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Team care to cure adolescents with braces (avoiding low quality of life, pain and bad compliance): a case-control retrospective study. 2011 SOSORT Award winner.

ABSTRACT: BACKGROUND: Bracing could be efficacious, given good compliance and quality of braces. Recently the SOSORT Brace TREATMENT Management Guidelines (SBTMG) have highlighted the perceived importance of the professional teams surrounding braced patients. PURPOSE: To verify the impact of a complete rehabilitation team in the adolescent patient with bracing. MATERIALS AND METHODS: Design. Initial cross-sectional study, followed by a retrospective case-control study. POPULATION: Thirty-eight patients (15.8?±?1.6?years; 26 females; 10 hyperkyphosis, 28 scoliosis of 29.2?±?7.9° Cobb) extracted from a single orthotist database (between January 1, 2008 and September 1, 2009) and treated by the same physician; brace wearing at least 15?hours/day for a minimum of 6?months; age 10 or more. TREATMENT: Braces: Sforzesco, Sibilla, Lapadula or Maguelone. Exercises: SEAS. METHODS: Two questionnaires filled in blindly by patients: SRS-22 and one especially developed and validated with 25 questions on adherence to treatment. Groups (main risk factor): TEAM (private institute: satisfied 44/44 SOSORT criteria; grade of teamwork, "excellent") included 13 patients and NOT 25 (National Health Service Rehabilitation Department: 35/44 SOSORT criteria respected; grade, "insufficient"). RESULTS: TEAM was more compliant to bracing than NOT (97?±?6% vs. 80?±?24%) and performed nearly double the exercises (38?±?12 vs. 20?±?13?minutes/session). The self-reduction of bracing was significant in NOT (from 16.8?±?3.7 to 14.8?±?4.9?hours/day, , P<0.05); TEAM showed a significant reduction in the difficulties due to bracing (from 8.9?±?1.4 to 3.5?±?2.0 in 12?months on a 10-point scale, P<0.05). Pain was perceived by 55% of NOT versus 7% of TEAM (P?

SUBMITTER: Tavernaro M

PROVIDER: S-EPMC3487862 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Team care to cure adolescents with braces (avoiding low quality of life, pain and bad compliance): a case-control retrospective study. 2011 SOSORT Award winner.

Tavernaro Marta M Pellegrini Anna A Tessadri Fabrizio F Zaina Fabio F Zonta Andrea A Negrini Stefano S

Scoliosis 20120920 1

<h4>Background</h4>Bracing could be efficacious, given good compliance and quality of braces. Recently the SOSORT Brace TREATMENT Management Guidelines (SBTMG) have highlighted the perceived importance of the professional teams surrounding braced patients.<h4>Purpose</h4>To verify the impact of a complete rehabilitation team in the adolescent patient with bracing.<h4>Materials and methods</h4>Design. Initial cross-sectional study, followed by a retrospective case-control study.<h4>Population</h4 ...[more]

PMID: 22995590

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Project description:Over the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. Yet, little information is available on the impact of compliance on the outcome of conservative treatment in scoliotic subjects. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS).Among 1.424 patients treated for idiopathic scoliosis, 645 were eligible for inclusion criteria. Three outcomes were distinguished in agreement with the SRS criteria: curve correction, curve stabilization and curve progression. Brace wearing was assessed by one orthopaedic surgeon (LA) and scored on a standardized form. Compliance to treatment was categorized as complete (brace worn as prescribed), incomplete A (brace removed for 1 month), incomplete B (brace removed for 2 months), incomplete C (brace removed during school hours), and incomplete D (brace worn overnight only). Chi square test, T test or ANOVA and ANOVA for repeated measures tests were used as statistical tests.The results from our study showed that at follow-up the compliance was: Complete 61.1%; Incomplete A 5.2%; Incomplete B 10.7%; Incomplete C 14.2%; Incomplete D 8.8%. Curve correction was accomplished in 301/319 of Complete, 19/27 Incomplete A, 25/56 Incomplete B, 52/74 Incomplete C, 27/46 Incomplete D. Cobb mean value was 29.8?±?7.5 SD at beginning and 17.1?±?10.9 SD at follow-up. Both Cobb and Perdriolle degree amelioration was significantly higher in patients with complete compliance over all other groups, both in juvenile, both in adolescent scoliosis. In the intention-to-treat analysis, the rate of surgical treatment was 2.1% among patients with definite outcome and 12.1% among those with drop-out. Treatment compliance showed significant interactions with time.Curve progression and referral to surgery are lower in patients with high brace compliance. Bracing discontinuation up to 1 month does not impact on the treatment outcome. Conversely, wearing the brace only overnight is associated with a high rate of curve progression.

