIVES: To determine the long-term outcome in terms of back pain and function in patients BT for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Few reports on long-term outcome of back pain and function have previously been presented for consecutive groups of these patients. MATERIALS AND METHODS: One hundred ten (87%) BT patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination, evaluation of curve size (Cobb method), and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality-of-life aspects as well as present back and pain symptoms were used. One hundred nine had complete follow-up. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. RESULTS: The deterioration of the curves was a mean of 7.9 degrees for all curves, excluding the only patient who underwent operation after 4 years (increase = 27 degrees). The patients had significantly more degenerative disc changes than the controls. Lumbar and thoracic back pain, although mild (2.7 on visual analogue scale), was significantly more frequent among the patients than the controls (75 vs. 47%, P = 0.0050 and 35.8 vs. 22.0%, P = 0.033, respectively). Only 24% of the patients admitted daily pain and analgesics were sparsely used.The patients had a slightly, but significantly, worse back function as measured by the Oswestry Disability Index (9.2 vs. 4.8, P = 0.0012) and general function score (7.7 vs. 4.2, P = 0.0006), but general health-related quality of life was not affected. No differences could be seen in sociodemographic variables between the groups, except for having ever been on sick leave because of the back (38% vs. 19%, P = 0.0036). Furthermore, no differences could be found between patients with different curve types (single thoracic, n = 50; lumbar, n = 19; double curves, n = 40). No correlation could be found between pain and its localization and curve size, an increase of at least 10 degrees since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, body mass index, or smoking. CONCLUSIONS: More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls. Compared with surgically treated patients with a mean end result similar to this group, no significant differences were found except that BT patients experience more affective components of their pain.

  2. #32
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    Are Some Canadian Doctors from the Dark Ages

    Linda,

    As I said I don't wish to have a debate on this. Personally, I'd prefer if you were right and bracing did work so well!!! Nonetheless, I'm not going to say that I was never told something when in fact I was (on more than one occasion). Or that I don't know an awful lot of patients that ended up needing surgery after being braced when in fact I do. Even doctors don't know everything about scoliosis so I certainly won't claim to. In addition, I'm sure that many factors have an influence on outcomes (curve size, age, daily hours braced, etc., etc.). So let's just leave it at that.

    Regards,

    Maria

  3. #33
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    I was doing a search on the internet and found this interesting study (NOT!!!!). It's referred to as: Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). The main premise is that the effectiveness of bracing is *still* in doubt! One good thing about the link is that it lists hospitals participating in this randomized "study" and hence we can all avoid them like the plague!!! Study chairs or principal investigators appears to be:

    Stuart L. Weinstein, MD, Principal Investigator, University of Iowa
    Lori A. Dolan, PhD, Study Director, University of Iowa

    Primary Outcomes: Progression of Cobb angle to greater than 50 degrees (proxy for surgical indication); Cessation of skeletal growth

    Secondary Outcomes: Clinical; Radiographic; Psychosocial

    Expected Total Enrollment: 500

    Study start: February 2007; Expected completion: August 2010

    Bracing is currently the standard of care for the treatment of adolescent idiopathic scoliosis (AIS). Despite many years of research, the effectiveness of bracing is still in doubt, and it is not known with any certainty, which, if any, patients with AIS will respond favorably to bracing. Many risk factors for curve progression have been observed, yet the science of bracing has not advanced to the point where reliable estimates of the risk of progression to surgery are possible for an individual patient, or even for a group of patients presenting with a common set of risk factors. Therefore, patients undergo this treatment without knowing the probability of success or failure. This trial is a multicenter, randomized, controlled study to quantify the effectiveness of bracing relative to observation alone for the treatment of adolescent idiopathic scoliosis (AIS). The primary aim of the study will be to measure the relative risk of curve progression to greater than 50 degrees in the two treatment arms. This outcome is significant because it indicates a high risk for continued curve progression throughout adulthood, and is therefore the parameter at which fusion and instrumentation are generally indicated. We will concurrently measure and compare the quality of life and psychosocial adjustment of these adolescents. We will also estimate the relationship between bracing dose (wear time) and curve response and to develop a predictive model for the outcome of curve progression. 23 states in the U.S. mandate school screening, which leads to an estimated cost of $41 million dollars annually. If bracing is not effective, these programs could be eliminated and the resources directed toward other adolescent health or social problems. On the other hand, discovering the most effective dosing schedules and ordering more appropriate treatment could lead to a decrease in the surgery rate and diminish the associated burden to the Medicaid budget. Therefore, this study, whether positive or negative, will have substantial impact on public health.


