A Cochrane review [Abstract] 1 included 7 studies with a total of 662 adolescents of both genders with idiopathic scoliosis from 15° to more than 45° curves. Five studies were planned as RCTs, and 2 as prospective controlled trials; 2 RCTs failed due to very low recruitment of participants. Elastic, rigid (polyethylene), and very rigid (polycarbonate) braces were studied. The two studies evaluating elastic bracing focused on low degree curves, while those using very rigid bracing focused on very high degree curves greater than 45°. Two studies compared bracing with observation, one study compared bracing plus physiotherapeutic-specific scoliosis exercises versus observation, one study compared rigid bracing with observation or electrical stimulation, and 2 studies compared two different types of braces. Due to important clinical differences among the studies, it was not possible to perform a meta-analysis.
Primary outcome measures: Results on pulmonary disorders and disability were not found. One small RCT showed that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation (MD -2.10, 95% CI -7.69 to 3.49; 1 RCT, n=111). A subgroup (n=77) from one prospective cohort study showed that QoL, back pain, psychological, and cosmetic issues did not differ significantly between rigid bracing and observation in the long term (16 years).
Secondary outcome measures (prevention of curve progression): Rigid bracing compared with observation significantly increased the success rate in 20° to 40° curves at 2 years' follow-up (RR 1.79, 95% CI 1.29 to 2.50; 1 RCT, n=116). Elastic bracing increased the success rate in 15° to 30° curves at 3 years' follow-up (RR 1.88, 95% CI 1.11 to 3.20; 1 RCT, n=47). Two prospective cohort studies with a control group showed that rigid bracing increased the success rate (curves not evolving to 50° or above) at 2 years' follow-up (RR 1.50, 95% CI 1.19 to 1.89; 1 study, n=242) and at 3 years' follow-up (RR 1.75, 95% CI 1.42 to 2.16; 1 study, n=240). A prospective cohort study showed that very rigid bracing increased the success rate (no progression of 5° or more, fusion, or waiting list for fusion) in adolescents with high degree curves (above 45°) (RR 1.79, 95% CI 1.04 to 3.07; 1 study, n=57).
Comparisons between different brace types: One RCT showed that a rigid brace was more successful than an elastic brace at curbing curve progression when measured in Cobb degrees in low degree curves (20° to 30°), with no significant differences between the two groups in the subjective perception of daily difficulties associated with wearing the brace (risk of success at 4 years' follow-up: RR 1.40, 1.03 to 1.89; 1 RCT, n=43). One RCT (n=12) showed that a rigid brace with a pad pressure control system was no better than a standard brace in reducing the risk of progression.
Adverse events: Only one prospective cohort study (n=236) assessed adverse events: neither the percentage of adolescents with any adverse event (RR 1.27, 95% CI 0.96 to 1.67) nor the percentage of adolescents reporting back pain, the most common adverse event, were different between the groups (RR 0.72, 95% CI 0.47 to 1.10).
Primary/Secondary Keywords