Clinical and Experimental Sciences Department, University of Brescia, 25121 Brescia, Italy; IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy.
Ann Phys Rehabil Med. 2019 Mar;62(2):69-76. doi: 10.1016/j.rehab.2018.07.010. Epub 2018 Aug 24.
In an ideal experimental setting, 2 randomized controlled trials recently showed the efficacy of physiotherapeutic scoliosis-specific exercises (PSSEs) for adolescents with idiopathic scoliosis (AIS). Now large observational studies are needed to check the generalizability of these results to everyday clinical life.
To explore the effectiveness of PSSEs for avoiding bracing or progression of AIS in everyday clinics.
This was a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients. Inclusion criteria were AIS, age≥10 years old at first evaluation, Risser sign 0-2, and 11-20°Cobbangle. Exclusion criteria were consultations only and brace prescription at baseline. Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle>29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design.
We included 293 eligible subjects after propensity score matching (SEAS, n=145; UP, n=95; controls, n=53). The risk of success was increased 1.7-fold (P=0.007) and 1.5-fold (P=0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2-3.7) and 1.8 (95% CI 1.5-2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis.
SEAS reduced the bracing rate in AIS and was more effective than UP. PSSEs are additional tools that can be included in the therapeutic toolbox for AIS treatment.
在理想的实验环境下，最近有两项随机对照试验表明，针对特发性脊柱侧凸（AIS）青少年的物理治疗性脊柱侧凸特定运动（PSSE）具有疗效。现在需要进行大规模的观察性研究，以检查这些结果在日常临床实践中的推广程度。
探讨 PSSE 在日常临床环境下预防支具使用或 AIS 进展的效果。
这是一项纵向比较观察性多中心研究，嵌套在一个门诊三级转诊诊所的前瞻性数据库中，纳入了 327 例连续患者。纳入标准为 AIS、首次评估时年龄≥10 岁、Risser 征 0-2 级和 11-20° Cobb 角。排除标准为仅咨询和基线时支具处方。各组根据 SEAS（科学运动治疗脊柱侧凸）学校、常规物理治疗（UP）和无治疗（对照组[CON]）进行 PSSE。治疗结束标准为医疗出院、Risser 征 3 级或失败（定义为生长结束前需要支具或 Cobb 角>29°）。失败的概率通过风险比（RR）和 95%置信区间（CI）来估计。需要治疗的人数通过估计。统计分析包括意向治疗分析，考虑所有参与者（脱落者视为失败）和疗效分析，仅考虑治疗结束时的参与者。采用倾向评分法来减少与观察性设计相关的混杂因素的潜在影响。
经过倾向评分匹配后，我们纳入了 293 例符合条件的受试者（SEAS 组，n=145；UP 组，n=95；对照组，n=53）。在疗效和意向治疗分析中，与对照组相比，SEAS 组的成功风险分别增加了 1.7 倍（P=0.007）和 1.5 倍（P=0.006），SEAS 与对照组相比，需要治疗的人数分别为 3.5（95%CI 3.2-3.7）和 1.8（95%CI 1.5-2.0）。在疗效分析中，SEAS 组的成功率高于 UP 组。
SEAS 降低了 AIS 的支具使用率，并且比 UP 更有效。PSSE 是治疗 AIS 的治疗工具包中的附加工具。
