Rivett LouAnn, Stewart Aimee, Potterton Joanne
Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Scoliosis. 2014 May 30;9:5. doi: 10.1186/1748-7161-9-5. eCollection 2014.
There is controversy as to whether conservative management that includes wearing a brace and exercises is effective in stabilising idiopathic scoliosis curves. A brace only prevents progression of the curve and has been shown to have favourable outcomes when patients are compliant. So the aim of this study was to: determine the effect of compliance to the Rigo System Cheneau (RSC) brace and a specific exercise programme on Idiopathic Scoliosis curvature; and to compare the Quality of Life (QoL) and psychological traits of compliant and non compliant subjects.
A pre/post test study design was used with a post study comparison between subjects who complied with the management and those who did not. Fifty one subjects, girls aged 12-16 years, Cobb angles 20-50 degrees participated in the study. Subjects were divided into two groups, according to their compliance, at the end of the study. The compliant group wore the brace 20 or more hours a day and exercised three or more times per week. The non-compliant group wore the brace less than 20 hours a day and exercised less than three times per week. Cobb angles, vertebral rotation, scoliometer readings, peak flow, quality of life and personality traits were compared between groups, using the student's two sample t-test and an analysis of covariance.
The compliant group, wore the brace 21.5 hours per day and exercised four times a week, and significantly improved in all measures compared to non compliant subjects, who wore the brace 12 hours per day, exercised 1.7 times a week and significantly deteriorated (p < 0.0001). The major Cobb angles in the compliant group improved 10.19°(±5.5) and deteriorated 5.52°(±4.3) in the non compliant group (p < 0.0001). Compliant subjects had a significantly better QoL than the non compliant subjects (p = 0.001). The compliant group were significantly more emotionally mature, stable and realistic than the non compliant group (p = 0.03).
Good compliance of the RSC brace and a specific exercise regime resulted in a significant improvement in curvatures, poor compliance resulted in progression/deterioration. A poorer QoL in the non compliant group possibly was caused by personality traits of the group, being more emotionally immature and unstable.
对于包括佩戴支具和进行锻炼在内的保守治疗方法能否有效稳定特发性脊柱侧凸曲线，目前存在争议。支具只能防止曲线进展，并且当患者依从时已显示出良好的效果。因此，本研究的目的是：确定对里戈系统雪纳（RSC）支具和特定锻炼计划的依从性对特发性脊柱侧凸曲率的影响；并比较依从和不依从受试者的生活质量（QoL）和心理特征。
采用前后测试研究设计，并在依从治疗和不依从治疗的受试者之间进行研究后比较。51名年龄在12 - 16岁、Cobb角为20 - 50度的女孩参与了该研究。在研究结束时，根据受试者的依从性将其分为两组。依从组每天佩戴支具20小时或更长时间，每周锻炼三次或更多次。不依从组每天佩戴支具少于20小时，每周锻炼少于三次。使用学生双样本t检验和协方差分析比较两组之间的Cobb角、椎体旋转、脊柱侧凸计读数、峰值流量、生活质量和人格特征。
依从组每天佩戴支具21.5小时，每周锻炼四次，与不依从组相比，所有测量指标均有显著改善。不依从组每天佩戴支具12小时，每周锻炼1.7次，且显著恶化（p < 0.0001）。依从组的主要Cobb角改善了10.19°（±5.5），不依从组恶化了5.52°（±4.3）（p < 0.0001）。依从受试者的生活质量明显优于不依从受试者（p = 0.001）。依从组在情感上比不依从组明显更成熟、更稳定和更现实（p = 0.03）。
对RSC支具和特定锻炼方案的良好依从性导致曲率显著改善，依从性差则导致进展/恶化。不依从组较差的生活质量可能是由该组的人格特征导致的，即情感上更不成熟和不稳定。
