Barriers and facilitators of receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic: A qualitative study in a developing country.

PURPOSE: This study investigated the barriers, challenges, and facilitators in receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic. MATERIALS AND METHODS: In this qualitative study, we conducted in-depth semistructured face-to-face interviews with individuals with lower limb amputation who needed prosthetic services during Covid-19 pandemic. We discussed about challenges and barriers that the participants had encountered during this period. The collected data were analyzed using a conceptual framework. RESULTS: Six broad themes of availability, accessibility, acceptability, affordability, accommodation, and awareness emerged from the analysis. Staff shortage, lack of remote services, accommodation, insurance and governmental support, and cost of services were the main concerns. Moreover, long waiting lists, postponed referrals, noncompliance with Covid-19 protocols and preventive measures, and lockdowns were the other important concerns that were noted. In addition, unsatisfactory services in hometown, distance to capital, transportation permit in lockdowns, traffic jam, and public transport problems were other reasons of service not being accessible. The positive aspects were the facilitators such as having home visits, social work and charity, and using private drive services. CONCLUSION: It seems that after the beginning of Covid-19 pandemic, people with lower limb amputation have faced more drastic challenges in accessing and receiving prosthetic services than in the prepandemic situations.

Parental Adherence to Cranial Remolding Orthotic Treatment of Infants with Positional Cranial Deformities: A Qualitative Content Analysis.

Background: This qualitative study was designed to investigate parental adherence to cranial remolding orthotic (CRO) treatment of infants with positional cranial deformities. Methods: A qualitative content analysis was employed in this study. Researchers sought to find parental behavior while using a CRO for their infant with cranial deformity. Through in-depth and in-person interviews, researchers collected data from 22 participants using semi-structured questions regarding adherence to CRO treatment. Data were examined for patterns until saturation occurred, yielding categories that focused on the parents' main barriers and facilitators. Results: Two general themes of "potential barriers to CRO treatment adherence" and "potential facilitators to CRO treatment adherence" were extracted from 12 subthemes of parental burden, transportation, availability of CRO services in hometown, financial responsibility, maternal/paternal attachment attitudes, CRO-related problems, others feedback, adjustment to the treatment, motivation and self-confidence, aesthetic satisfaction, communication with orthotist, and wife's empathy/spousal support. Conclusion: Getting time off work, transportation to the orthotics' clinic, the lack of medical insurance coverage for CRO, reduced physical contact between parents and their child, and getting negative feedback from others were the most reported challenges. However, overcoming the initial difficulties and adjustment to the treatment with CRO, the high motivation of parents during therapy, an orthosis with good fitting and minor complications, a strong relationship between the parents and orthotist, and the father's companionship were revealed to facilitate the treatment process and increase adherence of treatment with CRO.

Lived experience of children and adolescents with lower-limb loss who used a prosthesis: A qualitative study.

PURPOSE: Children's and adolescents' level of activity, the type of activity, and other features are special to them and can result in unique experiences with lower-limb prosthesis. The specific objective of this study was to explore the lived experience of children and adolescents with lower-limb loss (LLL) who used a prosthesis. METHODS: We used a descriptive qualitative study design and in-depth, semistructured, face-to-face interviews. Accordingly, 35 participants, including children and adolescents with LLL who used a prosthesis, their parents, and prosthetists, were interviewed. The collected data were analyzed thematically. RESULTS: One hundred sixty-eight codes about the experiences of children, parent(s), and prosthetists were extracted from the transcripts and categorized into 32 subthemes. Finally, 7 broad themes including suitability, provoke reactions, intrinsic nature, infrastructures, the school, availability, and parenting role were extracted. CONCLUSION: The experiences of children and adolescents with lower-limb prosthesis are specific as each may face unique challenges and deal with different difficulties. In this study that has been conducted in a developing country, the main challenges faced by children using lower-limb prosthesis and their parents are the prosthetic components, social reactions, long distance, and costs of services. Moreover, designing a more natural prosthesis and gait training for children with LLL were the most important issues faced by prosthetists. However, close relationships with friends and family members, and children's amazing ability to adapt can aid in facilitating prosthetic management.

Validity and Reliability of the Persian Version of Barriers to Physical Activity Questionnaire for People With Mobility Impairments.

