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
Like?
Share with your friends.
Facebook
Twitter
Email

Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS).

Abstract

 
Study design

Survey.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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

Level IV.

References

 

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

Article Google Scholar

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

Article PubMed Google Scholar

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

Article Google Scholar

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

CAS Article PubMed PubMed Central Google Scholar

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

Article PubMed Google Scholar

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

Article Google Scholar

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

Article Google Scholar

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

Article PubMed PubMed Central Google Scholar

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

Google Scholar

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

Article Google Scholar

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

Article Google Scholar

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

Article PubMed Google Scholar

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

Article PubMed Google Scholar

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

Article Google Scholar

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

Article PubMed Google Scholar

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

Google Scholar

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

Article PubMed PubMed Central Google Scholar

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

Article Google Scholar