Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis
By Benjamin D. Roye, Matthew E. Simhon, Hiroko Matsumoto, Prachi Bakarania, Hagit Berdishevsky, Lori A. Dolan, Kelly Grimes, Theodoros B. Grivas, Michael T. Hresko, Lori A. Karol, Baron S. Lonner, Michael Mendelow, Stefano Negrini, Peter O. Newton, Eric C. Parent, Manuel Rigo, Luke Strikeleather, John Tunney, Stuart L. Weinstein, Grant Wood & Michael G. Vitale
Share with your friends.
Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS).
The purpose of this study was to establish best practice guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal consensus building techniques.
Summary of background data
Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS.
We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised and repeat voting for consensus was performed.
Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached consensus on 67 items across 10 domains of bracing which were consolidated into the final best practice recommendations.
We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research.
Level of evidence
Roach JW, Weinstein SL, Dolan LA et al (2008) Adolescent idiopathic scoliosis. Lancet 371(9623):1527–1537. https://doi.org/10.1016/S0140-6736(08)60658-3
Negrini S, Minozzi S, Bettany-Saltikov J et al (2010) Cochrane review: braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. https://doi.org/10.1002/ebch.620
Dolan L, Weinstein S (2009) The best treatment for adolescent idiopathic scoliosis: what do current systematic reviews tell us? Scoliosis 4(Suppl 1):O67. https://doi.org/10.1186/1748-7161-4-S1-O67
Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521. https://doi.org/10.1056/NEJMoa1307337
Gomez JA, Hresko MT, Glotzbecker MP (2016) Nonsurgical Management of Adolescent Idiopathic Scoliosis. J Am Acad Orthop Surg 24(8):555–564. https://doi.org/10.5435/JAAOS-D-14-00416
Romano M, Minozzi S, Zaina F et al (2013) Exercises for adolescent idiopathic scoliosis: a cochrane systematic review. Spine (Phila Pa 1976) 38(14):E883–E893. https://doi.org/10.1097/BRS.0b013e31829459f8
Negrini S, Minozzi S, Chockalingam N et al (2015) Braces for idiopathic scoliosis in adolescents (review). Summ Find Main Comp. https://doi.org/10.1002/14651858.CD006850.pub3.www.cochranelibrary.com
Negrini S, Donzelli S, Aulisa AG et al (2018) 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Vol 13. Scoliosis Spinal Disord. https://doi.org/10.1186/s13013-017-0145-8
Dunn J, Henrikson NB, Morrison CC, Nguyen M, Blasi PR, Lin JS (2018) Screening for adolescent idiopathic scoliosis. Agency for healthcare research and quality (US). https://www.ncbi.nlm.nih.gov/pubmed/29638297. Accessed 5 Jun 2019
OCEBM Levels of Evidence Working Group, Durieux N, Pasleau F, Howick J (2011) The Oxford 2011 levels of evidence. Group 1(version):5653
Pill J (1971) The delphi method: substance, context, a critique and an annotated bibliography. Socioecon Plann Sci 5(1):57–71. https://doi.org/10.1016/0038-0121(71)90041-3
Okoli C (2004) The delphi method as a research tool: an example, design considerations and applications. Inf Manag 42:15–29. https://doi.org/10.1016/j.im.2003.11.002
Dalkey N, Helmer O (1963) An experimental application of the delphi method to the use of experts. Manag Sci https://doi.org/10.1287/mnsc.9.3.458
Roye BD, Campbell ML, Matsumoto H et al (2019) Establishing consensus on the best practice guidelines for use of halo gravity traction for pediatric spinal deformity. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001379
Vitale MG, Riedel MD, Glotzbecker MP et al (2013) Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 33(5):471–478. https://doi.org/10.1097/BPO.0b013e3182840de2
Vitale MG, Skaggs DL, Pace GI et al (2014) Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deform 2(5):333–339. https://doi.org/10.1016/j.jspd.2014.05.003
Vitale M, Minkara A, Matsumoto H et al (2018) Building consensus: development of best practice guidelines on wrong level surgery in spinal deformity. Spine Deform 6(2):121–129. https://doi.org/10.1016/j.jspd.2017.08.005
Linstone HA, Turoff M (1975) The delphi method: techniques and applications. Addison-Wesley Pub. Co, Boston, MA. https://doi.org/10.2307/1268751
Gordon TJ (1994) The delphi method. Futur Res Methodol 2(3):1–30
Brown BB (1968) Delphi process. https://www.rand.org/pubs/papers/P3925.html. Accessed 22 Feb 2016
McMillan SS, King M, Tully MP (2016) How to use the nominal group and delphi techniques. Int J Clin Pharm 38(3):655–662. https://doi.org/10.1007/s11096-016-0257-x
Vitale MG, Riedel MD, Glotzbecker MP et al (2017) Building consensus: development of a Best Practice Guideline (BPG) for Surgical Site Infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 33(5):471–478. https://doi.org/10.1097/BPO.0b013e3182840de2