Project description:Background/Objective People with spinal cord injury (SCI) access educational resources during their inpatient rehabilitation, but they can be overwhelmed by the amount of information they need to assimilate during ever-shorter stays. This project created e-learning courses to fill the knowledge needs of SCI consumers and evaluated user satisfaction and knowledge transfer. Methods/Overview A needs assessment of 83 consumers and 99 staff identified information needs for people with SCI (Toronto Rehabilitation Institute – UHN and CPAO, 2008). Key topics were selected for the creation of 10 online patient education courses, collectively called Spinal Cord Injury – University (SCI-U), and housed on the Spinal Cord Connections website (www.spinalcordconnections.ca/sci-u). Course content was developed collaboratively by over 100 consumers and professionals, from healthcare and community service organizations across Canada. Each course uses adult learning principles and presents key information on healthy living with SCI, in an accessible and engaging way. A team of professionals created multimedia courses using Articulate software, incorporating video, animation and interactivity. The courses show the positive faces of SCI, each one featuring 3 video presenters (all people with SCI), and video testimonials where consumers talk about their experience living with SCI and managing their health. Users are encouraged to complete course quizzes to reinforce their learning. A pilot study enrolled consumers and clinicians (n = 25) and evaluated knowledge acquisition and retention, as well as perceived utility and satisfaction with the first 3 courses in the series: SCI and You, Bladder and Bowel. Results Knowledge acquisition and retention: across-group mean pre-course, post-course and 1-month post-course scores were “SCI & You” (score/14) 8.19, 10.67, 10.75; “Bladder” (score/13) 5.73, 8.69, 7.09; and “Bowel” (score/12) 6.68, 9.23, 9.00. Perceived utility and satisfaction: across-group mean global satisfaction scores (/5) were “SCI & You” 4.25, “Bladder” 3.89, and “Bowel” 3.94. Across-group mean global effectiveness scores (/5) were “SCI & You”? 4.16, “Bladder” 4.36, and “Bowel” 4.28. Visits to the SCI-U home page were 773 (2010), 2084 (2011) and 803 (as of March 2012). Conclusions SCI-U is an effective tool for patient education, and integrating e-learning into SCI rehabilitation programs has the potential to improve the effectiveness of knowledge transfer. Acknowledgements Rick Hansen Institute Grant Number: 2010-77.

Project description:Insect pollination is important for food production globally and apples are one of the major fruit crops which are reliant on this ecosystem service. It is fundamentally important that the full range of benefits of insect pollination to crop production are understood, if the costs of interventions aiming to enhance pollination are to be compared against the costs of the interventions themselves. Most previous studies have simply assessed the benefits of pollination to crop yield and ignored quality benefits and how these translate through to economic values. In the present study we examine the influence of insect pollination services on farmgate output of two important UK apple varieties; Gala and Cox. Using field experiments, we quantify the influence of insect pollination on yield and importantly quality and whether either may be limited by sub-optimal insect pollination. Using an expanded bioeconomic model we value insect pollination to UK apple production and establish the potential for improvement through pollination service management. We show that insects are essential in the production of both varieties of apple in the UK and contribute a total of £36.7 million per annum, over £6 million more than the value calculated using more conventional dependence ratio methods. Insect pollination not only affects the quantity of production but can also have marked impacts on the quality of apples, influencing size, shape and effecting their classification for market. These effects are variety specific however. Due to the influence of pollination on both yield and quality in Gala, there is potential for insect pollination services to improve UK output by up to £5.7 million per annum. Our research shows that continued pollinator decline could have serious financial implications for the apple industry but there is considerable scope through management of wild pollinators or using managed pollinator augmentation, to improve the quality of production. Furthermore, we show that it is critically important to consider all production parameters including quality, varietal differences and management costs when valuing the pollination service of any crop so investment in pollinator management can be proportional to its contribution.

Project description:Study designRetrospective hospital-registry study.ObjectiveTo characterize the microbial epidemiology of surgical site infection (SSI) in spinal fusion surgery and the burden of resistance to standard surgical antibiotic prophylaxis.Summary of background dataSSI persists as a leading complication of spinal fusion surgery despite the growth of enhanced recovery programs and improvements in other measures of surgical quality. Improved understandings of SSI microbiology and common mechanisms of failure for current prevention strategies are required to inform the development of novel approaches to prevention relevant to modern surgical practice.MethodsSpinal fusion cases performed at a single referral center between January 2011 and June 2019 were reviewed and SSI cases meeting National Healthcare Safety Network criteria were identified. Using microbiologic and procedural data from each case, we analyzed the anatomic distribution of pathogens, their differential time to presentation, and correlation with methicillin-resistant Staphylococcus aureus screening results. Susceptibility of isolates cultured from each infection were compared with the spectrum of surgical antibiotic prophylaxis administered during the index procedure on a per-case basis. Susceptibility to alternate prophylactic agents was also modeled.ResultsAmong 6727 cases, 351 infections occurred within 90 days. An anatomic gradient in the microbiology of SSI was observed across the length of the back, transitioning from cutaneous (gram-positive) flora in the cervical spine to enteric (gram-negative/anaerobic) flora in the lumbosacral region (correlation coefficient 0.94, P < 0.001). The majority (57.5%) of infections were resistant to the prophylaxis administered during the procedure. Cephalosporin-resistant gram-negative infection was common at lumbosacral levels and undetected methicillin-resistance was common at cervical levels.ConclusionIndividualized infection prevention strategies tailored to operative level are needed in spine surgery. Endogenous wound contamination with enteric flora may be a common mechanism of infection in lumbosacral fusion. Novel approaches to prophylaxis and prevention should be prioritized in this population.Level of Evidence: 3.

