School Time Experiences of Adolescents with Spinal Deformities during Brace Treatment: A Qualitative Study.

Background: Adolescent idiopathic scoliosis (AIS) and Scheuermann kyphosis (SK) are the most common spinal deformities in adolescents aged 10 to 16. During the past 50 years, brace treatment has been suggested as the most common nonsurgical treatment for AIS and SK. The brace efficacy strongly depends on wearing time. Also, previous studies indicated that patients with spinal deformities undergoing brace treatment experience deformity-related emotional distress. This study aimed to comprehend the experiences of braces-treated adolescents during school time using a qualitative approach. Methods: This descriptive qualitative research was used with an interpretative framework and enlisted the help of children with spinal deformities who have been prescribed "brace wearing." This study was conducted using semi-structured, face-to-face, in-depth interviews and phone conversations from September 2020 to May 2021. Additionally, content analysis was employed. Results: A total of 64 participants were interviewed, including 32 adolescents with spinal deformities under brace treatment and their parents (27 mothers, and 5 fathers). Three main categories-concerns, actual problems, received support-6 subcategories, and 278 codes were discovered following data analysis about participants' experiences. Conclusion: Special school-based programs are required for such tortious conditions. This qualitative study motivates a better understanding of these special children and their hidden problems and suggests developing a supportive protocol.

The effect of local muscle vibration on clinical and biomechanical parameters in people with knee osteoarthritis: A systematic review.

Background: To identify and synthesize available published studies on the effect of local muscle vibration (LMV) on pain, stiffness, and function in individuals with knee OA. Methods: Five databases were searched to find relevant papers on April 29, 2020, including, PubMed, Scopus, EMBASE (Ovid), Science Citation Index, and COCHRANE Central Register for Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) and nonrandomized-controlled-trials (non-RCTs), such as interrupted time series and prospective cohort studies were included. Two independent reviewers screened articles and assessed inclusion through predefined criteria. Participants' characteristics, study design, intervention characteristics, outcomes, and main results were collected independently by 2 reviewers. The risk of bias assessment of included studies was conducted using Cochrane risk of bias tools for RCTs and non-RCTs. Results: Six studies were included: 3 RCTs and 3 non-RCTs. The risk of bias in included studies was generally moderate to high. Improvement of pain, stiffness, and function following the application of LMV were reported in all studies. Conclusion: This review revealed the promising effect of LMV on pain, stiffness, function, and knee range of motion (ROM) improvements for individuals with knee Osteoarthritis (OA). However, further well-designed studies are required to have a convincing conclusion on the effect of LMV in individuals with knee OA.

The effect of a lateral wedge insole and a subtalar strap on gait parameters in knee osteoarthritis.

Background: Lateral wedge insole (LWI) aims to reduce loading on medial compartment of tibiofemoral joint in mild knee osteoarthritis (KOA). This effect may be augmented by concomitant use of subtalar strap to fix the ankle joint. Moreover, longitudinal arch support embedded in insoles can cause foot comfort and may be beneficial for people with KOA. Therefore, this study aimed to assess the immediate effect of LWI with an arch support with and without a subtalar strap on the kinetics and kinematics of walking in mild KOA. Methods: A convenient sample of 17 individuals with mild KOA (Kellgren and Lawrence grade II), aged ≥ 40 years were assessed in 3 conditions: without the insole; LWI; and LWI with a subtalar strap, where an arch support was embedded in all insoles. The primary outcomes were external knee adduction moment and angular impulse. The secondary outcomes were hip flexion and adduction moments, knee flexion angle, ankle eversion moment, and walking speed. The repeated measurements ANOVA was used to compare the primary and secondary outcomes between the conditions using SPSS. Significance level was set at 0.05. Results: LWI and a subtalar strap can significantly increase the knee flexion angle at 0%-15% of the stance phase compared to no insole (p<0.001). No other changes were observed (p=0.142). Conclusion: LWI with an arch, with or without a subtalar strap, cannot impose any immediate changes on the kinetics and kinematics of lower limb joints during walking in people with mild KOA.

Knee osteoarthritis at the early stage: The four-week effect of lateral wedge insole on pain and risk of falls.