BACKGROUND: Although physical activity (PA) is an important determinant of health, physically disabled individuals tend to have a sedentary lifestyle. The Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) is a self-report instrument evaluating PA barriers. This study was intended to evaluate the validity and reliability of the Persian version of BPAQ-MI (P-BPAQ-MI) and to report the prevalence and severity of PA barriers among Persian-speaking individuals. METHODS: The translation and back translation of the BPAQ-MI was conducted according to an internationally accepted guideline and tested on 163 participants to assess its reliability and validity. Internal consistency and test-retest reliability were analyzed using Cronbach alpha and Spearman correlation coefficient. Convergent construct validity was established by comparing the scores of P-BPAQ-MI and The Baecke Habitual Physical Activity Questionnaire. Known-groups construct validity was assessed with regard to type of assistive device and sex of the individual. Prevalence and severity of the barriers were reported by computing the percentage and means of "yes" answers. RESULTS: The P-BPAQ-MI domains demonstrated very good internal consistency (Cronbach alpha of .77-.95) and excellent test-retest reliability (Spearman rho of .73-.96) with a significant inverse small correlation with Baecke Habitual Physical Activity Questionnaire indexes. The P-BPAQ-MI successfully discriminated between individuals with different assistive devices and sex. Community Built Environment barriers were the most prevalent and severe. CONCLUSIONS: The P-BPAQ-MI is a valid and reliable instrument to assess the PA barriers of people with physical disability. The community barriers were the most frequently reported obstacles to PA.

The effect of minimally invasive suturectomy with postoperative cranial remolding orthotic treatment for an infant with bilateral coronal craniosynostosis.

Minimally invasive suturectomy has been reported to significantly decrease the economic cost of treating infants with craniosynostosis. Nonetheless, treatment should be accompanied by a cranial remolding orthosis to maintain the constant correction and reshaping of the skull throughout the infant's development.

Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations.

INTRODUCTION: With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed. METHODS: In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis. RESULTS: Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness. CONCLUSION: Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.

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.

Does Bracing Control the Progression of Adolescent Idiopathic Scoliosis in Curves Higher Than 40°? A Systematic Review and Meta-analysis.

Routinely, adolescent idiopathic scoliosis (AIS) curves that progress beyond 40° in skeletally immature adolescents require surgery. However, some adolescents with AIS and their parents utterly refuse surgery and insist on wearing a brace. Debate continues regarding the appropriateness of bracing for AIS curves exceeding 40° in patients who have rejected surgical intervention. This systematic review and meta-analysis was conducted to review the literature on the effectiveness of bracing and its predictive factors in largermagnitude AIS curves ≥40°. This study replicated the search strategy used by the PICOS system for formulating study questions, which include consideration of the patient/population (P), intervention (I), comparison (C), outcome (O), and study design (S). The search was conducted up to January 2022 in the following bibliographic online databases only in the English language: PubMed, Google Scholar, Scopus, and Web of Science. Two assessors reviewed the articles for qualification. Eligible studies were assessed for risk of bias at the study level using the Newcastle-Ottawa Scale. The effect size across the studies was determined using standardized mean differences (Cohen's d) and 95% confidence intervals for the meta-analysis. Among the eight included moderate quality studies, evidence of potential publication bias (p <0.05) for the trials included was found in the Cobb angle outcome. Results obtained through meta-analysis indicated that the effectiveness of bracing in controlling Cobb angle progression in curves ≥40° is significantly positive. Additionally, initial curve severity, Risser stage, in-brace curve correction, curve type, and apical vertebral rotation were considered risk factors associated with brace effectiveness. This systematic review revealed that bracing could alter the normal course of AIS curves ≥40° in patients refusing posterior spinal fusion (PSF). However, the suggested course for patients refusing PSF remains unclear because of the significant heterogeneity in the risk factors associated with bracing failure.

Evaluating the effective pressure applied by a valgus knee orthosis in individuals with medial knee osteoarthritis based on the dose-response relationship.

BACKGROUND: There is evidence that valgus knee orthosis improves clinical and biomechanical outcomes in individuals with medial knee osteoarthritis (MKOA). It is unclear whether variations in pressure application by orthosis straps can affect the biomechanical outcomes. This study aimed to determine the dose-response relationship between different orthosis straps tensions and changes in knee adduction moment (KAM) parameters in individuals with MKOA. METHOD: Twenty-four individuals with symptomatic MKOA were enrolled in this quasi-experimental study. Five tension conditions in orthosis straps were tested in 20-mmHg increments, from 0 (no pressure) to 100 (maximal pressure) mmHg. Patients were asked to adjust the orthosis strap tension based on their perceived comfort. After each condition, a 3D gait analysis was performed, and KAM parameters were calculated. The participants also reported their satisfaction with knee orthosis adjustment for each pressure condition. RESULTS: With successive increases in strap tension from 40 to 80 mmHg, the first peak, second peak, and angular impulse of KAM decreased nonlinearly (from 6 % to 25 %). Increasing the orthosis strap tension to 100 mmHg significantly decreased (P < 0.05) the participants' satisfaction level. The effective dosages (IC50) of pressure for the first peak, second peak, and angular impulse of KAM as responses were 58, 65, and 69 mmHg, respectively. CONCLUSION: The KAM decline was not linear as the strap pressure increased. Patients were dissatisfied with orthosis adjustment when strap tension was above 80 mmHg. The optimum dosage of pressure on the knee joint's lateral side for adjusting an orthosis' strap tension is approximately 69 mmHg.

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.

Design and evaluation of a prosthetic socket for a patient with diabetic-related transtibial amputation: A case report.

This is a report of a diabetic transtibial amputee with severe pain and ulcer in the antero-distal of the tibia. A novel prosthetic socket with an antero-distal silicone wall was designed. The result showed that the patient's satisfaction was increased and the average peak pressure was reduced by using the new socket design.

Stress level and quality of life of adolescents with idiopathic scoliosis during brace treatment.

Objectives: This study aimed to evaluate the effect of brace treatment on the stress level and quality of life (QoL) of adolescents with idiopathic scoliosis. Patients and methods: A total of 194 adolescent individuals were evaluated in two groups: the adolescent idiopathic scoliosis (AIS) group with 97 patients (20 males, 77 females; mean age: 13.9±1.8 years; range 10 to 18 years) and the control group with 97 age-and sex-matched participants (20 males, 77 females; mean age: 14.3±1.7 years; range 10 to 18 years) with no spinal deformity. The AIS group wore the Milwaukee brace or a thoracolumbosacral orthosis based on the location of the apical vertebra. All participants of the AIS group filled the Persian versions of the revised Scoliosis Research Society 22-item questionnaire (SRS-22r), the eight-item Bad Sobernheim Stress Questionnaire (BSSQ)-Deformity, and BSSQ-Brace. The control group only answered the first 20 items (subtotal items) of the SRS-22r. The brace-related QoL and stress level were assessed based on sex, brace, and deformity types. Results: The subtotal score of the SRS-22r in the AIS group was significantly lower than the control group (p<0.001). There was a significant difference between deformity-related stress and brace-related stress (p<0.001). Regarding the type of treatment, there were no significant differences in QoL and stress level between the Milwaukee brace and thoracolumbosacral orthosis groups (p>0.05). Moreover, there was a weak correlation between the BSSQ-Brace and the self-image, mental-health scores, and the total scores of the SRS-22r (r=0.39 to 0.42, p<0.001); the low level of perceived stress was associated with a high level of perceived QoL. Conclusion: The stress due to brace treatment can decrease function/activity and self-image of adolescents with idiopathic scoliosis.

Disease-Specific Outcome Measures Evaluating the Health-Related Quality of Life of Children and Adolescents with Idiopathic Scoliosis and Scheuermann's Kyphosis: A Literature Review.

Adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) are the most common types of spinal deformities in adolescents, and both have substantial ramifications on health-related quality of life (HRQoL) parameters. Various questionnaires have been developed to assess HRQoL in age-group populations with spinal deformity. Nevertheless, there remains a lack of consensus across the literature as to which instrument is the most suitable for evaluating the HRQoL of this cohort. Thus, this literature review was conducted to present disease-specific questionnaires for children and adolescents with AIS and SK to provide their psychometric characteristics (validity, reliability, and responsiveness) across different languages. A literature search was performed in the Medline (PubMed), Scopus, EMBASE, and Google Scholar databases. Studies that outlined the development and application of questionnaires evaluating HRQoL of children and adolescents with spinal deformity were included, and data on their validity and reliability in different translated languages were collected. A total of 10 disease-specific questionnaires were identified. Except for one questionnaire that was a proxy-reported measure, the other questionnaires were self-reported. We determined that selecting the proper questionnaire for clinical and research purposes requires careful consideration of various factors including the type of treatment intervention planned as well as various patient demographic factors. For children with early-onset scoliosis, the ideal questionnaire to evaluate their HRQoL is the Early-Onset Scoliosis Questionnaire-24. For adolescents with AIS and SK who are potential candidates for surgical intervention, the use of Scoliosis Research Society-22, Scoliosis Japanese-27, and Quality of Life Profile Spinal Deformity questionnaires is appropriate. For patients who are under nonsurgical treatment, the Brace Questionnaire and Italian Spine Youth Quality of Life questionnaires can be utilized. Nonetheless, when the specific intent of a study is to evaluate the self-image perception of patients, the use of drawing-based questionnaires may be the optimal choice.

The Effects of Combining High-Top Shoes with Twister Wrap Orthoses on Balance Parameters of Children with Spastic Diplegic Cerebral Palsy.

BACKGROUND: Cerebral palsy (CP) is a non-progressive encephalopathy before, during, or after childbirth with almost the most common type, i.e. spastic diplegic, leading to a frequent walking problem, In-toeing. Orthoses can reduce the consequences of CP. OBJECTIVE: This study aimed to evaluate the effect of combining twister wrap orthoses (TWO) with high-top shoes on the balance parameters of children with spastic diplegic CP. MATERIAL AND METHODS: In this quasi-experimental study, twenty children (aged 6.8 ± 0.5 years) with spastic diplegic CP with in-toeing gait participated. The tests were conducted in three conditions: 1) in bare-foot, 2) with high-top shoes, and 3) with high-top shoes plus TWO and the orthoses effects on balance parameters were compared. RESULTS: High-top shoes positively decreased center of pressure (COP) sway in the anterior-posterior (AP) direction. Both high-top shoes and high-top shoes with TWO conditions compared to bare-foot conditions significantly improved standing balance by decreasing the ellipse area. Pairwise, wearing TWO and high-top shoes significantly reduced the COP sway in the medial-lateral (ML) and AP directions with a significant difference between using the combined orthoses and the shoe without TWO in ML of COP displacement. CONCLUSION: High-top shoes alone and the combination of high-top shoes with TWO conditions may enhance the stability of children with spastic diplegia more than barefoot. Although the use of combined orthoses induced significant improvement in the ML direction of COP displacement.

Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal.

BACKGROUND: Using foot orthoses for managing medial knee osteoarthritis (MKOA) is common, although its effectiveness is in debate. Most orthoses are placed inside the shoe as a lateral wedged insole. Thus, most studies in this area have focused on the effect of insoles used with shoes. This study compared the effects of a lateral wedge with subtalar strap (combined insole) used while barefoot and lateral wedged insole fitted within sandal on pain, function and external knee adduction moment (EKAM) in patients with MKOA to consider which orthotic treatment is better. METHODS: In this quasi-experimental pretest-posttest study, 29 participants with medial knee osteoarthritis were divided into two groups: (1) combined insole (n = 15) and (2) sandal (n = 14) groups. We recorded their gait while walking with and without orthoses using a motion analysis system. We evaluated their pain and performance with visual analog scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, 30 s chair stand, and Timed Up and Go functional tests. The pain and performance evaluations were repeated after one month. RESULTS: The pain immediately decreased after walking with both orthoses (p < 0.001). There was no significant difference in EKAM results between the two orthoses. Pain and performance improved in both groups after a one month using the orthoses (p < 0.01). CONCLUSION: Both types of orthoses have similar effect and lead to better performance and less pain after 1 month.

The Italian Spine Youth Quality of Life questionnaire: reliability and validity of the Persian version in adolescents with spinal deformities.

