Scottish Rite for Children, Dallas, TX.
J Pediatr Orthop. 2023 Jul 1;43(6):368-372. doi: 10.1097/BPO.0000000000002391. Epub 2023 Mar 16.
The effectiveness of physiotherapeutic scoliosis-specific exercises (PSSE) in addition to nighttime bracing compared with nighttime bracing alone is unknown. The purpose of this prospective comparative study was to evaluate the effectiveness of PSSE in skeletally immature patients with adolescent idiopathic scoliosis treated with nighttime bracing (PSSE group) compared with the standard of care of nighttime bracing alone (control group).
Patients with adolescent idiopathic scoliosis thoracolumbar or lumbar primary curves <35 degrees at Risser stage 0 who wore a Providence brace were prospectively enrolled into the PSSE or control group. A temperature sensor recorded the number of hours of brace wear. The PSSE group was instructed in the Schroth-based physical therapy method and a home exercise program for at least 15 minutes per day, 5 days per week, for 1 year.
Seventy-four patients (37 PSSE, 37 controls) were followed until the final visit of skeletal maturity or surgery. The PSSE and control groups had similar baseline Cobb angles (24 vs. 25 degrees) and average hours of brace wear (8.0 vs. 7.3 h). The PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P <0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P <0.01). The PSSE group also had less conversion to full-time bracing after 1 year (5% vs. 24%, P =0.046), but differences were no longer significant at the final visit (14% vs. 27%).
In this prospective series of patients in nighttime Providence braces, the addition of Schroth-based physical therapy reduced curve progression after 1 year and at skeletal maturity. These findings can educate motivated families interested in PSSE.
Level II.
脊柱侧弯矫形物理治疗（PSSE）在夜间支具治疗基础上的有效性，与单纯夜间支具治疗相比，目前尚不清楚。本前瞻性对照研究的目的是评估 PSSE 对接受夜间支具治疗的青少年特发性脊柱侧凸未成熟患者（PSSE 组）的有效性，并与单纯夜间支具治疗的标准护理（对照组）进行比较。
前瞻性招募 Risser 分期 0 期，胸腰段或腰椎原发脊柱侧凸<35°，佩戴 Providence 支具的青少年特发性脊柱侧凸患者，入组 PSSE 或对照组。温度传感器记录支具佩戴时间。PSSE 组接受基于 Schroth 的物理治疗方法和家庭锻炼计划指导，每天至少 15 分钟，每周 5 天，持续 1 年。
74 例患者（PSSE 组 37 例，对照组 37 例）随访至骨骼成熟或手术的最终随访。PSSE 组和对照组的基线 Cobb 角相似（24°比 25°），平均支具佩戴时间也相似（8.0 小时比 7.3 小时）。与对照组的曲线进展相比，PSSE 组在最终随访时的曲线幅度没有变化（1°比 7°，P<0.01）。此外，PSSE 组在最终随访时曲线进展>5°的比例较低（14%比 43%，P<0.01）。PSSE 组在 1 年后转为全天支具的比例也较低（5%比 24%，P=0.046），但在最终随访时差异不再显著（14%比 27%）。
在本前瞻性研究中，夜间 Providence 支具治疗的患者中，加入基于 Schroth 的物理治疗可以减少 1 年后和骨骼成熟时的曲线进展。这些发现可以为对 PSSE 感兴趣的有动力的家庭提供教育。
II 级。
