Dolan Lori A, Donnelly Melanie J, Spratt Kevin F, Weinstein Stuart L
Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, Iowa City, IA 52242, USA.
J Pediatr Orthop. 2007 Apr-May;27(3):270-6. doi: 10.1097/01.bpb.0000248579.11864.47.
To determine if community equipoise exists concerning the effectiveness of bracing in adolescent idiopathic scoliosis.
Bracing is the standard of care for adolescent idiopathic scoliosis despite the lack of strong reasearch evidence concerning its effectiveness. Thus, some researchers support the idea of a randomized trial, whereas others think that randomization in the face of a standard of care would be unethical.
A random of Scoliosis Research Society and Pediatric Orthopaedic Society of North America members were asked to consider 12 clinical profiles and to give their opinion concerning the radiographic outcomes after observation and bracing.
An expert panel was created from the respondents. They expressed a wide array of opinions concerning the percentage of patients within each scenario who would benefit from bracing. Agreement was noted concerning the risk due to bracing for post-menarchal patients only.
: This study found a high degree of variability in opinion among clinicians concerning the effectiveness of bracing, suggesting that a randomized trial of bracing would be ethical.
确定在青少年特发性脊柱侧凸中,对于支具治疗的有效性是否存在群体均衡。
尽管缺乏关于支具治疗有效性的确凿研究证据,但支具治疗仍是青少年特发性脊柱侧凸的标准治疗方法。因此,一些研究人员支持进行随机试验的想法,而另一些人则认为在有标准治疗方法的情况下进行随机分组是不道德的。
随机抽取脊柱侧弯研究学会和北美小儿骨科学会的成员,让他们考虑12种临床情况,并就观察和支具治疗后的影像学结果发表意见。
从受访者中组建了一个专家小组。他们对每种情况下能从支具治疗中获益的患者比例表达了广泛的意见。仅在初潮后患者因支具治疗所致风险方面存在共识。
本研究发现临床医生对于支具治疗有效性的意见存在高度差异,这表明对支具治疗进行随机试验是符合伦理的。