title: 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.
  
  
  OBJECTIVE
  To verify the impact of a complete rehabilitation team in the adolescent patient with bracing.
  
  
  METHODS
  Design. Initial cross-sectional study, followed by a retrospective case-control study.
  
  
  METHODS
  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.
  
  
  METHODS
  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 < 0.05). The populations did not differ at the baseline studied outcomes. The absence of a good team surrounding the patient increases by five times the risk of reduced compliance to bracing (odds ratio OR 5.5 - 95% confidence interval 95CI 3.6-7.4), along with more than 15 times that of QoL problems (OR 15.7 - 95CI 13.6-17.9) and pain (OR 16.8 - 95CI 14.5-19.1).
  
  
  CONCLUSIONS
  Provided the limits of this first study on the topic, the SBTMG seems to be important for brace treatment, influencing pain, QoL and compliance (and so, presumably, final results). Future studies on the topic are advisable.
authors.affiliation: University of Brescia, Brescia, Italy. stefano.negrini@isico.it.
authors.forename: Marta
authors.initials: M
authors.lastname: Tavernaro
authors.forename: Anna
authors.initials: A
authors.lastname: Pellegrini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tessadri
authors.forename: Fabio
authors.initials: F
authors.lastname: Zaina
authors.forename: Andrea
authors.initials: A
authors.lastname: Zonta
authors.forename: Stefano
authors.initials: S
authors.lastname: Negrini