Skip to main content
SpringerLink
Log in

Prospective evaluation of physical activity in patients with idiopathic scoliosis or kyphosis receiving brace treatment

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Bracing is an established method of conservative treatment for adolescent idiopathic scoliosis and kyphosis. Compliance among adolescents is frequently inadequate due to the discomfort of wearing a brace, cosmetic issues, and fear on the part of patients and parents that bracing may reduce everyday physical activities. The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS) or adolescent kyphosis (AK). Forty-eight consecutive patients (mean age 13.4 ± 2.3 years), consisting of 38 AIS patients (33 girls, 5 boys) and 10 AK patients (6 girls, 4 boys) were included. Once the decision to carry out bracing had been taken and while the patients were waiting for the individual brace to be built, step activity was assessed without braces by means of step activity monitoring (SAM) for seven consecutive days. After 8 weeks of brace wearing, step activity was assessed during regular brace treatment, again for seven consecutive days. In addition, brace-wearing times were simultaneously recorded using temperature probes implanted in the braces to measure compliance. Before and during brace treatment, patients completed the Scoliosis Research Society (SRS-22) questionnaire. The SAM was worn for an average of 12.7 ± 1.5 h/day during the first measurement and 12.3 ± 1.9 h on average during the second measurement. The mean gait cycles (GCs) per day and per hour before treatment were 5,036 ± 1,465 and 395 ± 105, respectively. No significant reduction in step activity was found at the follow-up measurement during bracing, at 4,880 ± 1,529 GCs/day and 403 ± 144 GCs/h. Taking the 23-h recommended time for brace wearing as a basis (100%), patients wore the brace for 72.7 ± 27.6% of the prescribed time, indicating an acceptable level of compliance. Girls showed a higher compliance level (75.6 ± 25.6%) in comparison with boys (56.7 ± 31.9%), although the difference was not significant (P = 0.093). The SRS-22 total score showed no differences between the two measurements (2.57 ± 0.23 vs. 2.56 ± 0.28). Implementing a simultaneous and objective method of assessing step activity and brace-wearing times in everyday life proved to be feasible, and it expands the information available regarding the impact of bracing on patients’ quality of life. The results clearly show that brace treatment does not negatively interfere with daily step activity in AIS and AK patients. This is an important finding that should help reduce patients’ and parents’ worries concerning bracing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Arlet V, Schlenzka D (2005) Scheuermann’s kyphosis: surgical management. Eur Spine J 14:817–827. doi:10.1007/s00586-004-0750-0

    Article  PubMed  Google Scholar 

  2. Bjornson KF, Belza B, Kartin D, Logsdon R, McLaughlin JF (2007) Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically. Phys Ther 87:248–257. doi:10.2522/ptj.20060157 (discussion 257–260)

    Article  PubMed  Google Scholar 

  3. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  PubMed  CAS  Google Scholar 

  4. Bulthuis GJ, Veldhuizen AG, Nijenbanning G (2008) Clinical effect of continuous corrective force delivery in the non-operative treatment of idiopathic scoliosis: a prospective cohort study of the TriaC-brace. Eur Spine J 17:231–239. doi:10.1007/s00586-007-0513-9

    Article  PubMed  Google Scholar 

  5. Bunge EM, Juttmann RE, de Kleuver M, van Biezen FC, de Koning HJ, NESCIO group (2007) Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment. Eur Spine J 16:83–89. doi:10.1007/s00586-006-0097-9

    Article  PubMed  Google Scholar 

  6. Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100:126–131

    PubMed  CAS  Google Scholar 

  7. Cheung KM, Cheng EY, Chan SC, Yeung KW, Luk KD (2007) Outcome assessment of bracing in adolescent idiopathic scoliosis by the use of the SRS-22 questionnaire. Int Orthop 31:507–511. doi:10.1007/s00264-006-0209-5

    Article  PubMed  Google Scholar 

  8. Coughlin SS (1990) Recall bias in epidemiologic studies. J Clin Epidemiol 43:87–91

    Article  PubMed  CAS  Google Scholar 

  9. de Mauroy J, Weiss H, Aulisa A, Aulisa L, Brox J, Durmala J, Fusco C, Grivas T, Hermus J, Kotwicki T, Le Blay G, Lebel A, Marcotte L, Negrini S, Neuhaus L, Neuhaus T, Pizzetti P, Revzina L, Torres B, Van Loon P, Vasiliadis E, Villagrasa M, Werkman M, Wernicka M, Wong M, Zaina F (2010) 7th SOSORT consensus paper: conservative treatment of idiopathic and Scheuermann’s kyphosis. Scoliosis 5:9. doi:10.1186/1748-7161-5-9

    Article  PubMed  Google Scholar 

  10. Dolan LA, Weinstein SL (2007) Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine (Phila Pa 1976) 32:S91–S100. doi:10.1097/BRS.0b013e318134ead9

    Article  Google Scholar 

  11. Heary RF, Bono CM, Kumar S (2008) Bracing for scoliosis. Neurosurgery 63:125–130. doi:10.1227/01.NEU.0000320387.93907.97

    Article  PubMed  Google Scholar 

  12. Heary RF, Madhavan K (2008) Genetics of scoliosis. Neurosurgery 63:222–227. doi:10.1227/01.NEU.0000320384.93384.28

    Article  PubMed  Google Scholar 

  13. Helfenstein A, Lankes M, Ohlert K, Varoga D, Hahne HJ, Ulrich HW, Hassenpflug J (2006) The objective determination of compliance in treatment of adolescent idiopathic scoliosis with spinal orthoses. Spine 31:339–344. doi:10.1097/01.brs.0000197412.70050.0d

    Article  PubMed  Google Scholar 

  14. Karol LA (2001) Effectiveness of bracing in male patients with idiopathic scoliosis. Spine 26:2001–2005

    Article  PubMed  CAS  Google Scholar 

  15. Katz DE, Durrani AA (2001) Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26:2354–2361

    Article  CAS  Google Scholar 

  16. Korovessis P, Zacharatos S, Koureas G, Megas P (2007) Comparative multifactorial analysis of the effects of idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived health status of adolescents treated with brace. