Forskning & artikler
- The natural history of adolescent idiopathic scoliosis. Indian J Orthop. 2010 Jan-Mar; 44(1): 9–13. doi: 10.4103/0019-5413.58601
Studie der viser kurver mellem 30-50 grader kan være progressive i voksen livet:
Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am 1983; 65(4): 447-55. [http://dx.doi.org/10.2106/00004623-198365040-00004] [PMID: 6833318]
One hundred and thirty-three curves in 102 patients who were followed for an average of 40.5 years were evaluated to quantitate curve progression after skeletal maturity and for prognostic factors leading to curve progression. Sixty-eight per cent of the curves progressed after skeletal maturity.
In general, curves that were less than 30 degrees at skeletal maturity tended not to progress regardless of curve pattern. In thoracic curves the Cobb angle, apical vertebral rotation, and the Mehta angle were important prognostic factors. In lumbar curves the degree of apical vertebral rotation, the Cobb angle, the direction of the curve, and the relationship of the fifth lumbar vertebra to the intercrest line were of prognostic value.
Translatory shifts played an important role in curve progression. Curves that measured between 50 and 75 degrees at skeletal maturity, particularly thoracic curves, progressed the most.
Randomised controlled study with 150 patients showing the effect of specific exercises:
Monticone M et al. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J.DOI 10.1007/s00586-014-3241-y
Our findings suggest that a rehabilitation programme including active self-correction, task-oriented exercises and education carried out until skeletal maturity is useful in reducing the course of spinal deformity and improving HRQL in adolescents with mild AIS. We recommend its use in secondary care settings in which the staff are ade- quately trained in managing AIS.
Book by Christa Lehnert-Schroth, daughter of Katharina Schroth founder of the Schroth method, describing the Schroth method:
Lehnert-Schroth C. Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. The Martindale Press. ISBN 978-0-914959-02-1
Randomised controlled study showing the effect of Schroth exercises on scoliosis Risser 0-3:
Kuru T et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis. Clin Rehabil. 2016 Feb;30(2):181-90. doi: 10.1177/0269215515575745. Epub 2015 Mar 16.
According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment.
Study showing the effect of a Schroth exercise supervised program and home exercise program on patients with scoliosis:
Schreiber S, Parent EC, Moez EK, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner.” Scoliosis. 2015;10:24. doi:10.1186/s13013-015-0048-5.
Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires’ domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed.
Study showing Schroth has an positive influence on cobb´s angle and vital capacity: Otman S, Kose N, Yakut Y: The efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Medical Journal 2005; 26: 1429–1435.
Schroth technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.
Study showing the effect on Schroth therapy on Vital capacity and rib mobility for patients with scoliosis:
Weiss HR. The effect of an exercise program on VC and rib mobility in patients with IS. Spine. 1991;16:88–93.
The average increase in chest expansion was more than 20% in all groups at all measuring points. These findings show that a course of inpatient treatment by the Schroth method can lead to an increase in vital capacity and chest expansion so that, even in adult scoliosis patients, effective treatment of the associated restrictive ventilatory disorder is possible.
Book describing the Schroth Best Practice method and evidence behind it:
Weiss H-R, Lehnert-Schroth C, Moramarco M. Schroth Therapy: Advancements in Conservative Scoliosis Treatment. Lambert Academic Publishing ISBN: 978-3-659-66795-4
Study showing the effect of the Schroth Best Practice program in regards to spinal curve and trunk improvements and out-patients programs seems to provide better results than in-patient rehabilitation:
Lee SG. Improvement of curvature and deformity in a sample of patients with Idiopathic Scoliosis with specific exercises. OA Musculoskeletal Medicine. 2014; Mar 12;2(1):6.
The Scoliologic ‘Best Practice’ program is highly effective with respect to improvements of spinal curves and trunk deformity.
Curvatures exceeding 30° show better results than smaller curvatures.
The out-patient Scoliologic ‘Best Practice’ program seems to provide better results than intensive in- patient rehabilitation using the old Schroth standard still in use today.
In phases of little growth or in the outgrown patient this program can be used as the sole form of treatment.
In phases of high growth velocity bracing is indicated primarily. Here this program is used as an adjunct to bracing regularly.
Casestudie showing the effect of Schroth Best Practice program for at girl Risser 4:
Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR). Moramarco M, Moramarco K, Fadzan M. The Open Orthopaedics Journal 2017;11(Suppl-9, M4):1490-1499.
Pilot study showing the effect on short-term Out-patient rehabilitation following Best Practice standards:
Borysov M, Borysov A. Scoliosis short-term rehabilitation (SSTR) according to ‘Best Practice’ standards – are the results repeatable? Scoliosis. 2012 Jan 17;7(1):1.7.
