title: An alternative to a randomised control design for assessing the efficacy and effectiveness of bracing in adolescent idiopathic scoliosis.
abstract: Randomised controlled trials (RCTs) that assessed the efficacy of bracing for adolescent idiopathic scoliosis have suffered from small sample sizes, low compliance and lack of willingness to participate. The aim of this study was to assess the feasibility of a comprehensive cohort study for evaluating both the efficacy and the effectiveness of bracing in patients with adolescent idiopathic scoliosis. Patients with curves at greater risk of progression were invited to join a randomised controlled trial. Those who declined were given the option to remain in the study and to choose whether they wished to be braced or observed. Of 87 eligible patients (5 boys and 63 girls) identified over one year, 68 (78%) with mean age of 12.5 years (10 to 15) consented to participate, with a mean follow-up of 168 weeks (0 to 290). Of these, 19 (28%) accepted randomisation. Of those who declined randomisation, 18 (37%) chose a brace. Patients who were more satisfied with their image were more likely to choose bracing (Odds Ratio 4.1; 95% confidence interval 1.1 to 15.0; p = 0.035). This comprehensive cohort study design facilitates the assessment of both efficacy and effectiveness of bracing in patients with adolescent idiopathic scoliosis, which is not feasible in a conventional randomised controlled trial.
authors.affiliation: The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
authors.forename: D Y T
authors.initials: DY
authors.lastname: Fong
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: K M C
authors.initials: KM
authors.lastname: Cheung
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: Y W
authors.initials: YW
authors.lastname: Wong
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: W Y
authors.initials: WY
authors.lastname: Cheung
authors.affiliation: The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
authors.forename: I C Y
authors.initials: IC
authors.lastname: Fu
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: E E
authors.initials: EE
authors.lastname: Kuong
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: K C
authors.initials: KC
authors.lastname: Mak
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: M
authors.initials: M
authors.lastname: To
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: D
authors.initials: D
authors.lastname: Samartzis
authors.affiliation: The University of Hong Kong, 5/F, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: K D K
authors.initials: KD
authors.lastname: Luk
mesh_terms: D000293:Adolescent; D001915:Braces; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012600:Scoliosis / Q000628:therapy*; D016896:Treatment Outcome
keywords: Adolescent idiopathic scoliosis; bracing; randomised controlled trial