Professional opinion concerning the effectiveness of bracing relative to observation in adolescent idiopathic scoliosis.
OBJECTIVE
To determine if community equipoise exists concerning the effectiveness of bracing in adolescent idiopathic scoliosis.


BACKGROUND
Bracing is the standard of care for adolescent idiopathic scoliosis despite the lack of strong reasearch evidence concerning its effectiveness. Thus, some researchers support the idea of a randomized trial, whereas others think that randomization in the face of a standard of care would be unethical.


METHODS
A random of Scoliosis Research Society and Pediatric Orthopaedic Society of North America members were asked to consider 12 clinical profiles and to give their opinion concerning the radiographic outcomes after observation and bracing.


RESULTS
An expert panel was created from the respondents. They expressed a wide array of opinions concerning the percentage of patients within each scenario who would benefit from bracing. Agreement was noted concerning the risk due to bracing for post-menarchal patients only.


CONCLUSIONS
: This study found a high degree of variability in opinion among clinicians concerning the effectiveness of bracing, suggesting that a randomized trial of bracing would be ethical.
Dolan
Lori A
LA
Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, Iowa City, IA 52242, USA. lori-dolan@uiowa.edu
Donnelly
Melanie J
MJ
Spratt
Kevin F
KF
Weinstein
Stuart L
SL
D000293:Adolescent; D001291:Attitude of Health Personnel; D001915:Braces; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009656:North America; D019370:Observation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000628:therapy*