Out-patient rehabilitation following the Scoliologic (TM) ‚Best Practice’ standards seems to provide an improvement of signs and symptoms of scoliosis patients in this study using a pre-/post prospective design. The results of the pilot study therefore seem to be repeatable.
Dette studie fra USA blev stoppet før tid, da man allerede havde påvist effekten ved korsettering af skoliose, og dermed ikke kunne forsvare at have kontrolgruppen uden korset:
Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of Bracing in Adolescents with Idiopathic Scoliosis N Engl J Med. 2013 Oct 17;369(16):1512-21.
Udklip fra Resultaterne af studiet omkring bæretid på 12,9 timer/dag eller over for bedst effekt af korsettering:
BRACE DOSE–RESPONSE RELATIONSHIP
The majority of patients assigned to bracing (68%) were treated with a customized Boston-type thora- columbosacral orthosis. Temperature data were available for 116 patients (from both the random- ized and preference cohorts). During the first 6 months, patients wore the brace for a mean (±SD) of 12.1±6.5 hours per day (range, 0 to 23.0). The quartile of duration of brace wear was positively associated with the rate of success (P<0.001). The lowest quartile of wear (mean hours per day, 0 to 6.0) was associated with a success rate (41%) sim- ilar to that in the observation group in the pri- mary analysis (48%), whereas brace wear for an average of at least 12.9 hours per day was associated with success rates of 90 to 93% (Fig. 2).
Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear.
Vigtigheden af bæretid i korset er allerede belyst i dette studie fra 1997:
Rowe DE, Bernstein SM et al. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997 May;79(5):664-74.
We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day
Studie omkring vigtigheden af korrektion i korsettet samt bæretid for slutresultatet:
Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Pediatr Rehabil. 2003 Jul-Dec;6(3-4):201-7.
Compliant patients with a high initial correction can expect a final correction of around 7 degrees, while compliant patients with low initial correction may maintain the curve extent. Bad compliance is always associated with curve progression.
Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995 Jun;77(6):815-22.
According to survivorship analysis, treatment with a brace was associated with a success rate of 74 per cent (95 per cent confidence interval, 52 to 84) at four years; observation only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33 per cent (95 per cent confidence interval, 12 to 60)
Cinella et al. The treatment of adolescent idiopathic scoliosis with Cheneau brace: long term outcome. Scoliosis. 2009; 4(Suppl 2): O44.
At the end of treatment we observed an improvement in correction around at 23% from the beginning curves, and after 5 years there was stabilization at approximately 15%). Our results demonstrate that conservative treatment with the Cheneau brace is corrective for the treatment of Idiopathic Scoliosis (IS).
De Giorgi S, Piazolla A et al. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J. 2013 Nov;22 Suppl 6:S815-22. doi: 10.1007/s00586-013-3020-1. Epub 2013 Sep 17.
Conservative treatment with Chêneau brace and physiotherapy was effective in our hands for halting scoliosis progression in 100 % of patients.
Weiss HR, Werkmann M. Rate of surgery in a sample of patients fulfilling the SRS inclusion criteria treated with a Chêneau brace of actual standard. Stud Health Technol Inform. 2012;176:407–410.
Rate of surgery can be reduced with the help of Chêneau braces of the latest standard and satisfactory in-brace correction. Brace treatment with the Chêneau brace seems effective and therefore clearly is indicated. Clinical outcomes may be more important for the patient than radiologic outcomes.
This study shows the first end-results for the Cheneau Gensingen brace in Germany:
Weiss H-R, Turnbull D et al. First end-result of a prospective cohort with AIS treated with a CAD Chêneau style brace. J. Phys. Ther. Sci. 31: 983–991, 2019
The results achieved with the GBW are significantly and better than the results achieved with the Boston brace. Therefore, the standards for bracing should be reviewed with the results that symmetric compression with Boston bracing is not as successful, when compared to asymmetric high correction bracing results, which allow a standardized classification-based corrective approach.
Studie omkring korsettering ved Cobbs vinkel >40°
Weiss HR, Tournavitis N, Seibel S, Kleban A. A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results The Open Orthopaedics Journal 2017;11 (Suppl-9, M8): 1558-1567.
Conservative brace treatment using the Gensingen brace was successful in 92% of cases of patients with AIS of 40 degrees and higher. This is a significant improvement compared to the results attained in the BrAIST study (72%). Reduction of the ATR shows that postural improvement is also possible.
Symmetriske vs asymmetriske korsetter:
Weiss HR, Seibel S, Moramarco M, Kleban A. Bracing Scoliosis – the Evolution to CAD/CAM Hard Tissue 2013 November. 2: 5.43.
Symmetrical braces for scoliosis are outdated. Asymmetric braces allow better in-brace correction compared to symmetric braces.