Effectiveness of Three Dimensional Correction During in Bracing in Adolescent Idiopathic Scoliosis

NCT ID: NCT04382638

Last Updated: 2023-02-06

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 134 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-07-02
• Study Completion Date: 2025-12-03

Brief Summary

The purpose of this study is to study the effectiveness of in-brace 3D scoliosis correction by comparing Rigo Chêneau orthoses (RCO) with conventional Traditional Boston-style thoracolumbosacral orthoses (TLSO) in Adolescent Idiopathic Scoliosis (AIS) patients, following Scoliosis Research Society (SRS) and The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) recommendations for non-operative AIS management and research studies. This group of patients that reach the threshold for bracing have an intrinsic higher risk for curve progression. Hence, the proposed study will provide novel and high quality evidence to improve the efficacy of bracing in the non-operative treatment of AIS. This will contribute significantly to the betterment of public health by reducing the number of patients requiring surgical intervention. Ultimately, new evidence-based clinical practice guidelines on the most effective type of scoliosis braces will benefit children diagnosed with AIS worldwide.

Detailed Description

Adolescent idiopathic scoliosis (AIS), a three-dimensional (3D) deformity of the spinal column characterized by lateral deviation and vertebral rotation, affects 3.5% of children during puberty in Hong Kong. Untreated scoliosis continues to deteriorate beyond adolescence, and curves that progress beyond 50 degrees can lead to chronic back pain, cardiopulmonary compromise, poor cosmesis and negative psychological impact. Hence, surgical correction of the deformity by instrumented spinal fusion is recommended when curves reach 50 degrees. Although surgical risks have decreased with improved techniques, surgeries for scoliosis correction still carry significant medical co-morbidities, psychological stress to the children and their families, and substantial financial burden on healthcare. Effective non-operative strategies to prevent curve progression during adolescence are needed. Currently, the most effective non-operative treatment supported by high quality randomised controlled trial to prevent curve progression is by spinal bracing. In the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) study, bracing was effective in preventing curve progression to threshold for surgery in 72% of cases. The failure rate, therefore, remains substantially high despite the best available non-operative treatment. Previous studies have identified factors affecting brace success, including skeletal age, curve type, curve magnitude, and flexibility, but none of these is modifiable. Brace treatment requires a wholistic approach, and brace design and fabrication are important determinants of brace effectiveness. Traditional Boston-style thoracolumbosacral orthoses (TLSO), such as those used in the BrAIST study, can achieve in-brace coronal curve correction reliably but their effects on the 3D curve correction are highly variable. Since AIS is a 3D deformity, it is reasonable to postulate that braces which can achieve correction in all three planes have a higher chance of success.

Rigo Chêneau orthoses (RCO) were developed approximately two decades ago by Dr. Manuel Rigo of Barcelona who made improvements to the Chêneau brace that French doctor Jacques Chêneau invented in 1978. RCO was designed with the intent to combine biomechanical forces in three dimensions, including curve derotation. They use an open pelvis design with anterior opening. Instead of focusing on one-dimensional correction, RCO treats scoliosis in all three dimensions and follows a unique curve Rigo classification protocol to guide brace design. RCO not only keeps the curves from getting worse as seen on an X-ray, but also corrects as much as possible the way the body looks. Every attempt is made to decrease the noticeable effects of scoliosis such as rib humps, uneven shoulders, hips which are translated or rotated, and centering the head over the pelvis. To achieve successful 3D scoliosis correction, in-brace Cobb angle correction must be 50% to be considered acceptable. This is often true and it is also true that the Cobb angle, which is easily assessed, has been the gold standard of measurement for brace quality. However, not all patients can and/or should be corrected to 50% in-brace correction. In some cases, a 25% in-brace correction coupled with good 3D correction is acceptable and sufficient to prevent scoliosis progression, when greater Cobb angle correction would cause negative compensations. Overall, some patients are best served by targeting a low in-brace correction, whereas for others an 80% in-brace correction is both achievable and desirable.

Conditions

Adolescent Idiopathic Scoliosis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

RCO group

Patients in the experimental group will receive RCO fabrication with standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will attend study assessments at baseline, 3 months, 6 months, 12 months and every year until they reach skeletal maturity or if surgical intervention is required.

Group Type: EXPERIMENTAL

RCO group

Intervention Type: COMBINATION_PRODUCT

Patients in the experimental group will receive RCO fabrication with standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will attend study assessments at baseline, 3 months, 6 months, 12 months and every year until they reach skeletal maturity or if surgical intervention is required.

TLSO group

Patients in the experimental group will receive TLSO fabrication with standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will attend study assessments at baseline, 3 months, 6 months, 12 months and every year until they reach skeletal maturity or if surgical intervention is required.

Group Type: ACTIVE_COMPARATOR

TLSO group

Intervention Type: DEVICE

Patients in the experimental group will receive TLSO fabrication with standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will attend study assessments at baseline, 3 months, 6 months, 12 months and every year until they reach skeletal maturity or if surgical intervention is required.

Interventions

RCO group

Patients in the experimental group will receive RCO fabrication with standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will attend study assessments at baseline, 3 months, 6 months, 12 months and every year until they reach skeletal maturity or if surgical intervention is required.

Intervention Type: COMBINATION_PRODUCT

TLSO group

Patients in the experimental group will receive TLSO fabrication with standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will attend study assessments at baseline, 3 months, 6 months, 12 months and every year until they reach skeletal maturity or if surgical intervention is required.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Diagnosis of AIS
• Male or female from 10 to 15 year-old, inclusive, at the time of consent provided
• Skeletal immaturity, defined as a Risser grade (amount of ossification and eventual fusion of the iliac apophysis) of 0, 1, or 2
• Cobb angle of 25-40
• No prior conservative or surgical treatment for AIS

Exclusion Criteria

• An underlying cause or association that may cause scoliosis
• Leg length discrepancies or lower limb deformities that may interfere with spinal posture
• Previous spinal surgery
• Cognitive impairment
• Those receiving any other forms of treatment including alternative medicine for the treatment of their scoliosis
• Those who are unable to return for follow-up to complete the trial

• Minimum Eligible Age: 10 Years
• Maximum Eligible Age: 15 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Hong Kong Polytechnic University

OTHER

Sponsor Role: collaborator

The University of Hong Kong

OTHER

Sponsor Role: lead

Responsible Party

Dr. Kenny Kwan

Clinical Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Dr Kenny Kwan, BMBCh (Oxon)

Role: PRINCIPAL_INVESTIGATOR

The University of Hong Kong

Locations

Duchess of Kent Children's Hospital

Hong Kong, , Hong Kong

Site Status: RECRUITING

Countries

Hong Kong

Central Contacts

Dr Kenny Kwan, BMBCh (Oxon)

Role: CONTACT

kyhkwan@hku.hk

+852 22554654

Ms Lee Yin Goh, MSc

Role: CONTACT

lygoh@hku.hk

+852 22554654

Facility Contacts

Dr Kenny Kwan, BMBCh (Oxon)

Role: primary

kyhkwan@hku.hk

+852 22554654

Ms Lee Yin Goh, MSc

Role: backup

lygoh@hku.hk

+852 22554654

Other Identifiers

UW 20-243

Identifier Type: -

Identifier Source: org_study_id