Background: Knee osteoarthritis (KOA) is associated with a decrease in function, increase in pain and risk of falls. Lateral wedge insole (LWI) is commonly prescribed in KOA to improve pain and function. Our study aimed to 1) evaluate the clinical symptoms and risk of falls in early KOA and compare with controls; 2) evaluate the immediate and four-week effect of LWI. Methods: A sample of 20 Persian dwelling individuals with early KOA and 19 matched controls were recruited. Pain with Visual Analogue Scale (VAS), Quality of life (QOL) with the knee injury and osteoarthritis outcome score, risk of falls with the Timed Up and Go (TUG) and static One-leg Balance (OLB) tests were assessed. The four-week effect of 5º LWI was considered for individuals with KOA. Independent t-test was done to report the between-group differences, and paired t-test was used to report the four-week effect of LWI. Results: At baseline, statistically significant higher scores for pain, lower scores for QOL, and higher risk of falls were observed in KOA compared to controls (p< 0.001). A significant statistical decrease was observed in pain, and risk of falls, and an increase in QOL in KOA after four-week effect of LWI compared to baseline (p< 0.001). Conclusion: People with early KOA showed higher pain and lower level of QOL that were associated with higher risk of falls. LWI may have the potential to improve clinical symptoms and reduce the risk of falls at the early stage of KOA.

A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain.

Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain. Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability. Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was <0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4 weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in the orthosis group (t = 3.60, P<0.001). Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.

The efficacy of a home-mechanical traction unit for patients with mild to moderate cervical osteoarthrosis: A pilot study.

BACKGROUND: Traction has been suggested to be an effective treatment for symptoms of neck disorder in patients with no contraindications. However, according to previous researches, the effectiveness of traction is controversial, particularly compared to other conservative treatments. This trial was conducted to evaluate the effect of sustained traction, using an over-the-door home cervical traction unit in combination with routine physical therapy on reducing cervical osteoarthrosis symptoms including neck pain, medication use and disability level compared to routine physical therapy alone. METHODS: In this double- blinded pilot study with a pre-post test design and a control group, 20 women with mild to moderate osteoarthrosis were systematically assigned to the over-the-door home cervical traction (mean±SD age: 50.5±4.45yrs) or control groups (mean±SD age: 55.6±7.34yrs). Pain, level of disability, and drug consumption were evaluated before and after 10 sessions of intervention. Data were analyzed using parametric or non-parametric statistic including the paired-sample t-test, independent sample t-test, and Wilcoxon and Mann-Whitney u test for intra and inter groups comparison based on the Kolmogorov-Smirnov test results. RESULTS: Patients in both groups showed a significant decrease in pain intensity and disability level (p<0.05). Despite the greater improvement in pain levels and disability in the experimental group compared to the controls, the differences were not significant (p>0.05). No significant differences were found in terms of drugs consumption within and between the groups at the end of the treatment (p>0.05). CONCLUSION: The results revealed that applying sustained traction using an over-the-door home cervical traction unit was not significantly superior to the routine physical therapy and ergonomic training to manage symptoms including neck pain and disability in a small group of mild to moderate cervical osteoarthrosis patients.

A comparison between the dimensions of positive transtibial residual limb molds prepared by air pressure casting and weight-bearing casting methods.

BACKGROUND: Creating a socket with proper fit is an important factor to ensure the comfort and control of prosthetic devices. Several techniques are commonly used to cast transtibial stumps but their effect on stump shape deformation is not well understood. This study compares the dimensions, circumferences and volumes of the positive casts and also the socket comfort between two casting methods. Our hypothesis was that the casts prepared by air pressure method have less volume and are more comfortable than those prepared by weight bearing method. METHODS: Fifteen transtibial unilateral amputees participated in the study. Two weight bearing and air pressure casting methods were utilized for their residual limbs. The diameters and circumferences of various areas of the residual limbs and positive casts were compared. The volumes of two types of casts were measured by a volumeter and compared. Visual Analogue Scale (VAS) was used to measure the sockets fit comfort. RESULTS: Circumferences at 10 and 15 cm below the patella on the casts were significantly smaller in air pressure casting method compared to the weight bearing method (p=0.00 and 0.01 respectively). The volume of the cast in air pressure method was lower than that of the weight bearing method (p=0.006). The amputees found the fit of the sockets prepared by air pressure method more comfortable than the weight bearing sockets (p=0.015). CONCLUSION: The air pressure casting reduced the circumferences of the distal portion of residual limbs which has more soft tissue and because of its snug fit it provided more comfort for amputees, according to the VAS measurements.

