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Physical therapy intervention studies on idiopathic scoliosis-review with the focus on inclusion criteria1
Hans-Rudolf Weiss
Scoliosis , 2012, DOI: 10.1186/1748-7161-7-4
Abstract: A PubMed search for outcome papers on PT was performed in order to detect study designs and inclusion criteria used.Real outcome papers (start of treatment in immature samples/end results after the end of growth; controlled studies in adults with scoliosis with a follow-up of more than 5 years) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications.There is no outcome paper on PT in scoliosis with a patient sample at risk for being progressive in adults or in adolescents followed from premenarchial status until skeletal maturity. However, papers on bracing are more frequently found and bracing can be regarded as evidence-based in the conservative management and rehabilitation of idiopathic scoliosis in adolescents.Scoliosis is a three dimensional deformity of the spine and trunk, which may deteriorate quickly during periods of rapid growth [1-3]. Although scoliosis may be the expression or a symptom of certain diseases, eg. neuromuscular, congenital, due to certain syndromes or tumors, the majority of the patients with scoliosis (80-90%) are called ？Idiopathic' because a certain underlying cause still has not been found. The treatment of the symptomatic scoliosis may primarily be determined by the underlying cause. The treatment of the so-called idiopathic scoliosis is determined by the deformity itself. As most of the scoliosis progress during growth, some also in later life, the main aim of any intervention is to stop curvature progression [1,2].While children grow until they have fully matured, there are certain times with more or less growth during childhood and adolescence and curvature progression is more or less probable during different phases of growth [1,2] (Figure 1). The ？baby spurt' ends at the age of five and a half to six years followed by a ？flat phase,' which lasts until the first signs of maturation. With the firs
Spinal deformities rehabilitation - state of the art review
Hans-Rudolf Weiss
Scoliosis , 2010, DOI: 10.1186/1748-7161-5-28
Abstract: A Pub Med review was completed in order to reveal substantial evidence for inpatient rehabilitation as performed in Germany. No evidence has been found in general to support claims for actual inpatient rehabilitation programmes as used today. Nevertheless, as there is some evidence that inpatient rehabilitation may be beneficial to patients with spinal deformities complicated by certain additional conditions, the body of evidence there is for conservative treatment of spinal deformities has been reviewed in order to allow suggestions for outpatient conservative treatment and inpatient rehabilitation.Today, for both children and adolescents, we are able to offer intensive rehabilitation programmes lasting three to five days, which enable the patients to acquire the skills necessary to prevent postures fostering scoliosis in everyday life without missing too much of school teaching subjects at home. The secondary functional impairments adult scoliosis patients might have, as in the opinion of the author, still today require the time of 3-4 weeks in the clinical in-patient setting. Time to address psychosocial as well as somatic limitations, namely chronic pains and cardiorespiratory malfunction is needed to preserve the patients working capability in the long-term.Outpatient treatment/rehabilitation is sufficient for adolescents with spinal deformities.Inpatient rehabilitation is recommended for patients with spinal deformities and pain or severe restrictive ventilation disorder.Medical rehabilitation aims at an improvement in function, capacity and participation [1]. Outpatient and inpatient programmes are available worldwide for the rehabilitation of patients with impairments or disabilities in various medical fields. Particularly in Germany, there is a long history of inpatient rehabilitation for various diseases. The German Pension Insurance scheme has introduced a comprehensive practice guidelines programme for the development of process guidelines for inpatient
Is there a body of evidence for the treatment of patients with Adolescent Idiopathic Scoliosis (AIS)?
