I haven’t had much to add lately but a recent post by mamandcrm on another thread got me thinking about something.
When it comes to bracing, just how important is it to get our kids fitted by an expert. There seems to be some evidence that results vary between the fitters (whether they be orthotists, orthopods, or whatever). Mamandcrm’s post about “Luke” got me thinking about something I read in the Danielson paper (the 15 year follow-up paper to the 1995 SRS Nachemson bracing study looking at just the Swedish patients). Danielson says (as always, emphasis added is mine):
During the original study, it was found that the observation treatment strategy resulted in subsequent brace treatment or surgery occurring in 19 of 65 cases (29%), but not a single case with progression was observed among the originally brace-treated patients. The fact that the late Stig Willner supervised the brace treatment in Malmo¨ might be a possible weakness of that study. He was very committed to the bracing of scoliosis patients and, by following the rules for performing brace treatment meticulously, he was able to obtain extraordinarily good results.26–28 It might therefore be true to say that the comparisons made between the 2 treatment strategies in this study cannot always be direct applied to every scoliosis center.
However, brace treatment performed at the other center in the study (Goteborg), which was performed correctly but probably somewhat less meticulously, has also been shown to alter curve progression, which means that bracing had the intended effect on curve magnitude. The patients braced after progression in this study had 36° before bracing and 32° after completed treatment. Similar results were obtained in another series of patients who were brace treated during the early 1970s in Goteborg and had a curve size of 33° at the start and 30° after completed brace treatment.29 We therefore think that the basic findings, that well-performed brace treatment can stop curve progression and that observation will allow some curves to progress until treatment is needed, are still valid.
Many of us travel to Montreal to have our kids fitted with the SpineCor by the inventors of the brace; Drs Rivard and Coillard. Some of the criticism of the SpineCor is countered by saying the other brace fitters lacked adequate skills, knowledge and/or experience. For example, Wong in Taiwan, Weiss in Europe, and even some of the orthopods here in the US who tried the SpineCor and apparently didn’t get very good results. The Boston Brace is so common in the US. Is it used so much here because it is ‘easier’ to fit? Are there other Boston Bracing experts? Apparently Mamandcrm’s Luke does a good job with the Rigo-Cheneau as Drs Rivard and Coillard have great results with the SpineCor. And the late Stig Willner sounds like he was a pretty committed individual (He used the Boston Brace in the study).
There is a business literally at the end of my street. Their name is “XYZ Limb and Brace” (with XYZ being the name of my town). We travel hundreds of miles to Montreal instead of 200 yards to the end of my street. I guess that obviously I think there is a difference.
I just thought I would throw this out there for comment.
When it comes to bracing, just how important is it to get our kids fitted by an expert. There seems to be some evidence that results vary between the fitters (whether they be orthotists, orthopods, or whatever). Mamandcrm’s post about “Luke” got me thinking about something I read in the Danielson paper (the 15 year follow-up paper to the 1995 SRS Nachemson bracing study looking at just the Swedish patients). Danielson says (as always, emphasis added is mine):
During the original study, it was found that the observation treatment strategy resulted in subsequent brace treatment or surgery occurring in 19 of 65 cases (29%), but not a single case with progression was observed among the originally brace-treated patients. The fact that the late Stig Willner supervised the brace treatment in Malmo¨ might be a possible weakness of that study. He was very committed to the bracing of scoliosis patients and, by following the rules for performing brace treatment meticulously, he was able to obtain extraordinarily good results.26–28 It might therefore be true to say that the comparisons made between the 2 treatment strategies in this study cannot always be direct applied to every scoliosis center.
However, brace treatment performed at the other center in the study (Goteborg), which was performed correctly but probably somewhat less meticulously, has also been shown to alter curve progression, which means that bracing had the intended effect on curve magnitude. The patients braced after progression in this study had 36° before bracing and 32° after completed treatment. Similar results were obtained in another series of patients who were brace treated during the early 1970s in Goteborg and had a curve size of 33° at the start and 30° after completed brace treatment.29 We therefore think that the basic findings, that well-performed brace treatment can stop curve progression and that observation will allow some curves to progress until treatment is needed, are still valid.
Many of us travel to Montreal to have our kids fitted with the SpineCor by the inventors of the brace; Drs Rivard and Coillard. Some of the criticism of the SpineCor is countered by saying the other brace fitters lacked adequate skills, knowledge and/or experience. For example, Wong in Taiwan, Weiss in Europe, and even some of the orthopods here in the US who tried the SpineCor and apparently didn’t get very good results. The Boston Brace is so common in the US. Is it used so much here because it is ‘easier’ to fit? Are there other Boston Bracing experts? Apparently Mamandcrm’s Luke does a good job with the Rigo-Cheneau as Drs Rivard and Coillard have great results with the SpineCor. And the late Stig Willner sounds like he was a pretty committed individual (He used the Boston Brace in the study).
There is a business literally at the end of my street. Their name is “XYZ Limb and Brace” (with XYZ being the name of my town). We travel hundreds of miles to Montreal instead of 200 yards to the end of my street. I guess that obviously I think there is a difference.
I just thought I would throw this out there for comment.
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