The validity and reliability of noninvasive methods for measuring kyphosis.

STUDY DESIGN: This is a cross-sectional study. OBJECTIVE: To examine the interrater and intrarater reliability and validity of tools for measuring thoracic kyphosis, namely the digital inclinometer and the flexicurve. SUMMARY OF BACKGROUND DATA: Various methods are used to measure kyphosis, and each has its own advantages and disadvantages. Radiography is common, highly reliable, and valid but unsuitable for regular use because of radiation exposure and cost. Other clinical methods allow safe and rapid assessment of spinal curvature. The validity and reliability of some nclinometers have been confirmed; however, there are no data that compare inclinometers and flexicurves using radiography for measuring thoracic kyphosis. METHODS: We enrolled 105 patients with hyperkyphosis, aged between 10 and 80 years. The Cobb angle was measured radiographically by a spine specialist. Two other examiners, blinded to the Cobb angles, measured thoracic kyphosis using the flexicurve and digital inclinometer. RESULTS: Comparing the kyphosis angle with the radiographic Cobb angle, as a gold standard, revealed that the digital inclinometer was reasonably valid for patients aged below 30 and above 50 years, whereas the validity of the flexicurve in both age ranges was poor. On the intrarater evaluation, the digital inclinometer provided a high reliability in patients aged below 30 and above 50 years; however, the flexicurve was also acceptable in this regard. In contrast, on the interrater evaluation, the digital inclinometer provided a high reliability in subjects aged below 30 and above 50 years. The flexicurve provided a poor interrater reliability in subjects aged below 30 years and an acceptable level of reliability in those aged above 50 years. CONCLUSIONS: The digital inclinometer is a valid and reliable instrument for measuring thoracic kyphosis and can be used for regular screening. In contrast, the flexicurve has poor interrater and intrarater reliability.

Evaluating the effect of equipping an unloading knee orthosis with local muscle vibrators on clinical parameters, muscular activation level, and medial contact force in patients with medial knee osteoarthritis: A randomized trial.

BACKGROUND: Unloading knee orthosis is prescribed for people with unicompartmental knee osteoarthritis (OA) to unload the damaged compartment. However, despite its benefits, wearing unloading knee orthoses in the long term may decrease knee muscle activity and have a side effect on knee OA progression rate. OBJECTIVES: Therefore, this study aimed to determine whether equipping an unloading knee orthosis with local muscle vibrators improves its effectiveness in improving clinical parameters, medial contact force (MCF), and muscular activation levels. METHODS: The authors performed a clinical evaluation on 14 participants (7 participants wearing vibratory unloading knee orthoses and 7 participants wearing conventional unloading knee orthoses) with medial knee OA. RESULTS: Wearing both orthoses (vibratory and conventional) for 6 weeks significantly improved ( p < 0.05) the MCF, pain, symptoms, function, and quality of life compared with the baseline assessment. Compared with the baseline assessment, the vastus lateralis muscle activation level significantly increased ( p = 0.043) in the vibratory unloading knee orthoses group. The vibratory unloading knee orthoses significantly improved the second peak MCF, vastus medialis activation level, pain, and function compared with conventional unloading knee orthoses ( p < 0.05). CONCLUSIONS: Given the potential role of medial compartment loading in the medial knee OA progression rate, both types of unloading knee orthoses (vibratory and conventional) have a potential role in the conservative management of medial knee OA. However, equipping the unloading knee orthoses with local muscle vibrators can improve its effectiveness for clinical and biomechanical parameters and prevent the side effects of its long-term use.

Effect of the type of brace on head to pelvis sagittal alignment of adolescents with Scheuermann's kyphosis.

The aim of this study was to determine the effects of the Milwaukee brace and thoracolumbosacral orthosis (TLSO) on head to pelvis sagittal alignment in adolescents with Scheuermann's kyphosis (SK). A total of 52 adolescents with SK who were under brace treatment were studied. They underwent biplanar radiography of the head to pelvis (EOS Imaging, Paris, France) before and 6 months after the beginning of bracing. We measured T1 slope, neck tilt (NT), cervical sagittal vertical axis (cSVA), thoracic inlet angle (TIA), C0-C2 lordosis, C2-C7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA) and T1 spinopelvic inclination (T1SPi). There were no significant differences in baseline values of TIA, PT, SS, PI, SVA, TK, cSVA, NT and T1 slope between the two groups (p > 0.05). There were significant differences between the baseline and final measurements of T1 slope, cSVA, TK, LL, T1SPi and TIA in both groups (p < 0.05). The results imply that brace treatment can significantly affect head to pelvis sagittal parameters of adolescents with SK. However, there are no significant differences in the values of head to pelvis sagittal parameters when comparing short-term effect of TLSO and the Milwaukee brace.

A new scoliosis brace padding method based on trunk asymmetry for scoliosis treatment.

BACKGROUND: Pressure pads are used with scoliosis braces to adjust the magnitude and location of corrective forces that mechanically support the torso to correct the spine deformity. In the conventional brace (C.B.) design approaches, the location and shape of pads are determined based on the visual assessment of the clinician. The accuracy of this approach could be improved because it is limited to the clinician's expertise. The present study aimed to develop a new brace (N.B.) padding method based on trunk asymmetry for adolescents with idiopathic scoliosis and compare the efficacy of the developed method with C.B. in improving the Cobb angle and body posture symmetricity. METHODS: The trunk surface geometry was scanned using a 3-dimensional scanner. The best plane of symmetry was determined, and the original trunk was reflected in the plane of symmetry, creating the reflected trunk. The difference between the reflected and original trunks was computed and color-coded using deviation contour maps. The boundary of deformed regions, with a minimum of 6-mm deviation contour maps, was identified as the trim lines for brace pads. Eight participants were recruited and divided into conventional and new padding groups. The variation of Cobb angle and torso asymmetry parameters, including the trunk rotation and back surface rotation, as well as the brace satisfaction and trunk appearance perception of the 2 groups, were compared after 3 months of treatment. RESULTS: Cobb angle improved equally in the N.B. and C.B. groups. However, back surface rotation improved in the N.B. group (+49.6%) and worsened in the C.B. group (-6.8%). The mean trunk rotation was improved by 30% in the N.B. and further exacerbated by -2.2% in the C.B. group. The brace satisfaction and trunk appearance perception scores were higher in the N.B. than in the C.B. group, however not statistically significant. CONCLUSIONS: The present study showed that the proposed brace padding system improved the trunk appearance without negatively affecting the Cobb angle correction.

Effect of equipping an unloader knee orthosis with vibrators on pain, function, stiffness, and knee adduction moment in people with knee osteoarthritis: A pilot randomized trial.

BACKGROUND: Wearing unloader knee orthoses for the long term may have a side effect on knee adduction moment (KAM). RESEARCH QUESTION: This study sought to determine whether equipping an unloader knee orthosis with vibrators improves its effectiveness in pain, stiffness, function, and reducing the KAM. METHODS: The authors performed a clinical evaluation with the Western Ontario and McMaster Universities (WOMAC) questionnaire and instrumented gait analyses on 14 participants with medial compartment knee osteoarthritis in two testing sessions: before wearing the orthosis and after 6 weeks of use. RESULTS AND SIGNIFICANCE: Wearing both orthoses for 6 weeks significantly improved (p < 0.05) pain, stiffness, and function compared to the baseline assessment. There was a significantly greater reduction in the first peak KAM (p = 0.016) and KAM impulse (p = 0.008) in the vibratory unloader knee orthosis than in the conventional knee orthosis in the second session. Equipping the unloader knee orthosis with vibrators can improve its effectiveness in reducing the KAM and can prevent the side effects of its use. Furthermore, equipping the unloader knee orthosis with the vibrators did not interfere with its effectiveness on pain, stiffness, and function.

Effect of Brace Treatment on Craniovertebral to Lumbopelvic Sagittal Parameters in Adolescents with Idiopathic Scoliosis: A Systematic Review.