Hans-Rudolf Weiss
Scoliosis , 2007, DOI: 10.1186/1748-7161-2-19
Abstract: One aim of the Scoliosis Society (SOSORT) should be; to help develop a body of research regarding the outcomes of conservative and operative treatment as well, and to highlight the problems of treatment indications in patients with AIS and other spinal deformities. Another aim is to help to improve the safety of patients who have surgery. By producing evidence-based information that can be used to develop guidelines that could aid both professionals and patients in making decisions about surgical and conservative options.Although 'Scoliosis' is the official journal of the SOSORT and is the main forum for experts in the field of conservative management of patients with spinal deformities, there needs to be more wide spread attempt to develop a fuller body of evidence focussing on spine surgery as well.Today evidence based medicine (EBM) and evidence based practice (EBP) are valuable instruments in the decision making process of professionals in the medical field. Restrictions upon resources of social health care systems have lead to calls for greater efficiency and cost effectiveness of treatment programmes. Therefore good quality evidence studies providing the highest of research are necessary to evaluate effectiveness of treatments.The Centre for Evidence Based Medicine (EBM) [1] provides guidelines to spread the knowledge about EBM and its use. There is a special hierarchy of evidence based knowledge:1. Smallest evidence is provided by "expert opinion"2. Case reports/case series3. Un-controlled studies4. Controlled studies5. Randomized controlled studies (RCT) and6. Meta analyses from RCTThe quality and types of evidence help to segregate research into levels. They are graded (IV [lowest] – I [highest]) and from those levels recommendations for treatment are derived (Grade D [lowest] – Grade A [highest]).Grade B recommendations for conservative treatment of scoliosis are justified. There are prospective controlled studies (level II) [2-4] and enough data from leve
"Brace technology" thematic series - the Gensingen brace？ in the treatment of scoliosis
Hans-Rudolf Weiss
Scoliosis , 2010, DOI: 10.1186/1748-7161-5-22
Abstract: This CAD/CAM Chêneau derivate has been called Gensingen brace？, a brace available to address all possible curve patterns. Once the patients' trunk is scanned with the help of a whole trunk optical 3D-scan and the patients' data from the clinical measurements are recorded, a model of the brace can be created by (1) modifying the trunk model of the patient 'on screen' to achieve a very individual brace model using the CAD/CAM tools provided or by (2) choosing a brace model from our library and re-size it to the patients' properties 'on screen'.End-result studies have been published on the Chêneau brace as early as 1985. Cohort studies on the Chêneau brace are available as is a prospective controlled study respecting the SRS criteria for bracing studies, demonstrating beneficial outcomes, when compared to the controls using a soft brace. Sufficient in-brace correction effects have been demonstrated to be achievable when the Chêneau principles of correction are used appropriately. As there is a positive correlation between in-brace correction and the final outcome, the Chêneau concept of bracing with sufficient in-brace corrections as published can be regarded as being efficient when applied well. Case reports with high in-brace corrections, as shown within this paper using the Gensingen brace？ promise beneficial outcomes when a good compliance can be achieved.The use of the Gensingen brace？ leads to sufficient in-brace corrections, when compared to the correction effects achieved with other braces, as described in literature.According to the patients' reports, the Gensingen brace？ is comfortable to wear, when adjusted properly.Further studies are necessary (1) in order to evaluate brace comfort and (2) effectiveness using the SRS inclusion criteria.Bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of PE on the one hand and soft braces on the other. The latest developments in the field of bracing, aim
Clinical improvement and radiological progression in a girl with early onset scoliosis (EOS) treated conservatively – a case report
Hans-Rudolf Weiss
Scoliosis , 2006, DOI: 10.1186/1748-7161-1-13
Abstract: The patient entered conservative treatment at the age of 13 years, premenarchial with Tanner II and a Cobb angle of 60° thoracic and 59° lumbar. The angle of trunk rotation (ATR; Scoliometer) was 13° thoracic and 13° lumbar. We have documented the findings of this patient (Surface topography, ATR, Cobb angles and angles of vertebral rotation (according to Raimondi) during the treatment period (27 Month) until 2 years after the onset of menarche.After a treatment time of 27 Month the Cobb angle increased to 74° thoracic and 65° lumbar. The angles of vertebral rotation according to Raimondi increased slightly from 26° thoracic and 28° lumbar to 30° thoracic and 28° lumbar. The ATR improved to 12° thoracic and 5° lumbar while Lateral deviation improved from 22,4 mm to 4,6 mm and average surface rotation improved from 10,6° to 6°. In the X-rays a reduction of decompensation was visible. The patient felt comfortable with the cosmetic result.Conservative treatment may improve cosmetic appearance while the curve progresses radiologically. This could be