The ScoliOlogiC "Chêneau light" brace--does the reduction of material affect the desired correction?

UNLABELLED: The "Chêneau light" brace, developed according to the Chêneau principles, promises a lesser impairment of quality of life in the brace. However material reduction should not result in reduced effectiveness. Therefore the primary correction effect in the "Chêneau light" brace has been evaluated and compared with that of other traditional braces. MATERIAL AND METHOD: The correction effects of the first 99 patients (main diagnosis AIS or EOS; 7 boys, 92 girls), treated according to the principles of the "Chêneau light" brace were evaluated after an average treatment time of 6 weeks by a full-body X-ray made in the standing position while wearing the brace and compared with the last X-ray before bracing. The average curvature angle of the whole group was 41 degrees , the average age was 13 years. RESULTS: The Cobb angle in the whole sample has been reduced by an average of 14,7 degrees, which corresponds to a correction effect of 42%. In patients from this sample who had their first brace (n=53; Cobb angle 36,6 degrees) the in-brace correction was at 49,8%. The correction effect correlated slightly negative with age (r = -0,18; p = 0,034) and correlated negatively with the Cobb angle measured before treatment (r = -0,49; p = 0,0001). CONCLUSIONS: The use of the "Chêneau light" brace leads to correction effects above average when compared to correction effects of other braces described in literature. The reduction of material seems to affect the desired correction in a positive way.

First results of pain treatment in scoliosis patients using a sagittal realignment brace.

UNLABELLED: For adult scoliosis patients with chronic pain bracing is indicated before spinal surgery is considered. The treatment with the "sagittal realignment brace" (physio-logic brace) has clearly improved chronic low back pain in a short test period. Thus we started a prospective study to estimate also medium term effects. MATERIAL AND METHODS: 29 Patients (Cobb angle 37 degrees ; age 41 years) have been treated with the physio-logic brace for an average of 7,5 Months (SD 5,6). Before brace prescription the brace action was simulated using the sagittal realignment test. Pain intensity was recorded before brace treatment, within the 1(st) week after brace adjustment and at follow-up using the Roland and Morris VRS. Period of daily wearing time as well as total wearing time / day was left up to the patients. RESULTS: Pain intensity was high (3,38) before treatment (scale 0-5) and low (1,28) in the brace after adjustment. The differences where highly significant in the Wilcoxon test (z=-4,29; p < 0,0001). After follow-up the pain intensity was moderate to severe (2,69; ns). There was a clear reduction of pain severity, however in most of the cases the compliance has been lost during the follow-up period. Only 7 Patients continued to wear the brace for a considerable time (> 4 hrs.). CONCLUSIONS: The brace action of the sagittal realignment brace leads to promising short-term effects. A better compliance might be achieved by prescribing the total wearing time / day and though a better efficiency of pain reduction in the long-term.

Application of passive transverse forces in the rehabilitation of spinal deformities: a randomized controlled study.

In our centre, physiotherapy and braces are the main approaches in the management of scoliosis and kyphosis as well. If a surgical intervention is necessary patients are guided to the appropriate centre for spine surgery. In order to avoid surgery, we are looking for possibilities to improve the conservative facilities of spinal deformities management. The aim of our study was to find out whether the use of passive transverse forces (PTF) applied on the deformed body is useful in the rehabilitation process of patients with spinal deformities. A randomized controlled study was undertaken including 126 patients with scoliosis treated with our intensive rehabilitation programme and 4 to 6 PTF treatments lasting 20 minutes per treatment. This group had a curvature angle of 38,7 degrees (SD 16,8) thoracic and 32 degrees (SD15,1) lumbar. Average age was 14,8 years (SD2,7). The control group of 126 patients had a curvature angle of 33,1 degrees (SD 16,1) thoracic and 26,9 degrees (SD12,7) lumbar. Average age was 15,2 years (SD2,3). The patients were randomized by the third author in order to have inpatient rehabilitation and PTF or intensive inpatient rehabilitation alone. For the result evaluation we carried out an investigation before and after the intensive inpatient rehabilitation phase of 4-6 weeks long with the surface measuring system (Formetric system). We evaluated the average lateral deviation value, measured in mm, as given out by the system. The value of average lateral deviation in the treatment group decreased highly significantly (p=.00157) with an average improvement of 1.27 mm. The controls also improved comparing the value for the average lateral deviation before and after rehabilitation with an average difference of 0.94 mm, which was not significant in the T-test (p=0.10032). When comparing the treatment group (PTF) without additional braces (n=52) the difference was even bigger with 1.50 mm (p=.0307). The control group without brace showed similar results as the entire control group. Only uncorrected posture can be measured with the Formetric system. When trying to show the possible postural corrections with the help of the Formetric system, more than 50% of the scans show artefacts resulting from the fact that the points necessary for calculating the spinal deviation can no longer be automatically recognized. For this reason also the changes after an intensive inpatient rehabilitation are very moderate, even if they show a significant tendency to postural correction in larger groups. In smaller groups however, we generally only find the nonsignificant tendency to postural correction. Significant values were obtained with additional application of the PTF treatment. This proves the efficacy of passive forces combined with intensive physiotherapy aiming at an active stabilization of the passively mobilized spine. The uncorrected posture is improved significantly by inpatient rehabilitation and PTF, thus the treatment of scoliotic patients with the described methods is superior to inpatient rehabilitation alone.

