TY - JOUR
T1 - Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis
AU - Roye, Benjamin D.
AU - Simhon, Matthew E.
AU - Matsumoto, Hiroko
AU - Bakarania, Prachi
AU - Berdishevsky, Hagit
AU - Dolan, Lori A.
AU - Grimes, Kelly
AU - Grivas, Theodoros B.
AU - Hresko, Michael T.
AU - Karol, Lori A.
AU - Lonner, Baron S.
AU - Mendelow, Michael
AU - Negrini, Stefano
AU - Newton, Peter O.
AU - Parent, Eric C.
AU - Rigo, Manuel
AU - Strikeleather, Luke
AU - Tunney, John
AU - Weinstein, Stuart L.
AU - Wood, Grant
AU - Vitale, Michael G.
N1 - Funding Information:
This work was conducted with the support of a grant from the Scoliosis Research Society.
Publisher Copyright:
© 2020, Scoliosis Research Society.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Study design: Survey. Objectives: Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS). The purpose of this study was to establish best practice guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal consensus building techniques. Summary of background data: Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS. Methods: We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised and repeat voting for consensus was performed. Results: Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached consensus on 67 items across 10 domains of bracing which were consolidated into the final best practice recommendations. Conclusions: We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research. Level of evidence: Level IV.
AB - Study design: Survey. Objectives: Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS). The purpose of this study was to establish best practice guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal consensus building techniques. Summary of background data: Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS. Methods: We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised and repeat voting for consensus was performed. Results: Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached consensus on 67 items across 10 domains of bracing which were consolidated into the final best practice recommendations. Conclusions: We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research. Level of evidence: Level IV.
KW - Adolescent idiopathic scoliosis
KW - Best practice guideline
KW - Bracing
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U2 - 10.1007/s43390-020-00060-1
DO - 10.1007/s43390-020-00060-1
M3 - Review article
C2 - 32026441
AN - SCOPUS:85079773890
SN - 2212-134X
VL - 8
SP - 597
EP - 604
JO - Spine deformity
JF - Spine deformity
IS - 4
ER -