The current study was carried out systematically by conducting a review of the literature. The purpose of this study was to conduct a systematic review of the literature to determine the effects of brace wearing on sagittal parameters in adolescents with idiopathic scoliosis (AIS). In this study, PubMed/MEDLINE (National Library of Medicine), Scopus, Ovid, CINAHL, PEDro, Google Scholar, and the Cochrane Library were accessed and searched using the patient, intervention, comparison, outcome, and study design model. We included studies that looked at the effects of brace treatment on sagittal spinopelvic parameters in AIS patients over the age of 18. The studies were chosen for their cross-sectional, retrospective, or prospective observational designs, and they were published in English. Review articles, case reports, case study designs, and conference abstracts were excluded from consideration. The methodological quality of the remaining articles was assessed using the Newcastle Ottawa Scale. A total of 12 studies were chosen, and 995 participants were evaluated, with 3 (25%) and 9 (75%) having high and moderate quality, respectively. The studies were classified based on the length of follow-up. Long-term, short-term, and immediate effects of brace wearing on sagittal spinopelvic parameters were reported in four, five, and three studies, respectively. The results of nine studies showed a significant decrease in Cobb angle after wearing the brace, which contradicted the findings of the other two. The cervical and sagittal pelvic parameters, thoracic kyphosis (TK), lumbar lordosis (LL), spinopelvic parameters, and sagittal balance were all evaluated in the intended studies, yielding varying results. According to the available literature, wearing a brace flattens the TK and LL. According to this systematic review, brace treatment may affect sagittal spinopelvic parameters in adolescents with AIS, particularly in TK and LL. The cervical and pelvic parameters yielded inconclusive results. This study backs up the idea that brace design and structure can influence sagittal parameter changes. The limitations of this study include different methods of parameter measurement, variations in the brace types and wear time, varying follow-up duration, and differences in participant characteristics.

Qualitative study of prosthetic suspension systems on transtibial amputees' satisfaction and perceived problems with their prosthetic devices.

OBJECTIVE: To investigate the effects of 3 dissimilar suspension systems on participants' satisfaction and perceived problems with their prostheses. DESIGN: Questionnaire survey. SETTING: A medical and engineering research center and a university biomedical engineering department. PARTICIPANTS: Persons with unilateral transtibial amputation (N=243), using prostheses with polyethylene foam liner, silicone liner with shuttle lock, and seal-in liner. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Descriptive analyses were performed on the demographic information, satisfaction, and prosthesis-related problems of the study participants. RESULTS: The results showed significant differences between the 3 groups regarding the degree of satisfaction and perceived problems with the prosthetic device. Analyses of the individual items revealed that the study participants were more satisfied with the seal-in liner and experienced fewer problems with this liner. The silicone liner with shuttle lock and seal-in liner users reported significant differences in maintenance time compared with the polyethylene foam liner. Users of the silicone liner with shuttle lock experienced more sweating, while those who used the seal-in liner had greater problems with donning and doffing the device. CONCLUSIONS: The results of the survey provide a good indication that prosthetic suspension is improved with the seal-in liner as compared with the polyethylene foam liner and silicone liner with shuttle lock. However, further prospective studies are needed to investigate which system provides the most comfort and the least problems for participants.

Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis.

PURPOSE: To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS). METHODS: In this retrospective multicenter study, the patient's sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up. RESULTS: A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11. CONCLUSION: C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS. LEVEL OF EVIDENCE: IV.

Cross-Cultural Adaptation and Validation of the Persian Version of the 24-Item Early-Onset Scoliosis Questionnaire.

