Improvement of Adolescent Idiopathic Scoliosis Primary Correction by Brace Design Optimization.

(1) Background: Primary in-brace correction has been shown to be related to conservative adolescent idiopathic scoliosis (AIS) treatment outcome. The purpose of the study was to evaluate TLSO brace design changes over eight years regarding primary Cobb correction and de-rotation of the (major) curve. (2) Methods: This retrospective analysis included AIS patients treated with a full-time TLSO-brace in a single Orthopedic University hospital in 2012-2014 and 2017-2019. Brace design changes resulted from an evolutionary process, from a 3-point bending to a 3D TLSO. The brace parameters (presence of an anterior shoulder pad, posterior high-thoracic pad, thoracic space, and angle of the lumbar and thoracic pressure points) were analyzed regarding the primary (major) Cobb angle and apex rotation correction with a multivariate analysis. (3) Results: A total of 74 (63 female) patients were included in the study. The Cobb angle primary correction was significantly improved over the timeframe. The primary correction was significantly influenced by all design parameters and partially by its interactions with (curve specific) different effects on the Cobb correction and apex de-rotation. (4) Conclusions: Knowledge about the effects of brace design parameters on the curve's angle and rotation correction enables improvements in individualized brace design and the brace optimization process.

Influence of Anxiety and Depression, Self-Rated Return-to-Work Problems, and Unemployment on the Outcome of Outpatient Rehabilitation After Shoulder Arthroscopy.

OBJECTIVE: The aim of this study was to research the influence of psychosocial confounders on outpatient rehabilitation after arthroscopic shoulder surgery. DESIGN: This retrospective study included patients who underwent such rehabilitation in a single center between January 2014 and October 2016. Shoulder function (Constant Shoulder Score) and pain (visual analog scale), improvements in these scores, and patient satisfaction were evaluated with regard to anxiety and depression (Hospital Anxiety and Depression Scale), self-rated return-to-work problems (Würzburg screening), and employment status. RESULTS: The analysis included 176 patients. The mean (SD) Constant Shoulder Score and visual analog scale improved from 53.9 (18) to 75.4 (16.5) and 4.6 (2.1) to 2.9 (2.4) cm, respectively. A total of 84.1% of the patients were satisfied with the outcome. Unemployed patients (P = 0.001) and Hospital Anxiety and Depression Scale-positive ones (P = 0.014) were less satisfied than their counterparts. Patients with a Würzburg screening-positive screening showed less improvement in pain (P = 0.015), function (P = 0.016), and satisfaction (P = 0.002) than those without. Unemployed reported more pain (P = 0.008) than employed patients when starting rehabilitation. At the end of rehabilitation, all psychosocial scores (Hospital Anxiety and Depression Scale, P = 0.002; Würzburg screening, P = 0.001; unemployment, P < 0.001) negatively influenced pain, Würzburg screening (P = 0.007), and unemployment (P = 0.008) function. CONCLUSIONS: Because we identified psychosocial factors that influence the success of outpatient shoulder rehabilitation, rehabilitation setup should be adjusted in patients with such problems.