    http://clinicaltrials-nccs.nlm.nih.g...37046?order=15


    *
    Last edited by Celia; 04-10-2007 at 03:00 PM.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  4. #34
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    CONCLUSIONS: More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls.
    Interesting conclusion given that the 'results' reported in the few sentences preceding this statement read as follows:

    The patients had significantly more degenerative disc changes than the controls.
    Lumbar and thoracic back pain, although mild (2.7 on visual analogue scale), was significantly more frequent among the patients than the controls (75 vs. 47%, P = 0.0050 and 35.8 vs. 22.0%, P = 0.033, respectively).
    The patients had a slightly, but significantly, worse back function as measured by the Oswestry Disability Index (9.2 vs. 4.8, P = 0.0012) and general function score (7.7 vs. 4.2, P = 0.0006)
    "..had a slightly, but significantly, worse back function..." What kind of contradictiory statement is that? .."slightly, but significantly, ..."????

    No differences could be seen in sociodemographic variables between the groups, except for having ever been on sick leave because of the back (38% vs. 19%, P = 0.0036).
    "No differences could be seen... " except a 50% HIGHER INCIDENCE OF SICK LEAVE! That qualifies for "no differences"???

    No correlation could be found between pain and its localization and curve size, an increase of at least 10 degrees since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, body mass index, or smoking.
    Smoking???? What does that have to do with this study???

    My point is this: Using studies to validate a point must be taken with a grain of salt. Any good researcher, scientist or Doctor knows that their are good studies and bad studies. They can be influenced and compromised by many factors including personal/professional gains and benefits which would be derived from a particularly biased "conclusion".

    As for the upcoming study that was just posted... it sounds like an unbiased approach to me. It's extensive and contains several parties who don't appear to have anything to gain personally from it's outcome, one way or another. I don't think it's fair to discredit this type of endeavor, even if it suggests a potential premise that one may disagree with. It's apparent that bracing is effective in some cases and not in others. Which means that we need to begin looking beyond the same two methods (bracing and surgery) that we've been using for a long time now to come up with something that is more consistent, intelligent and less invasive. At the same time it doesn't mean that we have to give up what we have... but open some new doors for consideration. Because the fact remains that although some of you ('the *we* of this forum) may be having success with bracing, others out there are not.

    structural

    p.s.- It amazes me that a forum "moderator" could be so partial in their privileged role. This thread sheds more light onto the attempts at devaluing and discrediting others opinions. It's no wonder there's such a limited point of view on this forum.

  5. #35
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    Quote Originally Posted by structural75
    It's apparent that bracing is effective in some cases and not in others. Which means that we need to begin looking beyond the same two methods (bracing and surgery) that we've been using for a long time now to come up with something that is more consistent, intelligent and less invasive. At the same time it doesn't mean that we have to give up what we have... but open some new doors for consideration. Because the fact remains that although some of you ('the *we* of this forum) may be having success with bracing, others out there are not.
    I'm sure many a parent would cringe at the thought of having their own precious child randomly selected as the control subject for the greater good of this idiotic "study". Not having a child with scoliosis you obviously can't relate. As for the collective "we" when did I become a representative for the masses?


    *

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  6. #36
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    23 states in the U.S. mandate school screening, which leads to an estimated cost of $41 million dollars annually. If bracing is not effective, these programs could be eliminated and the resources directed toward other adolescent health or social problems.
    This, I would agree, is not a very intelligent proposal... Otherwise, given the number of folks out there who are unfortunately following their Doctors orders to "wait and watch", I don't see how this study would be to blame for that if they're already taking the passive approach on their own. If I had it my way I'd make it illegal for doctors to avoid treating scoliosis as they often do (the wait and watch approach). Then I'd toss out this pseudo physics-based scientific approach to physical medicine and get people into treatment rather than watching them sit on their hands waiting for a 'study' to appear on the internet to validate their sense of well-being!

    You're harsh comments about avoiding associated hospitals participating in this study is inappropriate. Where do you get the right to insult hospitals such as Shriner's who have helped thousands of children with serious conditions beyond scoliosis?

    I'm sure many a parent would cringe at the thought of having their own precious child randomly selected as the control subject for the greater good of this idiotic "study".
    Just as many would cringe at the idea of continuing to treat scoliosis with a method that does absolutely nothing to attempt to address or acknowledge it's actual cause, known or unknown. You're forcing the body against its unfortunate, yet inherent will and then you wonder why curves often progress again later on... Meanwhile, you have no interest in considering more intelligent, comprehensive and dynamic approaches toward actual potential resolution of influential factors... Talk about "idiotic".

