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1.
J Med Case Rep ; 16(1): 20, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34986882

RESUMO

BACKGROUND: The recommended treatment for mild to moderate infantile idiopathic scoliosis curves involves serial casting. There are concerns, however, regarding the safety of repeated casting in very young children owing to the requirement for anesthetization during the casting process. Very little research has been conducted on the influence of bracing as an initial treatment for scoliosis in this age group. This report details the successful treatment of a large thoracic curve using a thoracolumbosacral orthosis in an infant diagnosed with infantile idiopathic scoliosis. CASE PRESENTATION: The Dutch-Australian patient presented at 11 weeks of age with a 44° thoracic scoliosis and a rib vertebral angle difference of 14°. The history and physical examination failed to reveal a cause of the curvature, and a diagnosis of infantile idiopathic scoliosis was made. The patient was prescribed a thoracolumbosacral orthosis (ScoliBrace) to be worn on a part-time basis for a period of 8 months. At the end of the bracing program, the patient's curve had been reduced to 7° and a rib-vertebral angle difference of 0°. A final follow-up of the patient at 2 years after the cessation of treatment revealed no evidence of scoliosis. The parents were compliant with the bracing protocol and reported that the treatment was tolerated by the infant. CONCLUSION: The use of an orthosis as a standalone treatment in this patient resulted in significant reduction in a large thoracic scoliosis. Based on the results witnessed in this patient, further investigation into bracing as an alternative to casting is warranted.


Assuntos
Escoliose , Austrália , Braquetes , Criança , Pré-Escolar , Humanos , Lactente , Aparelhos Ortopédicos , Estudos Retrospectivos , Escoliose/terapia , Resultado do Tratamento
2.
J Pediatr Orthop ; 42(1): 40-46, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34723893

RESUMO

BACKGROUND: Lower extremity brace-wear compliance has been studied in pediatrics, but failure to acquire a prescribed brace has not been included. The purpose of this study was to evaluate brace acquisition as a component of brace-wear compliance. METHODS: Records of patients (0 to 21 y) prescribed lower extremity braces from 2017 to 2019 were reviewed. Diagnoses included cerebral palsy, spina bifida, short Achilles tendon, clubfoot, and other. Brace type was categorized as clubfoot foot abduction orthosis, ankle-foot orthosis, knee, hip, or custom/other braces. Brace prescription and acquisition dates were recorded. Insurance was classified as government, private, or uninsured. Patient demographics included age, sex, race, and calculated area deprivation index. RESULTS: Of the 1176 prescribed lower extremity braces, 1094 (93%) were acquired while 82 (7%) were not. The odds ratios (OR) of failure to acquire a prescribed brace in Black and Hispanic patients were 1.64 and 2.71 times that in White patients, respectively (95% confidence interval: 1.01-2.71, P=0.045; 1.23-5.6, P=0.015); in patients without insurance, the OR was 8.48 times that in privately insured patients (95% confidence interval: 1.93-31.1, P=0.007). The ORs of failure to acquire were 2.12 (P=0.003) in patients 4 years or more versus 0 to 3 years, 4.17 (P<0.0001) in cerebral palsy versus clubfoot, and 4.12 (P=0.01) in short Achilles tendon versus clubfoot. There was no significant association between sex or area deprivation index and failure of brace acquisition. CONCLUSIONS: In our cohort, 7% of prescribed braces were not acquired. Black or Hispanic race, lack of insurance, and older age were associated with failure to acquire prescribed braces. Braces prescribed for clubfoot were acquired more often than for cerebral palsy or short Achilles tendon. Brace-wear compliance is an established factor in treatment success and recurrence. This study identified risk factors for failed brace acquisition, a critical step for improving compliance. These results may help effect changes in the current system that may lead to more compliance with brace wear. LEVEL OF EVIDENCE: Level III-retrospective cohort study.


Assuntos
Pé Torto Equinovaro , Órtoses do Pé , Ortopedia , Idoso , Braquetes , Criança , Pé Torto Equinovaro/terapia , Humanos , Extremidade Inferior , Cooperação do Paciente , Estudos Retrospectivos , Resultado do Tratamento
3.
J Sci Med Sport ; 25(1): 46-52, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34366244

RESUMO

OBJECTIVES: Conceptualisation of a clinically-relevant group of conditions as a region-based, load-related musculoskeletal pain condition ('tibial loading pain') to enable identification of evidence of treatment effect from load-modifying interventions. DESIGN: Systematic review and evidence synthesis based on a developed and justified theoretical position. METHODS: Musculoskeletal pain localised to the tibial (shin) region and consistent with clinical presentations of an exercise/activity-related onset mechanism, was conceptualised as a group of conditions ('tibial loading pain') that could be reasoned to respond to load modifying interventions. Five databases were searched for randomized controlled studies investigating any load-modifying intervention for pain in the anterior-anteromedial lower leg (shin). Study quality was evaluated (Risk of Bias Tool Version 2) and level of certainty for the findings assessed. RESULTS: Six studies reporting seven comparisons were included. Interventions included braces, anti-pronation taping, compression stocking and a stretch + strengthening programme. All included studies were assessed as having unclear or high risk of bias. The review found no evidence of beneficial effect from any of the load-modifying interventions on symptoms, physical performance or biomechanical measures, apart from a possible benefit of anti-pronation 'kinesio' taping. There was very low certainty evidence that kinesio taping improves pain and pain-free hopping distance after one week. The braces were associated with minor adverse effects and problems with acceptability. CONCLUSIONS: None of the treatments investigated by the included studies can be recommended. Conceptualisation of the problem as regional, primarily loading-related pain rather than as multiple distinct pathoanatomically-based conditions, and clearer load-modifying hypotheses for interventions are recommended.


Assuntos
Fita Atlética , Dor Musculoesquelética , Braquetes , Formação de Conceito , Humanos , Dor Musculoesquelética/terapia
4.
Spine (Phila Pa 1976) ; 47(1): 13-20, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34392277

RESUMO

STUDY DESIGN: Prospective randomized controlled trial. OBJECTIVE: To compare clinical effectiveness and quality of life (QoL) of the 3D-printed orthosis (3O) and conventional orthosis (CO) for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Using 3D printing technology to design and fabricate orthoses to manage AIS aiming to improve in-orthosis correction and patients' compliance that are considered essential factors of effective treatment. Clinical evaluation was conducted to study the effectiveness of this innovative method. METHODS: Thirty females with AIS who met the criteria (age 10-14, Cobb 20-40°, Risser sign 0-2, ≤12 months after menarche) were recruited. Subjects were randomly allocated to the 3O group (n = 15, age 12.4, Cobb 31.8°) and CO group (n = 15, age 12.0, Cobb 29.3°). All patients were prescribed for full-time wearing (23 hours/d) and follow-up every 4 to 6 months until bone maturity. Compliance was monitored by thermosensors, while QoL was assessed using three validated questionnaires. RESULTS: Comparable immediate in-orthosis correction was observed between 3O (-11.6°, P < 0.001) and CO groups (-12.9°, P < 0.001). In the QoL study via SRS-22r, the 3O group got worse results after 3 months in aspects of function, self-image, and mental health (-0.5, -0.6, -0.7, P < 0.05) while the CO group had worse results in aspects of self-image and mental health (-0.3, -0.3, P < 0.05). No significant difference was found in QoL assessments between groups. After 2 years of follow-up, 22 patients were analyzed with 4 dropouts in each group. Comparable angle reduction was observed in both groups (3O: -2.2°, P = 0.364; CO: -3.5°, P = 0.193). There was one subject (9.1%) in the 3O group while two subjects (18.2%) in the CO group had curve progression >5°. Daily wearing hours were 1.9 hours longer in the 3O group than the CO group (17.1 vs. 15.2 hours, P = 0.934). CONCLUSION: The 3O group could provide comparable clinical effects as compared with the CO group while patients with 3O showed similar compliance and QoL compared to those with CO.Level of Evidence: 1.


Assuntos
Qualidade de Vida , Escoliose , Adolescente , Braquetes , Criança , Feminino , Humanos , Aparelhos Ortopédicos , Impressão Tridimensional , Estudos Prospectivos , Escoliose/diagnóstico por imagem , Escoliose/terapia , Resultado do Tratamento
5.
Foot Ankle Clin ; 26(4): 619-637, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752231

RESUMO

The Ponseti method for treatment of congenital clubfoot is well established and has been introduced in most pediatric orthopedic centers worldwide. However, reported rates of recurrence are largely variable and open joint surgery is still performed frequently, even in the age group younger than 6 years of age. Preventing recurrence and residual deformity can be achieved by strict adherence to the Ponseti method, ensuring and enforcing brace compliance, frequent follow-up, and early treatment of recurrence. This review discusses reasons for clubfoot recurrence, prevention of clubfoot recurrence, and the treatment of recurrent congenital clubfoot within the realm of the Ponseti method.


Assuntos
Pé Torto Equinovaro , Braquetes , Moldes Cirúrgicos , Criança , Pé Torto Equinovaro/cirurgia , Seguimentos , Humanos , Manipulação Ortopédica , Recidiva , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-34515665

RESUMO

INTRODUCTION: Traditional plaster and fiberglass casts are not waterproof. This experimental study compares the water-resistant and drying properties of two commercially available orthoses with traditional cast liners. METHODS: Two orthotic brace systems were selected for comparative waterproof testing with plaster and fiberglass traditional cast liners. This entailed water submersion for 10 seconds, followed by light drip drying for another 10 seconds. Moisture levels were then measured at four different locations immediately after drip drying and then every 15 minutes up to 45 minutes. RESULTS: The Zero-Cast Wx orthosis retained the least moisture after initial immersion and was fully dry within 45 minutes. The Exos upper extremity brace also demonstrated a low initial mean moisture content but lost little moisture during drying. In comparison, both the cotton-lined plaster cast and Delta Dr. cast liner systems demonstrated the greatest amount of water absorbed and moisture retention. DISCUSSION: Both orthotic brace systems demonstrated markedly less water absorption compared with the cotton-lined plaster cast and Delta Dr. cast liner systems. The Zero-Cast Wx was the only orthosis to fully dry in 45 minutes. CONCLUSION: Both orthotic brace systems provide superior water-resistant properties to traditional cotton-lined plaster cast or fiberglass Delta Dr. cast liner systems.


Assuntos
Fraturas do Rádio , Braquetes , Moldes Cirúrgicos , Humanos , Extremidade Superior , Água
7.
Pediatr Rev ; 42(9): 475-485, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34470867

RESUMO

For many families, the possibility that their child may have scoliosis causes great anxiety because their child may be deformed for life, may need to wear a brace for years, or may need to undergo a large and dangerous operation. For most families, these fears are groundless. Up to 3% of the population has a spinal curvature, most of which are small curves that may not need referral or repeated imaging. Many adolescents with scoliosis do well and do not need to wear a brace or have surgery.


Assuntos
Escoliose , Adolescente , Braquetes , Criança , Família , Humanos , Atenção Primária à Saúde , Escoliose/diagnóstico , Escoliose/terapia , Fatores de Tempo , Resultado do Tratamento
8.
Bone Joint J ; 103-B(10): 1619-1626, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34587809

RESUMO

AIMS: The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial ligament "internal brace" reinforcement to treat irreparable massive rotator cuff tears, and report the preliminary results. METHODS: This is a retrospective review of patients with irreparable massive rotator cuff tears undergoing fascia lata autograft bridging repair with artificial ligament "internal brace" reinforcement technique between January 2017 and May 2018. Inclusion criteria were: patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (dimension > 5 cm or two tendons fully torn), stage 0 to 4 supraspinatus fatty degeneration on MRI according to the Goutallier grading system, and an intact or reparable infraspinatus and/or subscapularis tendon of radiological classification Hamada 0 to 4. The surgical technique comprised two components: first, superior capsular reconstruction using an artificial ligament as an "internal brace" protective device for a fascia lata patch. The second was fascia lata autograft bridging repair for the torn supraspinatus. In all, 26 patients with a mean age 63.4 years (SD 6.2) were included. RESULTS: All patients underwent more than two years of follow-up (mean 33.5 months (24 to 45)). All clinical scores were also improved at two-year follow-up (mean visual analogue scale 0.7 (SD 0.5) vs 6.1 (SD 1.2); p < 0.001; mean American Shoulder and Elbow Surgeons score 93.5 (SD 5.3) vs 42.5 (SD 10.8); p < 0.001; mean University of California, Los Angeles score, 31.7 (SD 3.7) vs 12.0 (SD 3.1); p < 0.001; and mean Constant-Murley score 88.7 (SD 3.5) vs 43.3 (SD 10.9); p < 0.001), and 24 of 26 fascia lata grafts were fully healed on MRI (92%). One patient had haematoma formation at the harvesting side of the fascia lata at two days postoperatively. CONCLUSION: The fascia lata autograft bridging repair combined with artificial ligament internal brace reinforcement technique achieved good functional outcomes, with a high rate of graft healing at two-year follow-up. Although the short-term results are promising, further studies with a greater number of patients would provide clearer results. Cite this article: Bone Joint J 2021;103-B(10):1619-1626.


Assuntos
Artroscopia/métodos , Braquetes , Fascia Lata/transplante , Lesões do Manguito Rotador/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Ligamentos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , Transplante Autólogo , Índices de Gravidade do Trauma , Resultado do Tratamento , Cicatrização
9.
Radiol Technol ; 93(1): 55-72, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34588279

RESUMO

Scoliosis, a condition in which the spine develops abnormal curvature and rotation, typically is diagnosed before adulthood. Scoliosis can be caused by another medical condition or can be idiopathic. Medical imaging is essential in diagnosing and grading the severity of this disorder. Treatments include anti-inflammatory drugs, body braces, and corrective surgical procedures. To provide high-quality patient care, radiologic technologists should understand spinal anatomy, classifications of scoliosis, and treatment options.


Assuntos
Escoliose , Adulto , Braquetes , Humanos , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/terapia , Coluna Vertebral
10.
BMC Musculoskelet Disord ; 22(1): 687, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384421

RESUMO

BACKGROUND: The Knee valgus brace is one of the accepted conservative interventions for patients with medial compartment knee osteoarthritis to correct the knee varus and increase functional activity level. Nevertheless, comprehensive overview of the effects of using this brace on self-reported pain activity level over time is not available. Thus, this study aimed to systematically review the effect of using this brace on pain and activity levels in the last 20 years in patients with medial compartment knee osteoarthritis. METHODS: Five databases were searched to find articles from the year 2000 to the end of November 2020: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Web of Science, and Scopus. Two reviewers independently evaluated the available articles for eligibility and assessed quality. The risk of bias in each study was assessed by two reviewers independently according to the Strengthening the Reporting of Observational Studies in Epidemiology tool (STROBE) for the non-randomized controlled studies and the Cochrane risk-of-bias tool for the randomized controlled studies. RESULTS: Seven randomized controlled studies and 17 cohort studies (in total 579 participants) were included in the systematic review. Most of these studies found using a knee valgus brace effective in reducing pain and improving activity level over different time intervals. The majority of the included studies (14 studies) evaluated the impact of the brace for a considerably short-term (less than 6 months). Thus, limited evidence is available on the long-term use of the knee valgus brace and its associated complications. CONCLUSION: The knee valgus brace is an effective conservative intervention to improve the quality of life and reduce pain during daily activities for some patients. However, the long term of using this brace is still not very convenient, and the patients who benefit most from using the brace should be identified with high methodological quality studies.


Assuntos
Osteoartrite do Joelho , Qualidade de Vida , Braquetes , Humanos , Articulação do Joelho , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/terapia , Dor
11.
PLoS One ; 16(8): e0255264, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34370760

RESUMO

INTRODUCTION: Idiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Patients are treated mainly with thoracolumbosacral orthosis (TLSO) if indicated. This form of brace treatment has been shown to be cumbersome and tough on growing individuals. However, computer aided design and manufactured (CAD/CAM) braces might increase comfortability and ultimately outcome if compliance is improved. In a multicenter, randomized controlled trial, we aim to compare CAD/CAM designed Boston 3D-brace to standard Boston brace. METHODS: Subjects: 170 previously untreated and skeletally immature children diagnosed with idiopathic scoliosis, aged 9-17 years of age (curve magnitude Cobb 25-40 degrees) will be included. Interventions: Both groups will receive a physical activity prescription according to the World Health Organization recommendations. Randomization will be performed 1:1 to a 3D CAD/CAM designed Boston 3D-brace or a standard Boston brace, both with prescribed daily wear time of 20 hours. Outcome: The subjects will participate in the study until curve progression or until skeletal maturity. The primary outcome variable is failure of treatment, defined as progression of the Cobb angle more than 6 degrees compared to the baseline x-ray. The progression is confirmed if seen on two consecutive standing spinal x-rays. Radiographs will be taken at each six-month follow-up. Secondary outcome measures include patient and clinical reported outcomes, including number of individuals requiring surgical intervention. DISCUSSION: This study will show if efficacy in brace treatment can be improved with new brace designs. TRIAL REGISTRATION: The protocol has been registered on ClinicalTrials.gov, identifier: NCT04805437.


Assuntos
Braquetes , Escoliose , Adolescente , Criança , Humanos , Masculino
12.
Spine (Phila Pa 1976) ; 46(23): 1653-1659, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34366411

RESUMO

STUDY DESIGN: Cost-utility analysis. OBJECTIVE: This study aimed to investigate the cost-utility of bracing versus observation in patients with thoracic scoliosis who would be indicated for bracing. SUMMARY OF BACKGROUND DATA: There is high-quality evidence that bracing can prevent radiographic progression of spinal curvature in adolescent idiopathic scoliosis (AIS) patients with curves between 25° and 40° and Risser 0 to 2 skeletal maturity index. However, to our knowledge, the cost-utility of bracing in AIS has not been established. METHODS: A decision-analysis model comparing bracing versus observation was developed for a hypothetical 10-year old girl (Risser 0, Sanders 3) with a 35° main thoracic curve. We estimated the probability, cost, and quality-adjusted life years (QALY) for each node based on comprehensive review of the literature. Costs were adjusted for inflation based on Consumer Price Index and reported in terms of 2020 real dollars. Incremental net monetary benefit (INMB) was calculated based on a probabilistic sensitivity analysis using Monte Carlo simulations of 1000 hypothetical patients. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates. RESULTS: Our decision-analysis model revealed that bracing was the dominant treatment choice over observation at $50,000/QALY willingness to pay threshold. In simulation analysis of a hypothetical patient cohort, bracing was associated with lower net lifetime costs ($60,377 ±â€Š$5,340 with bracing vs. $85,279 ±â€Š$4543 with observation) and higher net lifetime QALYs (24.1 ±â€Š2.0 with bracing vs. 23.9 ±â€Š1.8 with observation). Bracing was associated with an INMB of $36,093 (95% confidence interval $18,894-$55,963) over observation over the patient's lifetime. The model was most sensitive to the impact of bracing versus observation on altering the probability of requiring surgery, either as an adolescent or an adult. CONCLUSION: Cost-utility analysis supports scoliosis bracing as the preferred choice in management of appropriately indicated AIS patients with thoracic scoliosis.Level of Evidence: 5.


Assuntos
Escoliose , Adolescente , Determinação da Idade pelo Esqueleto , Braquetes , Criança , Análise Custo-Benefício , Feminino , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Escoliose/diagnóstico por imagem , Escoliose/terapia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34360060

RESUMO

Attempts to optimize monitoring of brace adherence prescribed to adolescents with idiopathic scoliosis (IS) have generally relied on sensors. Sensors, however, are intrusive and do not allow the assessment of psychological and physical consequences of brace use that might underlie poor adherence. Mobile applications have emerged as alternatives to monitor brace compliance. However, the feasibility and utility of these app-based systems to assess key psychological and physical domains associated with non-adherence remain unexplored. This feasibility study aims to test the usability, acceptability, and clinical utility of an app-based system that monitors brace use and related psychological and physical factors. Forty adolescents with IS daily respond to the app for 90 days. The patient responses may generate clinical alarms (e.g., brace non-adherence, discomfort, or distress) that will be sent daily to the medical team. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will include brace adherence, the number of side effects reported, number and type of clinical alarms, stress, quality of life, perceived health status, and mood. If accepted by patients and clinicians, apps may allow rapid detection and response to undesired events in adolescents undergoing brace treatment.


Assuntos
Escoliose , Telemedicina , Adolescente , Braquetes , Estudos de Viabilidade , Humanos , Cooperação do Paciente , Qualidade de Vida , Escoliose/terapia
14.
Chin Med J (Engl) ; 134(16): 1983-1987, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34354003

RESUMO

BACKGROUND: Scoliosis secondary to neurofibromatosis type 1 (NF1) in children aged <10 years is an important etiology of early-onset scoliosis (EOS). This study was performed to investigate the curve evolution of patients with EOS secondary to NF1 undergoing bracing treatment and to analyze high-risk indicators of rapid curve progression. METHODS: Children with EOS due to NF1 who underwent bracing treatment from 2010 to 2017 were retrospectively reviewed. The angle velocity (AV) at each visit was calculated, and patients with rapid curve progression (AV of >10°/year) were identified. The age at modulation and the AV before and after modulation were obtained. Patients with (n = 18) and without rapid curve progression (n = 10) were statistically compared. RESULTS: Twenty-eight patients with a mean age of 6.5 ±â€Š1.9 years at the initial visit were reviewed. The mean Cobb angle of the main curve was 41.7°â€Š±â€Š2.4° at the initial visit and increased to 67.1°â€Š±â€Š8.6° during a mean follow-up of 44.1 ±â€Š8.5 months. The overall AV was 6.6°â€Š±â€Š2.4°/year for all patients. At the last follow-up, all patients presented curve progression of >5°, and 20 (71%) patients had progressed by >20°. Rapid curve progression was observed in 18 (64%) patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up (t = 2.868, P = 0.008 and <0.001, respectively). The mean AV was 4.4°â€Š±â€Š1.2°/year before modulation and 11.8°â€Š±â€Š2.7°/year after modulation (t = 11.477, P < 0.010). CONCLUSIONS: Curve progression of >10°/year is associated with younger age at the initial visit, and modulation change indicated the occurrence of the rapid curve progression phase.


Assuntos
Neurofibromatose 1 , Escoliose , Braquetes , Criança , Pré-Escolar , Progressão da Doença , Humanos , Neurofibromatose 1/complicações , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Resultado do Tratamento
15.
J Pediatr Orthop ; 41(9): 543-548, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34354032

RESUMO

BACKGROUND: Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient's risk of curve progression based on modern treatment standards. METHODS: We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves >25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression. RESULTS: Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P<0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees). CONCLUSIONS: Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient's risk of progression and ultimate surgical risk. LEVEL OF EVIDENCE: Level III-retrospective cohort study.


Assuntos
Cifose , Escoliose , Adolescente , Braquetes , Progressão da Doença , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/terapia
16.
BMJ Open ; 11(8): e047273, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408037

RESUMO

OBJECTIVE: The treatment effect of orthoses for hallux valgus (HV) is unclear with little interventional studies, the design involves multiple complex factors, and therefore a systematic analysis with meta-analysis is necessary. The objective of this systematic review and meta-analysis is to determine whether current foot orthoses are effective in treating HV. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Electronic databases (PubMed, Scopus, Cinahl and Medline) are searched up to February 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Interventional studies with content focus on HV orthosis design and any of the outcomes related to effectiveness for treating HV are included. The standardised mean differences are calculated. The risk of bias in included studies is assessed using the Cochrane Collaboration's risk of bias tools. RESULTS: In total, 2066 articles are identified. Among them, nine are selected and quality rated, and data are extracted and closely examined. A meta-analysis is conducted, where appropriate. The main causes of potential bias are missing outcome data and outcome measurement error. The results show that orthosis with a toe separator has the best effect of correcting the HV angle (standardised mean difference: 0.50, 95% CI: 0.189 to 0.803). CONCLUSION: The orthoses design with a toe separator or an element that allows for the foot anatomic alignment is critical for reducing the HV angle and relieving foot pain. The results contribute to a better selection of treatment for patients. PROSPERO REGISTRATION NUMBER: CRD42021260403.


Assuntos
Órtoses do Pé , Hallux Valgus , Braquetes , , Hallux Valgus/terapia , Humanos , Qualidade de Vida
17.
Medicine (Baltimore) ; 100(33): e26965, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414966

RESUMO

ABSTRACT: There is an increasing concern about the impact of bracing on the quality of life (QoL) of patients with adolescent idiopathic scoliosis (AIS). However, up to now, few multidimensional questionnaires on this impact are available in China. This study aimed to evaluate the reliability and validity of the Chinese version of Brace Questionnaire (C-BrQ).The BrQ was translated from Greek into Chinese with proper cross-cultural adaptation.An observational, cross-sectional study in Chinese patients with AIS was conducted to measure the temporal stability of C-BrQ using the intraclass correlation coefficient (ICC). The effects of ceiling and floor were evaluated and the reliability was verified by examining the internal consistency. The C-BrQ domains were compared with the domains in Chinese version of Scoliosis Research Society-22 Outcomes Questionnaire (C-SRS-22) using Pearson correlation coefficient to assess the concurrent validity.A total of 208 patients were included in the study. The results of test-retest reliability for each dimension of C-BrQ were desirable. The floor or ceiling effects were not demonstrated in the C-BrQ and C-SRS-22. Satisfactory internal consistency was found in all the C-BrQ domains. Most C-BrQ and C-SRS-22 domains showed satisfactory correlation coefficients, except when vitality and school activity in C-BrQ were compared with self-image, mental health, and management satisfaction in C-SRS -22, respectively.C-BrQ is reliable in evaluating the QoL of AIS patients receiving brace treatment.


Assuntos
Braquetes , Escoliose/terapia , Adolescente , Criança , China , Estudos Transversais , Feminino , Humanos , Masculino , Qualidade de Vida/psicologia , Reprodutibilidade dos Testes , Escoliose/psicologia , Inquéritos e Questionários
18.
Medicine (Baltimore) ; 100(32): e26822, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397885

RESUMO

ABSTRACT: Neuromuscular scoliosis is a common deformity seen in patients with neuromuscular diseases. Although rigid thoracolumbosacral orthosis is the most frequently used brace, it has low compliance rates and can lead to complications including skin ulcers. Thus, alternative methods for treating neuromuscular scoliosis are needed. The purpose of this study is to evaluate the clinical effects of a novel flexible brace to prevent the progression of neuromuscular scoliosis.This study is a prospective observational study. Twenty-three patients with neuromuscular scoliosis were enrolled in the study. Among patients diagnosed with neuromuscular disease, spine radiographs were checked for a neuromuscular scoliosis diagnosis. The participants were treated with a novel flexible brace for 6 months. The control group (n = 46) was selected using propensity score matching method from a clinical data warehouse. The Cobb angle was measured and compared between the study and control groups.In the study group, the average Cobb's angle significantly decreased from 47.22 ±â€Š18.9° to 31.8 ±â€Š20.0 when wearing the flexible brace (P < .001). Thus, the correction rate was 36.9%. The annual progression rate was significantly lower in the study group than in the control group (P  < .05).The flexible brace showed a significant correction rate of scoliosis in patients with severe neuromuscular diseases. The flexible brace is an alternative treatment modality for patients with neuromuscular scoliosis. Daily application of the flexible brace during the growing period can reduce the degree of fixed deformity in the long term.