explained by assuming that (1) the Rigo Chêneau brace is able to improve cosmetic appearance by changing the shape of the thorax when the curve itself is too stiff to be corrected by a brace, that (2) reduction of decompensation leads to significant cosmetical improvements or (3) that the patient gained weight and therefore the deformation is masked. However, the weight the patient gained cannot explain the cosmetical improvement in this case.Conservative treatment with a certain standard of quality seems a viable alternative for patients with Cobb angles of > 60° when surgical treatment is refused.Specialists in scoliosis management should be aware of the fact that curve progression can occur even if the clinical measurements show an improvement.In Continental Europe [1-3] especially in Germany, a conservative treatment approach is pursued actively from the time of diagnosis [4-9]. In adolescence, this approach includes out
The method of Katharina Schroth - history, principles and current development
Hans-Rudolf Weiss
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-17
Abstract: Inspired by a balloon, she tried to correct by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. She also tried to ？mirror' the deformity, by overcorrecting with the help of certain pattern specific corrective movements. She recognized that postural control can only be achieved by changing postural perception.From 1921 this new form of treatment with specific postural correction, correction of breathing patterns and correction of postural perception was performed with rehabilitation times of 3 months in her own little institute in Meissen and in the late 30's and early 40's she was supported by her daughter, Christa Schroth.After World War II, Katharina Schroth and her daughter moved to West Germany to open a new little institute in Sobernheim, which constantly grew to a clinic with more than 150 in-patients at a time, treated as a rule for 6 weeks. In the 80's this institute was renamed to ？Katharina Schroth Klinik'. At this time the first studies were carried out and the patient series for the first prospective controlled trial was derived from the patient samples of 1989-1991.Content, rehabilitation times and patients meanwhile have changed, and braces have been developed to offer highest treatment security.Therefore today, bracing in the patient at risk has to be regarded as the primary treatment. We have been able to reduce the training times by adapting the old techniques and introducing new forms of postural education (sagittal correction, ADL correction and experiential learning) whilst the programme is still based on the original approaches of the 3-dimensional treatment according to Katharina Schroth, namely specific postural correction, correction of breathing patterns and correction of postural perception.The history of conservative treatment of scoliosis is rather long and leads us back to the original methods of Hippocrates (460-370 BC) [1]. Although more than two thousand years h
Adolescent Idiopathic Scoliosis – case report of a patient with clinical deterioration after surgery
Hans-Rudolf Weiss
Patient Safety in Surgery , 2007, DOI: 10.1186/1754-9493-1-7
Abstract: A 15-year old female patient originally presenting with a well-compensated double curve pattern scoliosis. The patient was advised to undergo surgery due to the long-term negative impact of signs and symptoms of scoliosis upon her health. The patient agreed to surgery, which was performed in one of Germanys leading centres for spinal surgery. The thoracolumbar curve was corrected and fused, while the thoracic curve, clearly showing wedged vertebrae, defined as structural scoliosis, remained untreated.This operation left the patient with an unbalanced appearance, with radiological and clinical imbalance to the right. The clinical appearance of the patient though clearly deteriorated post-surgery. Furthermore, the wedged disc space below the fusion area indicates future problems with possible destabilisation accompanied probably by low back pain.Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. Therefore the treatment leading to the best possible clinical appearance and balance has to be chosen. Patients should be informed that surgery will not necessarily improve their health status. Clinical deterioration after surgery may occur, and such information is crucial for an adequate informed consent.Adolescent Idiopathic Scoliosis (AIS), the most common form of scoliosis, is a structural three-dimensional deformity of the spine and trunk, occurring in otherwise healthy children during puberty. Curvatures < 10° are viewed as a variation of normal [1], as those curves have little potential for progression [1]. Historically, in southern and central Europe the treatment for AIS consists of: physiotherapy (PT) on an out-patient basis; Scoliosis In-patient Rehabilitation (SIR); corrective bracing and surgery with or without spinal fusion.Scoliosis management is usually regarded as effective when curvature progression has been stopped below a certain limit, although other parameters than progression may play an important role for
Scoliosis: a journal dedicated to multidisciplinary research on prevention, control, and treatment of scoliosis and other spinal deformities
Hans-Rudolf Weiss
Scoliosis , 2006, DOI: 10.1186/1748-7161-1-1
Abstract: Scoliosis is dedicated to multidisciplinary research on prevention, control, and treatment of scoliosis and other spinal deformities. Scoliosis was described in the Hippocratic Collection (500 B.C.) and has clinical implications for a wide range of disciplines, including biomechanics, epidemiology, exercise physiology, physical therapy, orthopaedics, osteopathy, physiatry, psychology, and respiratory science. The following contributions are welcome: research, reviews, methodology articles, and case reports. The journal will also publish "technical notes" that focus on new technical developments in the field of physiotherapy, rehabilitation and orthotics.Scoliosis is published by BioMed Central, an independent publisher committed to ensuring peer-reviewed biomedical research is open access. Articles will be freely and universally accessible online, and archived in several internationally recognized free access repositories, including PubMed Central, the US National Library of Medicine's full-text repository of life science literature, and repositories at the University of Potsdam in Germany, at INIST in France, and in e-Depot, the National Library of the Netherlands' digital archive of all electronic publications. Authors publishing in the journal retain copyright, allowing anyone to reproduce or disseminate articles, according to the BioMed Central copyright and license agreement.Scoliosis will be a valuable resource in the field of conservative scoliosis therapy. The prevalence of mild to moderate scoliosis in adolescents is 3000–5000 per 100,000 population, and in adults as high as 12% [1,2]. Fortunately, only a small minority of cases (<1%) progress to a magnitude at which spinal fusion surgery is recommended [1,3]. Treatment indications for the remaining patients, as well as those individuals with severe scoliosis who decline surgery, have been a source of controversy [4,5]. Yet the lifetime disease burden for scoliosis patients has become increasingly clear [6-
Brace Treatment Can Improve Thoracic Kyphosis During Growth: A Case Report
Hans-Rudolf Weiss
Open Access Journal of Science and Technology , 2013, DOI: 10.11131/2013/100006
Abstract: . While in scoliosis bracing today there is evidence that during growth curvatures can be corrected significantly, there is no evidence that the standard of kyphosis bracing we use today may lead to final corrections after weaning off the brace. Case report: A 12-year-old kyphosis patient presented at the office of the author with a curve of 58° in summer 2009. Brace treatment with a modern kyphosis brace was started immediately with an in-brace correction of more than 30 degrees. After one year of treatment the patient had outgrown his first brace, but was still immature. Therefore a new brace was constructed. The curvature was 37° without and 25° in the new brace. This brace was worn for another two years for 16 h/day and weaned off in summer 2012. 6 months later—the patient meanwhile was nearly mature (Risser 4/voice change 2.6 years) the final X-ray showed an angle of 38° (normal range of kyphosis angles) with full flexibility of the spine. Conclusion: Bracing with small size orthosis in kyphosis patients during growth can lead to an improvement of the curvature angle after the end of growth. The functional limitations there are in severe kyphosis angles can be improved and normalized in some cases.
Soft braces in the treatment of Adolescent Idiopathic Scoliosis (AIS) – Review of the literature and description of a new approach
Hans-Rudolf Weiss, Mario Werkmann
Scoliosis , 2012, DOI: 10.1186/1748-7161-7-11
Abstract: A review of literature as available on Pub Med was performed using the key words ‘scoliosis’ and ‘soft brace’ at first. The search was expanded using ‘scoliosis’ and the known trademarks (1) ‘scoliosis’ and ‘SpineCor’, (2) ‘scoliosis’ and ‘TriaC’, (3) ‘scoliosis’ and ‘St. Etienne brace’, (4) ‘scoliosis’ and ‘Olympe’. The papers considered for inclusion were new technical descriptions, preliminary results, cohort studies and controlled studies.When searching for the terms ‘scoliosis’ and ‘SpineCor’: 20 papers have been found, most of them investigating a soft brace, for ‘scoliosis’ and ‘TriaC’: 7 papers displayed, for ‘scoliosis’ and ‘St. Etienne brace’: one paper displayed but not meeting the topic and for ‘scoliosis’ and ‘Olympe’: No paper displayed. Four papers found on the SpineCor？ were of prospective controlled or prospective randomized design. These papers partly presented contradictory results. Two papers were on soft Boston braces used in patients with neuromuscular scoliosis.There is a small but consistent body of evidence for the use of soft braces in the treatment of scoliosis. Contradictory results have been published for samples treated during the pubertal growth spurt. In a biomechanical analysis the reason for the lack of effectiveness during this period has been elaborated. Improved materials and the implementation of corrective movements respecting also the sagittal correction of the scoliotic spine will hopefully contribute to an improvement of the results achievable.The treatment of scoliosis using soft braces is supported by some papers providing a small body of evidence. During the growth spurt the use of soft braces is discussed contradictory. There is insufficient evidence to draw definite conclusions about effectiveness and safety of the intervention.
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