Improving Adherence and Safety of Orthopedic Treatment of Idiopathic Scoliosis in Adolescents Using Information and Communication Technologies

NCT ID: NCT04881591

Last Updated: 2021-08-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

10 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-01

Study Completion Date

2022-12-31

Brief Summary

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The present project aims to test the feasibility of a new management mechanism for inter-visit monitoring of adolescent patients with idiopathic scoliosis that improves the quality and safety of current orthopedic treatments using information and communication technologies (ICT).

Detailed Description

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Idiopathic scoliosis is defined as a spinal deformity affecting the anteroposterior plane and exceeding 10 degrees of angulation. The label idiopathic arises from ruling out other causes, such as tumors, trauma or infections, that may explain the deformity. This pathology affects approximately 2% of the population, being up to 5 times more frequent in girls than in boys and age playing a fundamental role in the progression and worsening of the problem.

In most cases, scoliosis appears during adolescence (up to 89% of cases according to studies), being very rare up to 3 years of age (between 1% and 5% of detected cases) and slightly more frequent in the infantile stage (7 to 10.5% of scoliosis cases). Scoliosis often does not cause pain or other complications associated with the deformity. However, as the curvature deformity increases (especially after 25 degrees), complications become more pronounced and treatment becomes necessary. For example, in the case of curvatures between 30 and 40 degrees and curves between 20 and 29 degrees that have progressed rapidly in the last year (more than 5 degrees), bracing has become the indicated treatment, while more invasive intervention (surgery) will be necessary in more severe cases.

The prevalence of cases requiring treatment (by bracing or, in the worst case, surgery) is estimated to be between 0.2 and 0.3% of the population under 18 years of age. However, although in many cases scoliosis is not associated with medical complications, it has been shown that, even in people with less severe curvature, this deformity is associated with psychological complications, such as lower self-esteem, a more depressed mood, high alcohol consumption and even suicidal ideation, which are aggravated during treatment.

Through bracing, applied early on, it is hoped that the proper curvature of the spine will be aided by the guidance imposed by the brace. However, although review studies indicate promising results with this intervention, they also indicate that the use of bracing does not yet possess sufficient scientific evidence. This is mainly due, as indicated by the literature, to the low adherence to bracing in this population, which tends to be exaggerated when evaluated retrospectively. Given that one of the best predictors of the effectiveness of orthopedic treatment of scoliosis is, in fact, time in brace use, greater efforts should be made to improve adherence to treatment in this population. Some authors have proposed that factors such as beliefs about the pathology and treatment (e.g., "I don't care about my back" or "I think people will see the brace under my clothes"), as well as the undesirable effects of brace use (e.g., chafing, discomfort when sleeping, or pain), may be at least partly responsible for this low adherence.

With the aforementioned purpose in mind, we hope that the use of our Pain Monitor App, which has been recently validated in an empirical study, will allow early detection of low adherence to brace use, the appearance of undesirable effects of its use or the persistence of dysfunctional beliefs. All this with the aim of acting quickly to promote their adherence to brace use, make changes to the brace when it causes undesirable effects, or perform psychoeducational interventions when dysfunctional beliefs about scoliosis or treatment persist. As a result of the above, we expect to increase the effectiveness of the intervention (better curvature evolution) and the quality of life and emotional well-being of the patients. Avoiding progression of the curvature is important since surgery is associated with significant post-surgical complications, such as infections and mechanical and neurological problems, with low success rate and frequent need for several surgeries, while untreated scoliosis in the adult is often accompanied by chronic low back pain and significant instability.

Conditions

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Scoliosis Idiopathic Scoliosis; Adolescence Brace

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

One condition
Primary Study Purpose

DEVICE_FEASIBILITY

Blinding Strategy

NONE

Patients will be informed of the condition they have been assigned to.

Study Groups

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APP+Usual Treatment

Participants at this condition will receive the usual medical treatment for their scoliosis but also they will be monitored daily using the Scoliosis Pain Monitor APP. Alarms will be generated in the face of certain preestablished undesired events. Physicians will be asked to call patients and change/stop treatment if an alarm is received.

Group Type EXPERIMENTAL

Treatment as usual + APP

Intervention Type DEVICE

Participants at this condition will receive the usual medical treatment for their scoliosis but also they will be monitored daily using the Scoliosis Pain Monitor APP. Alarms will be generated in the face of certain preestablished undesired events. Physicians will be asked to call patients and change/stop treatment if an alarm is received.

Interventions

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Treatment as usual + APP

Participants at this condition will receive the usual medical treatment for their scoliosis but also they will be monitored daily using the Scoliosis Pain Monitor APP. Alarms will be generated in the face of certain preestablished undesired events. Physicians will be asked to call patients and change/stop treatment if an alarm is received.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adolescente patient (between 10 and 18 years old)
* Wearing a brace for less than 3 months
* The patient has a mobile phone with Android or iOS operating systems
* The patients has the physical ability to use the application
* The patient does not present psychological and or cognitive alterations/ problems with language that make their participation difficult
* The patient (or the legal tutor) voluntarily wants to participate and sings the informed consent

Exclusion Criteria

* The patient does not have an own mobile phone or has a mobile phone with uncompatible characteristics
* Cognitive alterations, lenguage problems to understand the use of the app and to respond its questions
* The patient presents a severe mental health issues or substance abuse.
Minimum Eligible Age

