Quality of life of adolescent idiopathic scoliosis patients under brace treatment: a brief communication of literature review

A search within the PubMed database was conducted on June 6, 2019, with the query: “adolescent idiopathic scoliosis AND brace treatment AND quality of life”. Results were not limited by publication date. Studies were excluded if they A) are review papers, B) involved AIS patients under surgical treatment and assessed their QoL, C) were published not as full-text in English.

Data were extracted from the included publications using a standardized form recording title, authors, sample size, methods, outcome measures and results.

The results of all the reviewed papers were analysed and grouped per patient reported outcome measurement questionnaire. Finally, the most affected domains were identified either based on the authors’ self-report, or if the authors did not explicitly identify the most affected domains, by selecting those domains with QoL results below a threshold value. These threshold values were selected based on the threshold values used by the authors who self-reported on most affected domains. For publications in which the authors concluded that no significant differences were found, neither within different domains of one questionnaire nor within different cohorts using the same questionnaire, we used the classification “No Significance”.

Law et al. [70] found that an aesthetically pleasing brace and the involvement of patients in the design process of the brace were important for increasing user compliance and also addressing psychological issues during treatment. Moreover, patients’ concerns on self-appearance inspired researchers to design flexible braces consisting of elastic straps and a soft shell, which allows more freedom of movement, less physical restrictions, and more importantly, allows to be hidden under clothes. To date, the most widely discussed flexible brace is SpineCor, which was proposed by the Sainte-Justine Hospital [71]. However, the effectiveness of SpineCor remains controversial. Guo et al. [72], Coillard et al. [73] and Wong et al. [74]. found significant differences between SpineCor and rigid brace group in terms of effectiveness. Whilst Gammon et al. [75] reported no significant difference in the treatment outcomes comparing thoraco-lumbar sacral orthosis (TLSO) and SpineCor-treated patients and Coillard et al. [76] demonstrated that SpineCor brace reduced the probability of the progression of early idiopathic scoliosis (15°–30°) after at least 5 years follow-up. However, patients’ acceptance and compliance (which have been shown to have a close correlation with the treatment efficacy [7, 77, 78]) to the SpineCor were comparable to rigid spinal orthoses. The SpineCor brace was also found to be better than TLSO at improving QoL, reported by Ersen et al. [37], patients treated with SpineCor brace have a better self-image, feel more active in daily life and experience less pain according to SRS-22 results. Whilst Misterska et al. [79] found that there was no significant difference in most of the analyzed domains of QoL between patients with the SpineCor brace and the Cheneau brace. Given the currently mixed outcomes of studies on flexible braces, we can conclude that even flexible braces, like SpineCor, has no comparable effectiveness as rigid brace, the merits of improving QoL are promising. A further challenge is in weighing potentially improved QoL against reduced effectiveness.

Mental health/psychological stress is defined as the distress AIS patients have because of their deformity or brace. Moreover, the impact of the brace to the self and body image of adolescent is reported as a contributing factor for stress production [80, 81]. This review has found that distress associated with bracing is significantly worse than distress associated with spinal deformity, based on the reviewed literature measuring psychological stress using BSSQ. Andersen et al. [82] found that uncertainty regarding the duration of the brace treatment is one of the reasons causing psychological sequela and they suggested a flexible bracing strategy, such as part-time bracing schemes where patients were urged to participate in sports and social activities without their braces, to avoid social isolation. Lin et al. [83] compared the stress levels of juvenile and adolescent idiopathic scoliosis patients with brace treatment and found that female adolescents were more vulnerable to depressive psychological status. Higher levels of cognitive function and independence and negative parental attitudes resulted in a greater incidence of depression.

Vitality is evaluated by patients’ feelings of energetic and enthusiastic attitudes to daily activities [19], which directly correlates to physical performance. Our findings that show a brace’s impact on vitality corroborate with Daryabor et al. [84], who reported a review on gait and energy consumption of AIS patients treated with orthoses. They found that after 6 months of treatment, excessive oxygen consumption was observed, and results of an endurance test also show a diminished exercise capacity caused by the brace. Moreover, a significant decrease in walking speed and more excessive energy cost were found from the subjects with AIS treated with orthoses versus those without orthoses. They suggested that it could be helpful to intensively train patients with endurance exercises to improve physical performance in AIS.