    Sorry Celia, but this sort of thing is happening in the field of medicine everyday and I don't hear many folks complaining... human trials for drugs, etc.... And just imagine what the 'original' patients using spinecor... I mean the very first people to wear a 'soft' brace... How would you justify that endeavor without knowing what you know now? That could have potentially ruined a lot of lives by failing and consuming their small window of opportunity for real change had it not worked.

    Quote Originally Posted by Celia Vogel
    As for the collective "we" when did I become a representative for the masses?
    I have know idea who decided that one...
    Quote Originally Posted by Celia Vogel
    If I remember correctly... *we* determined Dr. Weiss didn't get adequate training in fitting the Spinecor brace and hence his results were flawed
    Not having a child with scoliosis you obviously can't relate.
    I'd kindly suggest keeping the personal comments to yourself... you don't know what my child has!

  7. #37
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    Your attempts to start an argument with me are an exercise in futility! I've once again reported you to Joe O'Brien!


    *

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  8. #38
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    Celia,

    Thank you... once again.
    Quote Originally Posted by Celia Vogel
    Your attempts to start an argument with me are an exercise in futility!
    Don't remind me...

    What was your point in dredging up this thread that ended on October 10, 2005??? Are you deliberately seeking out topics that you can discredit even further? Is it not bad enough that you're friends on this forum drove off some other previous members on this thread years ago in the same manner that you all have tried with me?

    It's perfectly clear that your behavior leans towards foul mouthing anyone with a different opinion or perspective than yourself... You even went so far as to dig up this old thread... Why not start a new one with your recent 'findings'?
    Quote Originally Posted by Celia Vogel
    I was doing a search on the internet and found this interesting study (NOT!!!!). It's referred to as: Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). The main premise is that the effectiveness of bracing is *still* in doubt! One good thing about the link is that it lists hospitals participating in this randomized "study" and hence we can all avoid them like the plague!!! Study chairs or principal investigators appears to be:
    Yes, that's right... it is NOT effective for everyone, or even close to that. So give others less fortunate than yourself an opportunity for a more objective view and exploration on matters.

  9. #39
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    We Will Respond To Your Comments To Provide Additioinal Insight To Balance Your Input, But You Can't Start An Argument.

    You Still Need To Find A Forum For Frustrated Practitioners, And Stop Attacking Members Of This Forum.
    God has used scoliosis to strengthen and mold us. He's good all the time!On this forum these larger curves have not held forever in Spinecor,with an initial positive response followed by deterioration. With deterioration, change treatment.The first year she gained 4 or 5 inches and was stable at around 20/20 in brace, followed by rapid progression the next year.She is now 51/40 (Jan2008)out of brace (40/30 in Spinecor) and started at 38/27 out of brace(Jan2006.) Now in Cheneau.

  10. #40
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    Cheryl,

    Did the points I raised (not attacks!) in these previous posts just go completely unheard or unnoticed? Why seak out and pull forth a post from two years ago when a new thread could have been started? It just seems as though some folks here actively engage in providing fuel for their fire.

    We Will Respond To Your Comments To Provide Additioinal Insight To Balance Your Input,
    That sounds like a great idea, so why don't any of you do that? I don't understand??? What you appear to be doing is making unintelligent remarks about "idiotic" studies and "avoiding hospitals like the plague"... That doesn't qualify as "additional insight" to balance my input... does it? If I posted a study with such contradictory remarks and conclusions in it you folks would tear me to shreds.... It seems as though I'm always having a one way conversation because all you guys do is insult other forum members, doctors, practitioners, hospitals and methods that you don't subscribe to or understand.

    And what's this "we" all about? Don't you folks have an independent voice? "We will respond" makes it sound as though other people on this forum have to present themselves to 'the board of trustees'... give me a break.

    You Still Need To Find A Forum For Frustrated Practitioners, And Stop Attacking Members Of This Forum.
    Is this not an insult or attack??? How is this constructive or "balancing". The frequency of frustrated practitioners will decrease on the day when ignorance is overcome by education and people begin to make choices for themselves rather than following the masses... But thank you for thinking of my well being anyhow.
    Last edited by structural75; 04-12-2007 at 04:43 PM.

  11. #41
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    Cheryl,

    One last thing... I've noticed in reading many past threads that it is very rare that members of this forum argue, EXCEPT for those of you that frequently get into it with me. I noticed that some of these folks have gotten into arguments with other members as well (I'm certainly not the only one who's come under the wrath of a select few). So why is it that the consistency in arguing doesn't come from me, but from the very people you defend constantly? I've only been on this forum for less than a year and I've read plenty of arguments from your 'friends' with other folks previous to that....