STUDY DESIGN: Cross-sectional study. PURPOSE: To translate and culturally adapt the original English version of the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) to the Persian language as well as assess its reliability and validity. OVERVIEW OF LITERATURE: Early-onset scoliosis (EOS) patients with progressive curves require active treatments, such as serial elongation- derotation-flexion casting, bracing, and surgery, which are stressful and expensive. In order to evaluate the impact of EOS and its treatment strategies, it is important to consider the patients and their parents' quality of life as the clinical and radiological parameters. The EOSQ-24 is a parent-based measure that evaluates the health-related quality of life of patients with EOS and their caregivers/parents. Similar to other widely used questionnaires, EOSQ-24 needs to be translated into other languages to make it usable in populations from different cultures and societies. METHODS: We evaluated the translation and back translation of the EOSQ-24 and made the required revisions as per the analysis performed by the expert committee and an international guideline to adapt it for use in this study. Thereafter, we recruited 100 EOS patients in order to evaluate its reliability and validity. The reliability was assessed with internal consistency. Convergent validity was assessed by comparing the scores of the EOSQ-24 and the 22-item Scoliosis Research Society Questionnaire (SRS-22r). Finally, the known groups validity was assessed as per patient's sex, curve magnitude, and treatment type. RESULTS: The Persian EOSQ-24 demonstrated very good internal consistency (Cronbach's α=0.88). All the items had an acceptable corrected item-total correlation (>0.3). Further, the EOSQ-24 and the SRS-22r scores (p <0.001) were significantly correlated. The EOSQ-24 could discriminate patients with different curve magnitudes. CONCLUSIONS: The Persian EOSQ-24 can serve as a disease-specific instrument with strong validity and reliability in the evaluation of EOS patients. Its applicability in other Persian-speaking countries and regions of the world needs to be investigated further.

Comparison of the quality of life in individuals with spinal cord injury wearing either reciprocating gait orthosis or hip knee ankle foot orthosis: a cross-sectional study.

BACKGROUND: The quality of life (QoL) for patients with spinal cord injuries (SCI) is lower than that for healthy individuals. The main purpose of prescribing orthoses for these individuals is to improve their mobility and QoL. The hip knee ankle foot orthosis (HKAFO) has been the conventional choice for such patients, whilst the reciprocating gait orthosis (RGO) is a more contemporary option. Although the impact of these two types of orthoses on the biomechanics of walking has been previously evaluated in patients with SCI, there has been no specific comparison of their relative effects on QoL. OBJECTIVES: This study aimed to evaluate the Sickness Impact Profile (SIP-68) QoL questionnaire's total score and its sub-scores in patients with SCIs wearing either RGOs or HKAFOs. METHODS: This study was performed on 22 participants (11 participants wearing RGOs and 11 wearing HKAFOs). QoL scores were evaluated in each group of patients using the total and sub-scores from the SIP-68 questionnaire. RESULTS: There were no significant differences in the total SIP-68 scores between the RGO and HKAFO groups (p = .57). However, emotional stability and emotional independence sub-scores were significantly lower for the RGO users than for the HKAFO users (p = .03 and p = .01), respectively. CONCLUSIONS: Based upon this preliminary study, participants wearing RGOs or HKAFOs had similar QoL scores. However, those wearing RGOs may experience better emotional stability, communication, and emotional independence. This preliminary study does not provide definite conclusions since a large randomized control trial is required to compare the effects of these orthoses on the QoL scores in patients with SCIs.Implications for rehabilitationOur main aim in the current investigation was to shed light on the question that does the biomechanical superiority of the RGO to the HKAFO leads to better quality of life in SCI subjects who are using RGO. Regarding the fact that the primary goal of rehabilitation of people with SCI is to improve their quality of life, it seems that the more complicated newer orthosis (RGO) has no difference with the older type (HKAFO) in achieving the rehabilitation goals. More studies will in fact be necessary to find a definitive answer for this important question.According to the findings of our study, it seems to be more appropriate to prescribe RGO for male participants with higher body weight.

Efficacy of Computer-Aided Design and Manufacturing Versus Computer-Aided Design and Finite Element Modeling Technologies in Brace Management of Idiopathic Scoliosis: A Narrative Review.