Brace related stress in scoliosis patients - Comparison of different concepts of bracing.

BACKGROUND: The BSSQbrace questionnaire has been shown to be reliable with good internal consistency and reproducibility estimating the stress scoliosis patients have whilst wearing their brace. Eight questions are provided focussing on this topic. A max. score of 24 can be achieved (from 0 for most stress to 24 for no stress). The subdivision of the score values is: 0-8 (strong stress), 9-16 (medium stress) and 17-24 (little stress). STUDY DESIGN: Two BSSQbrace questionnaires have been posted to 65 patients under brace treatment from our Cheneau light data base. All patients had another kind of brace prior to the Cheneau light. The patients have been asked to rate their stress level using one questionnaire for the current brace and the other for the previous one. RESULTS: 63 Patients (59 girls and 4 boys) returned their fully completed questionnaires (average age 13,6 years, average Cobb angle 43,7 degrees). Stress level in the previous brace was 11,04 and in the Cheneau light(r) 13,87. The differences were highly significant in the t-test; t = -4,67; p < 0,001. CONCLUSION: The use of the Cheneau light(R) brace leads to reduced stress and/or impairment for the patients under treatment compared to heavier brace models used so far.

Correction effects of the ScoliOlogiC "Chêneau light" brace in patients with scoliosis.

BACKGROUND: Different bracing concepts are used today for the treatment of scoliosis. The plaster cast method worldwide seems to be the most practiced technique at the moment. CAD (Computer Aided Design) systems are on the market which allow brace adjustments without plaster. The latest development however, is the use of the ScoliOlogiC off the shelf system enabling the orthopaedic technician to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This "Chêneau light" brace, developed according to the Chêneau principle, promises a reduced impediment of quality of life in the brace. However, material reduction should not result in reduced effectiveness. Therefore the primary correction effect in the "Chêneau light" brace has been evaluated and compared with that of other braces used today. METHODS: The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principle of the "Chêneau light" brace were evaluated after an average treatment time of 6 weeks by a full-body X-ray made in the standing position whilst wearing the brace and compared with the last X-ray before bracing. The average curvature angle of the whole group was 35,6 degrees , the average age was 12,9 years (SD 1,9), average Risser sign was 1,3 (SD 1,5), average Tanner rating 2,75 (SD 0,7). RESULTS: The Cobb angle in the whole group was reduced by an average of 16,4 degrees , which corresponds to a correction effect of 51%. The differences were highly significant in the T-test (T = 17,4; p < 0,001). The best correction effects reported in literature so far are about 40% in two different studies. The correction effect was highest in lumbar and thoracolumbar curve pattern (62 %; n = 18). In thoracic scoliosis the correction effect was 36 % (n = 41) and in double major curve pattern 50 % (n = 22). The correction effect correlated slightly negative with age (r = -0,24; p = 0,014), negatively with the Risser stage (-0,29; p = 0,0096) and correlated negatively with the Cobb angle measured before treatment (r = -0,43; p < 0,0001). CONCLUSION: The use of the "Chêneau light" brace leads to correction effects above average when compared to the correction effects of other braces described in literature. The reduction of material seems to affect the desired correction in a positive way.

The reliability of the Bad Sobernheim Stress Questionnaire (BSSQbrace) in adolescents with scoliosis during brace treatment.

BACKGROUND: A new instrument to assess stress scoliosis patients have whilst wearing their brace has been developed. Aim of this study was to test the reliability of this new instrument. METHODS: Eight questions are provided focussing on this topic only, including two questions to test the credibility. A max. score of 24 can be achieved (from 0 for most stress to 24 for least stress). We have proposed a subdivision of the score values as follows: 0-8 (strong stress), 9-16 (medium stress) and 17-24 (little stress).85 patients were invited to take part in this study and to complete the BSSQbrace questionnaire twice, once at the first presentation and a second after a further three days.62 patients with an average age of 14,5 years and an average Cobb angle of 40 degrees returned their fully completed questionnaires. RESULTS: The average stress value was 12,5/24 at the first measurement and 12,4/24 at the second measurement. Ceiling value was 23; floor value 2. The average stress value was 12,5 / 24 at the first measurement and 12,4 / 24 at the second measurement (from 0 for most stress to 24 for least stress). Ceiling value was 23; floor value 2. There was a correlation of 0,88 (Intraclass Correlation Coefficient) between the values of the two measurements. Cronbach alpha was 0, 97. CONCLUSION: The BSSQbrace questionnaire is reliable with good internal consistency and reproducibility. It can be used to measure the coping strategies a patient uses and the impairment a patient feels to have, whilst wearing a brace.