Question

• In adolescent females with idiopathic scoliosis, does exercise or bracing result in a better outcome?

Clinical Bottom Lines

1. Bracing is more effective than observation and Lateral Electrical Surface Stimulation in treatment of idiopathic scoliosis.
   
2. The Milwaukee brace is the most effective type of brace in preventing progression of spinal curvature in scoliosis.
   
3. 23 hours of bracing was most effective at preventing progression of spinal curvature in scoliosis, compared to 16 hours and 8 hours of bracing.

Summary of Key Evidence

1. The authors conducted a meta-analysis of 20 articles dealing with scoliosis treatments. They began with a bibliography from a textbook and eliminated articles that only addressed psychological or social issues regarding wearing a back brace, as well as articles whose data were insufficient.¹
   
2. The authors performed data collection for each article and assigned a quality score to each article.
   
3. Three variables were chosen for evaluation based on availability of information in each article: type of treatment, level of maturity, criterion to determine progression of curve.
   
4. Statistical analyses were performed on each of the three variables.
   
5. Bracing was found to be more effective at preventing the progression of the spinal curvature with a 92% success rate than lateral electrical surface stimulation (LESS) (39% success rate), and observation (49% success rate).
   
6. The type of brace used was also found to have an impact on the outcome. The Milwaukee brace was the most successful brace at preventing progression of spinal curvature, followed by the other group (mostly TLSO), and the Charleston brace, respectively.
   
7. The duration of bracing each day also influenced the outcome. 23 hours of bracing was most effective at preventing progression of spinal curvature than 16 hours and 8 hours daily. There was no difference in outcome between 16 hours and 8 hours of bracing daily.
   
8. Spinal curvature was less likely to progress as maturity increased.
   
9. Publication bias is a big limitation of this meta-analysis. They did not perform their own literature search or include abstract reviews. The starting point was a bibliography from a textbook.
   
10. They did not address the validity of each article included in the meta-analysis although a quality score was assigned to each study. The quality score was assigned to each article based on 9 aspects of the each study. The highest quality score possible was 42 points.

Additional Comments

• Another article looked at the effect of strength training in idiopathic scoliosis. 12 patients with scoliosis used a torso strengthening machine twice a week for months. At the end 1 participant went on for surgical correction of her scoliosis while four participants had improvement of their spinal curvature. This study, however, was very small, did not include control group, and no statistical analyses were included.²

Citation

1. Rowe DE, Bernstein SM, Riddic MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. Journal of Bone and Joint Surgery 1997; 79-A:664-74.
   
2. Mooney V, Gulick J, Pozos R. A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis. Journal of Spinal Disorders 2000; 13:102-7.
   

CAT Author: Lynn Johnson, MD

CAT Appraisers: Jonathan E. Fliegel, MD

Date appraised: August 19, 2002