Adolescent Idiopathic Scoliosis Clinical Trial
Official title:
Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST)
Adolescent idiopathic scoliosis (AIS) is a structural curve of the spine with no clear underlying cause. Bracing is currently the standard of care for preventing curve progression and treating AIS. However, the effectiveness of bracing remains unclear. The purpose of this study is to compare the risk of curve progression in adolescents with AIS who wear a brace versus those who do not and to determine whether there are reliable factors that can predict the usefulness of bracing for a particular individual with AIS.
AIS is characterized by a lateral curvature of the spine greater than 10 degrees plus
rotation of the spinal vertebrae. AIS is found in adolescents between the age of 10 and time
of skeletal maturity. Progression of a spinal curve to 50 degrees suggests a high risk for
continued curve progression throughout adulthood and usually indicates the need for spinal
fusion surgery. Only about 10 percent of adolescents with AIS end up having curves that
progress and require surgical intervention. While certain risk factors for curve progression
have been identified, there is no reliable way of estimating the likelihood of needing
surgery. Bracing is currently the standard of care for treating AIS. However, the
effectiveness of bracing remains unclear, and it is unknown which adolescents in particular
may benefit from bracing. Therefore, adolescents undergo bracing without knowing their
likelihood of avoiding surgery. The purpose of this study is to compare the risk of curve
progression in adolescents with AIS who wear a brace versus those who do not and to determine
whether there are reliable factors that can predict the usefulness of bracing for a
particular individual with AIS. The study will also evaluate the best dosing and duration
schedule and how bracing affects quality of life, functioning, and psychosocial adjustment
among participants.
Participation in this study will last until a participant reaches skeletal maturity or their
spinal curve progresses to 50 degrees, after which usual care will continue. Participants
will either be 1)randomly assigned to a treatment or 2) may decline randomization and choose
their own treatment arm. Study visits will occur every 6 months at an orthopaedic surgeon's
office and will include x-rays, a clinical exam, and questionnaires. Participants assigned to
braces will be instructed to wear the brace at least 18 hours per day. Temperature monitors
placed in the brace will be used to determine the actual wear time by each participant.
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