Research quality in scoliosis conservative treatment: state of the art.
The publication of research in the field of conservative treatment of scoliosis is increasing after a long period of progressive decline. In 2014, three high quality and scientifically sound papers gave new strength to the conservative scoliosis approach. The efficacy of treatment over observation was demonstrated by two RCTs for bracing, and one for scoliosis-specific exercises provided by a physical therapist. It is difficult to design strong studies in this field due to the long time needed for follow up and the challenge of recruiting patients and families willing to be involved in the decision process. Nevertheless, the main methodological errors are not related to the study design but rather on the way it is performed, which very frequently affects the reliability of results. The most common errors are: selection bias, with many studies including functional rather than a true structural scoliosis; inappropriate outcome measures, utilizing parameters not related to scoliosis progression or quality of life; inappropriate follow up, reporting only immediate results and not addressing end of growth results; an incorrect interpretation of findings, with an overestimation of results; and missing the evaluation of skeletal maturity, without which results cannot be considered stable. Being aware of these errors is extremely important both for authors and for readers in order to avoid questionable practices based on inconclusive studies that could harm patients.
ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1 20141, Milan, Italy ; Italian Scoliosi Study Group (GSS), Vigevano, Italy.
Fabio
F
Zaina
ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1 20141, Milan, Italy ; Italian Scoliosi Study Group (GSS), Vigevano, Italy.
Michele
M
Romano
Rosalind Franklin Hospital, Chicago, IL USA.
Patrick
P
Knott
Clinique du Park, Lyon, France.
Jean Claude
JC
de Mauroy
"Tsaneio" General Hospital of Piraeus, Piraeus, Greece.
Theodoros B
TB
Grivas
Department of Pediatric Orthopaedics, University of Medical Sciences, Poznan, Poland.
Tomasz
T
Kotwicki
Department of Orthopaedic Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, Saitama Japan.
Toru
T
Maruyama
National Scoliosis Foundation, Boston, USA.
Joseph
J
O'Brien
Quera Salvà Institut, Barcelona, Spain.
Manuel
M
Rigo
Deparment of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy ; IRCCS Fondazione Don Gnocchi, Milan, Italy.
Stefano
S
Negrini