# Comparing Bracing Interventions for Adolescent Idiopathic Scoliosis

> Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care.

## Blended Intensive Program (BIP) on EBP
At week 43 in 2024, a Blended Intensive Program (BIP) regarding Evidence-Based Physical Therapy (EBP) was held at Charles University in the Czech Republic. The program opened with welcome words from the president of The European Network of Physiotherapy in Higher Education (ENPHE) and covered the foundations of EBP, highlighting challenges across different physical therapy fields.

More than 43 physiotherapy students and 9 teachers from five universities participated:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Prague
* Universidad Europea de Madrid, Spain
* CEERRF, France

Students collaborated on articles covering themes such as sports, prevention, injuries, neurological diseases, respiratory diseases, cardiovascular diseases, and care for children and older adults. As part of the learning task, students conducted a mini-review and utilized the PEDro scale to assess study quality.

## Adolescent Idiopathic Scoliosis (AIS) Review
Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine with unclear etiology. Bracing is intended to prevent the progression of spinal curvature to a point requiring surgery. This review explores the most effective bracing interventions.

### Methodology
* **Criteria:** English language, free full text available, published between 2022–2024.
* **Keywords:** Idiopathic, scoliosis, bracing.
* **Databases:** PubMed and Scopus.
* **Selection:** A total of 2,920 records were identified. After applying criteria and focusing on randomized controlled trials, 4 articles were selected for analysis:
    * Cheung et al. (2024)
    * Charalampidis et al. (2024)
    * da Silveira et al. (2022)
    * Zapata et al. (2024)

### Findings
* **Cheung et al. (2024):** Found that gradual weaning of brace wear does not result in better curve magnitude.
* **Charalampidis et al. (2024):** Showed that nighttime bracing (8 hrs/day) is more effective than physical activity alone, slowing curve progression of 6° or less in 76% of patients compared to the control group.
* **da Silveira et al. (2022):** Compared short-term (24 h/day for 1 day) vs. long-term (15–18 h/day for 6 months) bracing with exercise. Short-term use showed a 12° reduction in Cobb angle, compared to 5.3° in the long-term group. Results also indicated better plantar load distribution and increased body sway in static balance.
* **Zapata et al. (2024):** Measured brace wear adherence in nighttime bracing. Results indicated a high rate of adherence, with a lack of curve progression associated with increased brace wear.

### Conclusion
The most effective bracing interventions are short-term, nighttime use after acute presentation, and weaning from the brace as soon as possible. Future research should prioritize brace adherence and the psychological effects of bracing to better support the bio-psycho-social model of patient care.

## Authors
* **Tomáš Kabelka**, physiotherapy student, Charles University, Czech Republic
* **Gabriela Němcová**, physiotherapy student, Charles University, Czech Republic
* **Salla Pekkala**, physiotherapy student, Savonia University of Applied Sciences, Finland
* **Melania Busto Acedo**, physiotherapy student, University of A Coruña, Spain
* **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
* **Ivana Vláčilová**, Physiotherapist, PhD., Charles University, Czech Republic
* **Marja Äijö**, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland
* **Veronica Robles García**, PhD. PT. OT. Lecturer, University of A Coruña, Spain
* **Beatriz Martínez Toledo**, PT, University of A Coruña, Spain
* **Montserrat Fernández**, PT, University of A Coruña, Spain
* **Lorena Canosa Carro**, PT, MSc, PhD, Lecturer at Universidad Europea de Madrid, Spain
* **Adrien Pallot**, PT, MSc, Lecturer at CEERRF, France

## References
* Cheung, P. W. H., Chan, O. K. O., Wu, H., Lai, M. K. L., Wong, L. P. K., Tang, S., & Cheung, J. P. Y. (2024). Immediate vs Gradual Brace Weaning Protocols in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. JAMA pediatrics, 178(7), 657–668.
* Charalampidis A, Diarbakerli E, Dufvenberg M, Jalalpour K, Ohlin A, Ahl AA, Möller H, Abbott A, Gerdhem P; CONTRAIS Study Group. Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2352492. doi: 10.1001/jamanetworkopen.2023.52492. PMID: 38285447; PMCID: PMC10825714.
* da Silveira, G. E., Andrade, R. M., Guilhermino, G. G., Schmidt, A. V., Neves, L. M., & Ribeiro, A. P. (2022). The Effects of Short- and Long-Term Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis. Medicina (Kaunas, Lithuania), 58(8), 1024. https://doi.org/10.3390/medicina58081024
* Zapata, K. A., Virostek, D., Ma, Y., Datcu, A.-M., Gunselman, M. R., Herring, J. A., & Johnson, M. E. (2024). Outcomes for nighttime bracing in adolescent idiopathic scoliosis based on brace wear adherence. Spine Deformity, 12(3), 643–650. https://doi.org/10.1007/s43390-024-00835-w