Guidelines for management of scoliosis in Rett syndrome patients based on expert consensus and clinical evidence.
METHODS
Modified Delphi technique.


OBJECTIVE
To develop guidelines for the clinical management of scoliosis in Rett syndrome through evidence review and consensus expert panel opinion.


BACKGROUND
Rett syndrome is a rare disorder and clinical expertise is thus with small case series. Scoliosis is a frequent association and the evidence base dealing with scoliosis management in this syndrome is limited. Parents of affected girls and women have expressed needs for more information about scoliosis and Rett syndrome.


METHODS
An initial draft of scoliosis guidelines was created based on literature review and open-ended questions where the literature was lacking. Perspectives of four parents of Rett syndrome patients informed this initial draft. Access to an online and a Microsoft Word formatted version of the draft were then sent to an international, multidisciplinary panel of clinicians via e-mail with input sought using a 2-stage modified Delphi process to reach consensus agreement. Items included clinical monitoring and intervention before the diagnosis of scoliosis; monitoring after the diagnosis of scoliosis; imaging; therapy and conservative management; bracing; and preoperative, surgical, and postoperative considerations.


RESULTS
The first draft contained 71 statements, 65 questions. The second draft comprised 88 items with agreement to strong agreement achieved on 85, to form the final guideline document. A comprehensive, life-span approach to the management of scoliosis in Rett syndrome is recommended that takes into account factors such as physical activity, posture, nutritional and bone health needs. Surgery should be considered when the Cobb angle is approximately 40 degrees to 50 degrees and must be supported by specialist management of anesthesia, pain control, seizures, and early mobilization.


CONCLUSIONS
Evidence- and consensus-based guidelines were successfully created and have the potential to improve care of a complex comorbidity in a rare condition and stimulate research to improve the current limited evidence base.
Downs
Jenny
J
Centre for Child Health Research, Telethon Institute for Child Health Research, Perth, Australia.
Bergman
Anke
A
Carter
Philippa
P
Anderson
Alison
A
Palmer
Greta M
GM
Roye
David
D
van Bosse
Harold
H
Bebbington
Ami
A
Larsson
Eva Lena
EL
Smith
Brian G
BG
Baikie
Gordon
G
Fyfe
Sue
S
Leonard
Helen
H
D002648:Child; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007391:International Cooperation; D015518:Rett Syndrome / Q000150:complications*; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*