PURPOSE: To assess the reliability and validity of the Persian version of the Italian Spine Youth Quality of Life (P-ISYQOL) questionnaire. METHODS: Forward/backward translations and cultural adaption processes of the ISYQOL questionnaire into Persian were conducted by an expert committee. We recruited 178 adolescents with idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) and 103 age-matched adolescents with no spinal deformity. Reliability was assessed by evaluating internal consistency and test-retest reliability using Cronbach's alpha and intraclass correlation coefficient (ICC). Convergent construct validity was assessed by measuring the association between the ISYQOL and revised 22-item Scoliosis Research Society (SRS-22r) questionnaires scores. Known-groups construct validity was assessed regarding curve magnitude, deformity, age, sex, and treatment type. RESULTS: Cronbach's alpha and ICC for P-ISYQOL total score was 0.8 and 0.9, respectively. An acceptable association was observed between P-ISYQOL and SRS-22r total scores (r = - 0.5, p < 0.01). The P-ISYQOL could discriminate between adolescents with spinal deformities and adolescents with no spinal deformity as well as those with different types of deformity and treatment (p < 0.01). CONCLUSIONS: The P-ISYQOL is a reliable and valid survey to assess the outcomes of adolescents with spinal deformities. LEVEL OF EVIDENCE: Level I-diagnostic studies.

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.

Assessment of reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire in adolescents with idiopathic scoliosis.

PURPOSE: This study investigates the reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire (P-SAQ). METHODS: The stages of cross-cultural adaptation were conducted according to an internationally accepted guidelines. Reliability of the P-SAQ was measured by evaluating internal consistency and test-retest reproducibility using Cronbach's α and intraclass correlation coefficient (ICC). Validity of the P-SAQ was assessed by factor analysis, and convergent and known-groups validities. Convergent validity was assessed through participant response on the P-SAQ and the revised 22-item Persian version of the Scoliosis Research Society (SRS-22r) questionnaire. Known-groups validity was assessed by comparing the P-SAQ scores according to the patients curve magnitude and treatment type. RESULTS: A total of 106 patients with a diagnosis of adolescent idiopathic scoliosis (AIS) were included. The P-SAQ demonstrated an acceptable internal consistency with a Cronbach's α of 0.77 (range 0.65-0.72). The test-retest reliability was excellent (range ICC 0.85-0.98). There was a correlation between the total score, average scores of the general, curve, rib prominence, kyphosis, and trunk shift subscales of the P-SAQ and subtotal and total scores of the SRS-22r, r = - 0.2 to - 0.4, p < 0.05. The P-SAQ discriminated between patients with differing Cobb angle magnitudes and treatment types (p < 0.01). Factor analysis supported the use of the appearance and expectations items as separate scales for the P-SAQ. CONCLUSION: The P-SAQ is a valid and reliable tool that could be utilized to evaluate the perception of appearance for Persian-speaking AIS patients with different curve magnitude and treatment strategies. LEVEL OF EVIDENCE: Level I- diagnostic studies.

Predictive Factors for Outcomes of Overcorrection Nighttime Bracing in Adolescent Idiopathic Scoliosis: A Systematic Review.

Predictive clinical and radiological factors can potentially identify adolescent idiopathic scoliosis (AIS) most likely to benefit from overcorrection nighttime bracing. These factors can provide helpful information in clinical decision making. However, the relationship between these factors and outcomes of overcorrection nighttime bracing is unclear. This systematic review determined the predictive factors for identifying outcomes of overcorrection nighttime bracing in AIS. A systematic search was conducted on PubMed, MEDLINE, Scopus, and Embase from January 1986 to January 2021. Studies on AIS patients, aged 10-18 years, with a Risser sign of 0-2 and an initial Cobb angle of 20°-45°, who were treated with overcorrection nighttime bracing and for whom at least one predictive factor of treatment outcome (failure and/or success) was assessed were included. Two blinded reviewers independently evaluated the studies using a quality assessment tool. To determine predictive factors, the level of evidence was rated through best-evidence synthesis. A total of nine studies met the inclusion criteria. A Providence brace was used in six of the included studies, while a Charleston bending brace was used in three. Findings from two high-quality studies provided strong evidence of the association between curve flexibility and brace treatment success. In terms of the Risser sign, this evidence was obtained from three high-quality studies. Moderate evidence indicated a positive association between premenarchal status and nighttime bracing failure. Inconclusive evidence indicated that poor brace compliance is associated with treatment failure. Conflicting evidence of treatment failure was indicated for initial curve magnitude, curve type, in-brace correction, age, Risser sign, curve apex, and sex. These findings show that greater curve flexibility and a higher Risser sign are associated with overcorrection nighttime bracing success.