Biomechanics Laboratory, Division of Orthopedics, Oslo University Hospital, Oslo, Norway -
Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
Eur J Phys Rehabil Med. 2021 Feb;57(1):101-109. doi: 10.23736/S1973-9087.20.06190-0. Epub 2020 Oct 5.
Identifying factors that predict successful bracing in patients with idiopathic scoliosis may help planning treatment.
To assess predictors for long-term curve progression and health-related quality of life after Boston brace treatment.
Observational retrospective cohort study with analysis of brace treated patients followed from start until at least 10 years after treatment.
Patients recruited from the country's entire population consecutively treated at the National Hospital.
365 patients (339 girls/26 boys) with idiopathic scoliosis. Mean (SD) chronological age/bone age at start bracing was 13.2 (1.9)/12.6 (1.9) years. The primary major curve measured 33.2 (7.4°), and the major levels were thoracic (N.=248), thoracolumbar (N.=78) and lumbar (N.=39). Mean bracing time was 2.8 (1.5) years. Long-term follow-up was in average 23.3 (4.1) years after weaning with a mean major curve of 33.0 (13.1°). Successful treatment was defined as a stable primary curve with progression ≤5°, and secondary the SRS-22 questionnaire assessed quality of life.
We applied linear or logistic regression with backward elimination. Internal validation was assessed by bootstrapping. Twelve variables were included in the prediction models: age, bone age, scoliosis in close family, major curve size, level, shape, flexibility and in-brace redressement, compliance, curve magnitude after 1 year, treatment time and quality of life (SRS-22).
290 patients (79%) had rated good compliance using the brace >20 hours daily. Treatment failure was observed in 65 patients (18%), and 27 of them were operated. The best baseline predictors were age and brace redressement. During treatment compliance, major curve after 1 year, and treatment time were the best predictors, while thoracic major curve, curve size at start bracing and scoliosis in close family also contributed to the final model. The model's ability to predict quality of life was low.
The best predictors for a long-term success were good redressement and compliance, unchanged or reduced major curve after one year and short treatment time.
Predictors at baseline and during early treatment can help identifying patients who benefit from bracing.
识别预测特发性脊柱侧凸患者支具治疗成功的因素有助于治疗计划的制定。
评估波士顿支具治疗后脊柱侧凸患者的长期曲线进展和健康相关生活质量的预测因素。
对从开始治疗到治疗后至少 10 年连续在国家医院接受治疗的支具治疗患者进行观察性回顾性队列研究，进行分析。
从全国人群中招募的患者在国家医院接受治疗。
365 名特发性脊柱侧凸患者（339 名女孩/26 名男孩）。起始时的平均（标准差）年龄/骨龄为 13.2（1.9）/12.6（1.9）岁。主要曲线测量值为 33.2（7.4°），主要水平为胸段（N=248）、胸腰段（N=78）和腰段（N=39）。平均支具佩戴时间为 2.8（1.5）年。平均在撤去支具后 23.3（4.1）年进行长期随访，平均主曲线为 33.0（13.1°）。成功治疗定义为主要曲线稳定，进展≤5°，次要指标为 SRS-22 问卷评估生活质量。
我们应用线性或逻辑回归，采用后向消除法。内部验证通过自举法进行评估。12 个变量被纳入预测模型：年龄、骨龄、家族中有脊柱侧凸、主曲线大小、水平、形状、柔韧性和支具内矫正、依从性、1 年后的曲线幅度、治疗时间和生活质量（SRS-22）。
290 名患者（79%）每天使用支具>20 小时，评为良好依从性。65 名患者（18%）治疗失败，其中 27 名患者接受了手术。最佳基线预测因素为年龄和支具矫正。在治疗期间，依从性、1 年后的主曲线和治疗时间是最佳预测因素，而胸段主曲线、起始时的曲线大小和家族中有脊柱侧凸也对最终模型有贡献。该模型预测生活质量的能力较低。
长期成功的最佳预测因素是良好的矫正和依从性、一年后主曲线无变化或减少以及治疗时间短。
基线和早期治疗时的预测因素有助于识别受益于支具治疗的患者。