Project description:BackgroundIn North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS.Material and methodsFifty patients with AIS, aged 10-18 years, with curves 10-45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported.ResultsAfter 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p?=?0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p?=?0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p?=?0.03), where (SRS-22 pain score)(4) increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain?=?18.4 %, function?=?28.6 %), and SAQ (prominence?=?26.5 %, waist?=?29.2 %, chest?=?46.9 %, trunk shift?=?12.2 % and shoulders?=?18.4 %).ConclusionsSupervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires' domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed.Trial registrationSchroth Exercise Trial for Scoliosis NCT01610908.

Project description:ObjectiveIn 2017, the National Institute for Health Research (NIHR) academy produced a strategic review of training, which reported the variation in application characteristics associated with success rates. It was noted that variation in applicant characteristic was not independent of one another. Therefore, the aim of this secondary analysis was to investigate the inter-relationships in order to identify factors (or groups of factors) most associated with application numbers and success rates.DesignRetrospective data were gathered from 4388 applications to NIHR Academy between 2007 and 2016. Multinominal logistic regression models quantified the likelihood of success depending on changes in the explanatory factors; relative risk ratios with 95% CIs. A classification tree analysis was built using exhaustive χ2 automatic interaction detection to better understand the effect of interactions between explanatory variables on application success rates.Results936 (21.3%) applications were awarded. Applications from males and females were equally likely to be successful (p=0.71). There was an overall reduction in numbers of applications from females as award seniority increased from predoctoral to professorship. Applications from institutions with a medical school had a 2.6-fold increase in likelihood of success (p<0.001). Classification tree analysis revealed key predictors of application success: award level, type of programme, previous NIHR award experience and applying form a medical school.ConclusionSuccess rates did not differ according to gender, and doctors were not more likely to be successful than applications from other professions. Taken together, these findings suggest an essential fairness in how the quality of a submitted application is assessed, but they also raise questions about variation in the opportunity to submit a high-quality application. The companion qualitative study (Burkshaw et al. (2021) BMJ Open) provides valuable insight into potential candidate mechanisms and discusses how research capacity development initiatives might be targeted in the future.

Project description:Background:Recent randomized controlled trials (RCTs) support using physiotherapeutic scoliosis-specific exercises (PSSE) for adolescents with idiopathic scoliosis (AIS). All RCTs reported statistically significant results favouring PSSE but none reported on clinical significance. The number needed to treat (NNT) helps determine if RCT results are clinically meaningful. The NNT is the number of patients that need to be treated to prevent one bad outcome in a given period. A low NNT suggests that a therapy has positive outcomes in most patients offered the therapy. The objective was to determine how many patients require Schroth PSSE added to standard care (observation or brace treatment) to prevent one progression (NNT) of the Largest Curve (LC) or Sum of Curves (SOC) beyond 5° and 10°, respectively over a 6-month interval. Methods:This was a secondary analysis of a RCT. Fifty consecutive participants from a scoliosis clinic were randomized to the Schroth PSSE + standard of care group (n = 25) or the standard of care group (n = 25).We included males and females with AIS, age 10-18 years, all curve types, with curves 10°- 45°, with or without brace, and all maturity levels. We excluded patients awaiting surgery, having had surgery, having completed brace treatment and with other scoliosis diagnoses. The local ethics review board approved the study (Pro00011552).The Schroth intervention consisted of weekly 1-h supervised Schroth PSSE sessions and a daily home program delivered over six months in addition to the standard of care. A prescription algorithm was used to determine which exercises patients were to perform. Controls received only standard of care.Cobb angles were measured using a semi-automatic system from posterior-anterior standing radiographs at baseline and 6 months.We calculated absolute risk reduction (ARR) and relative risk reduction (RRR). The NTT was calculated as: NNT = 1/ARR. Patients with missing values (PSSE group; n = 2 and controls; n = 4) were assumed to have had curve progression (worst case scenario). The RRR is calculated as RRR = ARR/CER. Results:For LC, NNT = 3.6 (95% CI 2.0-28.2), and for SOC, NNT = 3.1 (95% CI 1.9-14.2). The corresponding ARR was 28% for LC and 32% for the SOC. The RRR was 70% for LC and 73% for the SOC. Patients with complete follow-up attended 85% of prescribed visits and completed 82.5% of the home program. Assuming zero compliance after dropout, 76% of visits were attended and 73% of the prescribed home exercises were completed. Conclusions:The short term of Schroth PSSE intervention added to standard care provided a large benefit as compared to standard care alone. Four (LC and SOC) patients require treatment for the additional benefit of a 6-month long Schroth intervention to be observed beyond the standard of care in at least one patient. Trial registration:NCT01610908 April 2, 2012.

Dataset Information

Team care to cure adolescents with braces (avoiding low quality of life, pain and bad compliance): a case-control retrospective study. 2011 SOSORT Award winner.

Publications

Team care to cure adolescents with braces (avoiding low quality of life, pain and bad compliance): a case-control retrospective study. 2011 SOSORT Award winner.

Similar Datasets

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