Introduction. Adult scoliosis is sometimes associated with back pain, and severe curves can progress over time. Bracing is quite a common approach in such patients, but only a few papers are available to assess their efficacy. This study aims to test the effectiveness of six months of a custom-made brace, worn at night, in reducing pain and improving function in adult scoliosis patients compared to a prefabricated day-time brace worn 2-4 hours daily.
Methods.
Retrospective cohort study with a historical control group.
We compared a sample of consecutively recruited adult females with back pain and scoliosis treated with a custom-made TLSO night-time brace to those treated with day-time prefabricated brace.
Outcomes: Graphical rating scale (GRS), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI).
Patients were evaluated at baseline and six months after they started wearing their braces.
We used two-ways ANOVA. We checked results according to the Minimal clinically important differences. We defined improvement as a change equal or greater than the MCID and we checked the association between the proportion of clinically meaningful improved patients and the brace type with chi2.
We ran a logistic regression model to see if the OR of reaching results were higher with one of the braces.
Results. The night-time TLSO group included 25 adult females, age 62.3±9.5, curve 60.4±17.7° Cobb, wearing the brace 7.2±2.2 hours per day. The day-time prefabricated group included 20 adult females, age 67.8±10.5, curve 62±13° Cobb, wearing the brace 2-4 hours a day.
Improvements were similar for both braces for back and leg pain. There was a statistically significant improvement in worst pain score in patients wearing a TLSO compared to those treated with day-time brace (F 6.32 p=0.0158) the change is significant also over time from start to end (F=20.54 p=0.000),
Considering MCID for ODI, 32% of the patients treated with TLSO improved compared to 25% in the prefabricated day-time brace group (chi2 0.26 p=0.607).
COMI total score had minimal MCID in 44% of cases in TLSO and 30% of those wearing a prefabricated day-time brace (chi2 0.93 p=0.34).
Leg pain: 15% of patients reaching MCID in the prefabricated day-time brace group compared to 8% in the TLSO group (chi2 0.55 p=0.46).
Back pain: 20% patients in the prefabricated day-time brace group compared to 4% in the TLSO group (chi2 2.88 p=0.09).
The proportion of subjects with results exceeding the MCID did not show a statistically significant difference between the 2 braces.
The logistic regression model showed that the odds of improvement were not different between the two braces. COMI total results were 56% higher in patients treated with TLSO (p=0.34 95%CI 0.2-1.9). ODI results were 22% higher in patients treated with TLSO p=0.61 95%CI 0.2-2.6.
Discussion Night-time bracing shows interesting positive effects on chronic low back pain secondary to Scoliosis. The impact is like a day-time brace worn for 2-4 hours. Not all the parameters improved and not all the patients did, but this approach seems worth exploring as a further option for these patients.