The efficiency and design quality of scoliosis braces produced by the conventional casting method depends highly on the orthotist's experience. Recently, advanced engineering techniques have been used with the aim of improving the quality of brace design and associated clinical outcomes. Numerically controlled machine tools have provided enormous opportunities for reducing the manufacturing time and saving material. However, the effectiveness of computer-aided brace manufacturing for scoliosis curve improvement is controversial. This narrative review is aimed at comparing the efficacy of braces made by the conventional method with those made by two computer-aided methods: computer-aided design and manufacturing (CAD-CAM), and computer-aided design and finite element modeling (CAD-FEM). The comparison was performed on scoliosis parameters in coronal, sagittal, and transverse planes. Scientific databases were searched, and 11 studies were selected for this review. Because of the diversity of study designs, it was not possible to decisively conclude which brace-manufacturing method is most effective. Similar effectiveness in curve correction was found in the coronal plane for braces made by using advanced manufacturing and conventional methods. In the sagittal plane, modern braces seem to be more effective than traditional braces, but there is an ongoing debate among clinicians, about which CAD-CAM and CAD-FEM brace provides a better treatment outcome. The relative effectiveness of modern and conventional methods in correcting deformities in the transverse plane is also a controversial subject. Overall, advanced engineering design and production methods can be proposed as time- and cost-efficient approaches for scoliosis management. However, there is insufficient evidence yet to conclude that CAD-CAM, and CAD-FEM methods provide significantly better clinical outcomes than those of conventional methods in the treatment of scoliosis curve. Moreover, for some factors, such as molding and the patient's posture during the data acquisition, in brace curve-correction plan, the orthotist's experience and scoliosis curve flexibility should be explored to confidently compare the outcomes of conventional, CAD-CAM, and CAD-FEM methods.

The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study.

OBJECTIVE: To evaluate the effect of Milwaukee brace treatment on adolescents with idiopathic scoliosis (AIS) with large curves (40° to 55°) who refuse to do surgery. METHODS: In this retrospective cohort study, we gathered the clinical records of all adolescents with AIS with an initial curve of 40° to 55°. They had been referred to our center from December 1990 to January 2017. Although they had been advised to do surgery, they had all refused to do it. Their clinical data were recorded, such as sex, age, Risser sign, scoliosis, and kyphosis curve magnitude (at the beginning of brace treatment, weaning time, brace discontinuation, and minimum of 2 years after the treatment). Based on treatment success, the patients were divided into 2 groups: progressed and nonprogressed. RESULTS: Sixty patients with an average initial Cobb angle of 44.93° ± 4.86° were included. The curve progressed in 57%, stabilized in 25%, and improved in 18% of the patients. In the progressed group (34 patients), 31 patients had undergone surgery. There was no significant association between the age of beginning the brace treatment and the final Cobb angle of nonprogressed group (p > 0.05). However, in-brace correction and initial Risser sign had a significant correlation with curve magnitude at the final follow-up (p < 0.05). CONCLUSION: Brace treatment seems to be effective in controlling the further curve progression in AIS with 40° and 55° curves. Our results can help physicians make sound decisions about the patients with larger curves who refuse to do surgery.

Infantile Idiopathic Scoliosis: Outcomes of Brace Treatment until Skeletal Maturity or Spinal Fusion.

BACKGROUND: Serial casting under general anesthesia, which is considered as a gold standard of treatment for patients with infantile idiopathic scoliosis (IIS), can lead to significant negative neurodevelopmental effects. Therefore, the appropriateness of this type of treatment is controversial. Brace treatment is one alternative method of treatment for IIS patients. However, long-term studies have not yet verified its effectiveness. Thus, the present study aimed to evaluate the effectiveness of brace treatment in patients with IIS until skeletal maturity or spinal fusion. METHODS: The medical records of all IIS patients with the referral age of 0-3 years who received brace treatment from June 1986 to November 2013 were reviewed. Those patients with pre-brace Cobb angle > 20° were included and followed up to skeletal maturity or the time of spinal fusion. The Cobb angle was recorded at the time of diagnosis before the initiation of bracing, weaning time, brace discontinuation, and final follow-up. In addition, the maximum in-brace curve correction was measured. RESULTS: Out of 87 patients with IIS, a total of 29 cases (19 males and 10 females) with the average curve magnitude of 35.62° at the time of diagnosis were included in the study. The average best in-brace correction was 57.32% for successfully treated patients and 36.97% for progression/surgery patients. Based on the results, brace treatment failed for a total of 20 patients (69%), with a scoliosis curvature progress ≥ 45°. Of these patients, 12 cases (60%) reached spinal fusion. Finally, four patients (13%) in the surgery-treated group underwent surgery before the age of 10. CONCLUSION: The results revealed that bracing was successful for more than two-thirds of patients with IIS curves, preventing surgery before the age of 10.