Assuntos
Braquetes , Vértebras Lombares/cirurgia , Doenças Neuromusculares/cirurgia , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Criança , Feminino , Humanos , Masculino , Doenças Neuromusculares/diagnóstico , Aparelhos Ortopédicos , Estudos Prospectivos , Radiografia , Escoliose/diagnóstico , Resultado do Tratamento
19.
Sports Med Arthrosc Rev ; 29(3): 173-179, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398124

RESUMO

Injuries to the meniscus, particularly tears, can have significant negative impacts on pain, function, and quality of life. Preservation of the meniscus is favorable, especially in the athletic and active populations. While first line treatment is often nonoperative in nature, recalcitrant, and more complex tears, typically require surgery. Meniscus repair rates have increased significantly during the last 2 decades as surgical techniques and postoperative outcomes have improved. Longer postoperative timeframes are to be expected when compared with menisectomy, however, accelerated programs have demonstrated favorable outcomes. Rehabilitation and return to play guidelines should reflect the intricacies of the tear type and repair procedure. Close communication with the surgeon is a vital component to optimize patient outcomes. Further, the patient's goals and expected level of return to function, or sport, must be taken into account for a rehabilitation program to be fully successful.


Assuntos
Volta ao Esporte , Lesões do Menisco Tibial/reabilitação , Braquetes , Constrição , Terapia por Estimulação Elétrica , Exercício Físico , Humanos , Força Muscular , Tratamentos com Preservação do Órgão , Músculo Quadríceps/fisiologia , Qualidade de Vida , Amplitude de Movimento Articular , Fluxo Sanguíneo Regional , Retorno ao Trabalho , Ruptura/reabilitação , Ruptura/cirurgia , Lesões do Menisco Tibial/cirurgia , Suporte de Carga
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(7): 801-806, 2021 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-34308584

RESUMO

Objective: To develop a smart orthosis personalized management system for the treatment of patients with adolescent idiopathic scoliosis (AIS) and to evaluate the feasibility and efficiency through clinical preliminary applications. Methods: The smart orthosis personalized management system consists of a wireless force monitor, a WeChat Mini Program, a cloud-based storage system, and a website backstage management system. Twenty-two patients with AIS who underwent orthosis treatment and met the selection criteria between March 2020 and December 2020 were enrolled. The follow-up time was 4 months. The parameters used to evaluate patients' compliance were as follows (back and lumbar): baseline force value, measured force value, force compliance (measured force value/baseline force value×100%), measured wearing time (wearing time of force value was more than 0 N), and time compliance (measured wearing time/prescribed wearing time×100%), in which the prescribed wearing time was 23 hours/day. The baseline force values were measured at initiation, while the measured force value, measured wearing time, force compliance, and time compliance were measured during follow-up. The differences of these parameters between back and lumbar, and the differences among these parameters at 1, 2, 3, and 4 months after orthosis wearing were analyzed. Results: The average measured force value of 22 patients (back and lumbar) was (0.83±0.34) N, the average force compliance was 68.5%±17.9%, the average measured wearing time was (15.4±1.7) hours, and the average time compliance was 66.9%±7.7%. The baseline force value and measured force value of back were significantly higher than those of lumbar ( P<0.05); the measured wearing time, force compliance, and time compliance between back and lumbar showed no significant difference ( P>0.05). The measured force value, measured wearing time, force compliance, and time compliance at 1 month after wearing were significantly lower than those at 2, 3, and 4 months after orthosis wearing ( P<0.05), no significant difference was found among 2, 3, and 4 months after orthosis wearing ( P>0.05). At different time points after wearing, the measured force value of back were significantly higher than that of lumbar ( P<0.05), while there was no significant difference between back and lumbar on the other parameters ( P>0.05). Conclusion: The smart orthosis personalized management system has high feasibility to treat AIS, and can improve the compliance of such patients with orthosis wearing.


Assuntos
Cifose , Escoliose , Adolescente , Braquetes , Humanos , Aparelhos Ortopédicos , Cooperação do Paciente , Escoliose/terapia
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