Beneficial Effects of Orthotist Training on Bracing Success for Adolescent Idiopathic Scoliosis

Summary: We examined bracing success prior to and following orthotist training in a technique for fabricating custom molded TLSO braces. All braced patients with adolescent idiopathic scoliosis were reviewed before and after orthotic bracing methods were updated. Pre-brace Cobb measurement was compared to first x-ray in brace and final follow up. Results demonstrate statistically significant improvements in all measured outcomes. Bracing can successfully treat adolescent idiopathic scoliosis. Success is dependent upon orthotic skills and brace compliance.

Purpose: Despite a preponderance of literature concerning the success of various scoliosis braces, there is little information concerning the effects of orthotist training and education on bracing success. We examined bracing success prior to and following such training utilizing a custom molded TLSO.

Methods: All braced patients with adolescent idiopathic scoliosis were reviewed before and after orthotic bracing methods were updated. 30 braced patients completing treatment prior to orthotist retraining were compared to 42 patients completing bracing after retraining. Non-idiopathic scoliosis was excluded. Demographic data, follow-up, brace treatment, reported brace compliance and radiographs were reviewed. Brace success was defined as less than 10 degrees of progression at final follow up. Failure was defined as progression 10 degrees or more, or the need for surgery.

Results: The two groups were similar in age (13+2 vs.13+6), gender (83% vs. 80% female), and Cobb measurement at brace initiation (29 vs. 26 degrees). All measured outcomes improved following orthotist retraining, with statistically significant (p = 0.0001) differences in measurement. Cobb angle on first inbrace x-ray improved (5.9 vs. 11.9 degrees) as did Cobb progression, pre-brace to final follow up (9.36 vs. 1.5 degrees). Bracing success was 12/30 (40%) prior to orthotist retraining and 34/42 (81%) after retraining. Compliance decreased with age, time in brace and the presence of psychologic co-morbidity (ADHD, depression). Surgery was required for 12/30 (40%) prior to orthotist retraining and only 4/42 (9.5%) after retraining. The only patients requiring surgery following orthotist retraining had Cobb measurements greater than 43 degrees at brace initiation or were being treated for attention deficit and depression.

Conclusion: Bracing can successfully treat adolescent idiopathic scoliosis. Success is dependent upon brace compliance and orthotic skills.

Significance: A trained, skilled orthotist is essential to successful scoliosis bracing. Among compliant patients, brace failure is unusual.