title: Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study.
abstract: BACKGROUND
  The feasibility of conducting a definitive randomised controlled trial (RCT) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises (SSEs) for adolescent idiopathic scoliosis (AIS) is uncertain.
  
  
  OBJECTIVE
  The aim of this study was to assess the feasibility of conducting a large, multicentre trial of SSE treatment for patients with AIS, in comparison with standard care, and to refine elements of the study design. The objectives were to (1) update a systematic review of controlled trials evaluating the efficacy of SSE in AIS; (2) survey UK orthopaedic surgeons and physiotherapists to determine current practice, patient populations and equipoise; (3) randomise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites; (4) develop, document and assess acceptability and adherence of interventions; (5) assess and describe training requirements of physiotherapists; and (6) gain user input in all relevant stages of treatment and protocol design.
  
  
  METHODS
  Multicomponent feasibility study including UK clinician survey, systematic literature review and a randomised feasibility trial.
  
  
  METHODS
  The randomised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS.
  
  
  METHODS
  The randomised feasibility study recruited people aged 10-16 years with mild AIS (Cobb angle of < 50°).
  
  
  METHODS
  The randomised study allocated participants to standard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan. Our choice of intervention was informed by a systematic review of exercise interventions for AIS.
  
  
  METHODS
  The main outcome was feasibility of recruitment to the randomised study. Other elements were to inform choice of outcomes for a definitive trial and included curve severity, quality of life, requirement for surgery/brace, adverse events, psychological symptoms, costs and health utilities.
  
  
  RESULTS
  A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services. It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study. A systematic review update found five new studies that were generally of low quality but showed some promise of effectiveness of SSE. The randomised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month, with acceptable 6-month follow-up (currently 73%). Adherence to treatment was variable (56% of participants completed treatment offered). The qualitative study found the exercise programme to be highly acceptable. We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation, as well as practical elements such as scheduling of intervention sessions.
  
  
  CONCLUSIONS
  A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible. Such a RCT is a priority for future work in the area. There is a sufficiently large patient base, combined with willingness to be randomised within specialist UK centres. Interventions developed during the feasibility study were acceptable to patients, families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN90480705.
  
  
  BACKGROUND
  This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 55. See the NIHR Journals Library website for further project information.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Williams
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Heine
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Williamson
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Francine
authors.initials: F
authors.lastname: Toye
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Melina
authors.initials: M
authors.lastname: Dritsaki
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Stavros
authors.initials: S
authors.lastname: Petrou
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Crossman
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Lall
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.|Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Barker
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.|Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Fairbank
authors.affiliation: North Bristol NHS Trust, Bristol, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Harding
authors.affiliation: Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gardner
authors.affiliation: Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Slowther
authors.affiliation: School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Coulson
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.|Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
mesh_terms: D000293:Adolescent; D002648:Child; D003365:Costs and Cost Analysis; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D010560:Personnel Selection; D011788:Quality of Life; D012107:Research Design; D012600:Scoliosis / Q000534:rehabilitation*; D006113:United Kingdom