10 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universitat Jaume I

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Azucena García-Palacios, PhD

Role: STUDY_CHAIR

Universitat Jaume I

Judith Sánchez-Raya, PhD

Role: STUDY_CHAIR

Hospitla Universitario Vall d'Hebron

Amanda Díaz-García, PhD

Role: STUDY_CHAIR

Universidad de Zaragoza

Diana Castilla, PhD

Role: STUDY_CHAIR

University of Valencia

Verónica Martínez-Borba, MsC

Role: STUDY_CHAIR

Universitat Jaume I

Locations

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Vall d'Hebron Hospital

Barcelona, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Carlos Suso-Ribera, PhD

Role: CONTACT

670421577

Facility Contacts

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Judith Sanchez

Role: primary

References

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Aebi M. The adult scoliosis. Eur Spine J. 2005 Dec;14(10):925-48. doi: 10.1007/s00586-005-1053-9. Epub 2005 Nov 18.

Reference Type BACKGROUND
PMID: 16328223 (View on PubMed)

Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D; Study Group on Scoliosis. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976). 2012 Apr 15;37(8):693-700. doi: 10.1097/BRS.0b013e31822ff5c1.

Reference Type BACKGROUND
PMID: 22504517 (View on PubMed)

D'Astous JL, Sanders JO. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 2007 Oct;38(4):477-84, v. doi: 10.1016/j.ocl.2007.03.006.

Reference Type BACKGROUND
PMID: 17945127 (View on PubMed)

Dunn J, Henrikson NB, Morrison CC, Blasi PR, Nguyen M, Lin JS. Screening for Adolescent Idiopathic Scoliosis: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Jan 9;319(2):173-187. doi: 10.1001/jama.2017.11669.

Reference Type BACKGROUND
PMID: 29318283 (View on PubMed)

Fong DY, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, Mak KH, Yip PS, Luk KD. A meta-analysis of the clinical effectiveness of school scoliosis screening. Spine (Phila Pa 1976). 2010 May 1;35(10):1061-71. doi: 10.1097/BRS.0b013e3181bcc835.

Reference Type BACKGROUND
PMID: 20393399 (View on PubMed)

Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatr Child Health. 2007 Nov;12(9):771-6. doi: 10.1093/pch/12.9.771.

Reference Type BACKGROUND
PMID: 19030463 (View on PubMed)

Lenssinck ML, Frijlink AC, Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther. 2005 Dec;85(12):1329-39.

Reference Type BACKGROUND
PMID: 16305271 (View on PubMed)

Morton A, Riddle R, Buchanan R, Katz D, Birch J. Accuracy in the prediction and estimation of adherence to bracewear before and during treatment of adolescent idiopathic scoliosis. J Pediatr Orthop. 2008 Apr-May;28(3):336-41. doi: 10.1097/BPO.0b013e318168d154.

Reference Type BACKGROUND
PMID: 18362800 (View on PubMed)

Negrini S, Atanasio S, Zaina F, Romano M. Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies. Europa Medicophysica-SIMFER 2007 Award Winner. Eur J Phys Rehabil Med. 2008 Jun;44(2):169-76.

Reference Type BACKGROUND
PMID: 18418337 (View on PubMed)

Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O'Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. eCollection 2018.

Reference Type BACKGROUND
PMID: 29435499 (View on PubMed)

Reichel D, Schanz J. Developmental psychological aspects of scoliosis treatment. Pediatr Rehabil. 2003 Jul-Dec;6(3-4):221-5. doi: 10.1080/13638490310001644593.

Reference Type BACKGROUND
PMID: 14713589 (View on PubMed)

Suso-Ribera C, Castilla D, Zaragoza I, Ribera-Canudas MV, Botella C, Garcia-Palacios A. Validity, Reliability, Feasibility, and Usefulness of Pain Monitor: A Multidimensional Smartphone App for Daily Monitoring of Adults With Heterogenous Chronic Pain. Clin J Pain. 2018 Oct;34(10):900-908. doi: 10.1097/AJP.0000000000000618.

Reference Type BACKGROUND
PMID: 29659375 (View on PubMed)

Tones M, Moss N, Polly DW Jr. A review of quality of life and psychosocial issues in scoliosis. Spine (Phila Pa 1976). 2006 Dec 15;31(26):3027-38. doi: 10.1097/01.brs.0000249555.87601.fc.

Reference Type BACKGROUND
PMID: 17173000 (View on PubMed)

Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008 May 3;371(9623):1527-37. doi: 10.1016/S0140-6736(08)60658-3.

Reference Type BACKGROUND
PMID: 18456103 (View on PubMed)

Yaman O, Dalbayrak S. Idiopathic scoliosis. Turk Neurosurg. 2014;24(5):646-57. doi: 10.5137/1019-5149.JTN.8838-13.0.

Reference Type BACKGROUND
PMID: 25269032 (View on PubMed)

Yang S, Andras LM, Redding GJ, Skaggs DL. Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions. Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-0709. Epub 2015 Dec 7.

Reference Type BACKGROUND
PMID: 26644484 (View on PubMed)

Other Identifiers

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ScoliosisAPP

Identifier Type: -

Identifier Source: org_study_id

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