  12. #42
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    Structural,

    I don't see why I have to explain to you why I put the BrAIST study in this thread because it is the *very* same study that was referred to 2 years ago! This is "not" a Canadian study, it is being led by some very influential doctors in the United States - Dr. Weinstein, I believe. A number of SRS studies have already spelled out the conditions required for successful bracing during the adolescent growth spurt/ Peak Height Velocity Period and that is to brace curves when they're still below 30 degrees. Granted there are a lot of variables involved but I don't believe "doing nothing" and watching these children progress to surgery levels is the way to go. If you can't *see* why this study is using innocent helpless children as guinea pigs in the control group, THEN I CAN'T HELP YOU!!!! Maybe you enjoy playing devils advocate????


    *
    Last edited by Celia; 04-12-2007 at 05:15 PM.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  13. #43
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    You Still Need To Find A Forum For Frustrated Practitioners, And Stop Attacking Members Of This Forum.[/QUOTE]

    Thats a bit harsh on structural from the posts i have read which is most of them its not all been one way traffic and structural does seem to be trying to offer an alternative point of view and often has evidence to back his arguments. I see and can see all sides of the argument, you are all very pasionnate people with evidence in abundance to support your paticular points of view. But that should not be used as an excuse to pick on someone. If someone posts something then they should expect to recieve a reply, if they do not agree with the reply then just shrug your shoulders, accept someone is disagreeing with you and move on. But i do think its time to leave the poor guy alone
    Last edited by zuma; 04-12-2007 at 05:58 PM.

  14. #44
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    Celia,

    I want to thank you for the first two thirds of you reply... it felt as though you were actually speaking to me for once... again, thank you!

    As for the last couple of comments... I agree with you that "waiting and watching" is a horrible approach. But the fact is that there are a lot of people out there doing just that upon their own will or recommendation of their doctor. Even if this study didn't take place those folks would still be "waiting and watching". So it seems sensible to apply the information from their decision to help shed some more light on the topic. I'm not necessarily a stark supporter of this study, nor am I against it... but why not make use of data that would otherwise be lost if just ignored?? I don't know... ??? I certainly don't think the book has been written on the effectiveness of bracing, that's for sure. This one seems to be less biased than others by incorporating many hospitals from several geographic regions... .
    Quote Originally Posted by Celia Vogel
    If you can't *see* why this study is using innocent helpless children as guinea pigs in the control group, THEN I CAN'T HELP YOU!!!! Maybe you enjoy playing devils advocate????
    Yes, I see your point... but as I mentioned before, didn't the very first recipients of the spinecor brace take a risk as guinea pigs with the potential for failure and lost opportunity for correction? I just feel that's risky as well... but that's the nature of clinical trials... even if we don't like it or agree with it, someone is always at risk.

    Sincerely Celia, I don't play devil's advocate to tick anyone off or get under your skin... I actually think it's healthy to play devils advocate otherwise we don't grow and learn. It's always necessary to challenge beliefs and ideas, not to discredit them, but to ensure that we're covering all of the bases and being thorough in our considerations.

    At the end of the day I do not subscribe to any single belief or opinion... I only follow the leads that show promise for something better. In the case of scoliosis I think it's dangerous to marry oneself to any single approach or method, as it will never apply generically to all individuals. There are reasons why some have success with a particular approach and others don''t... and vice versa. Although some avenues of exploration may not suit your needs in particular, others have not had the success you have with your chosen methods so they should be encouraged to explore other options, not discouraged.

    I hope that clarifies where I'm coming from here.

    structural
    Last edited by structural75; 04-12-2007 at 06:56 PM.

  15. #45
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    Remember that some people are more than willing to try or to not try new things because they don't like the alternative. For example, we couldn't put Nicole in the prescribed hard brace. We just couldn't do it. And Nicole wouldn't have worn it. No way. So if someone would have asked us to try this brand new Spinecor that has never been used before, we most likely would have said, "Yes" because the alternative would have been to do nothing.

    If the Spinecor hadn't been invented and we were adamant on not putting her in that hard brace, then maybe we would have done nothing because we couldn't imagine her having a life for four years in middle and high school in a hard brace. Physical movement is a huge part of her life and it goes against so much of what we believe.
    Melissa
    From Bucks County, Pa., USA

    Mom to Matthew,19, Jessica, 17, and Nicole, 14
    Nicole had surgery with Dr. Dormans on 9/12/07 at Children's Hospital of Phila. She is fused T-2 - L-3

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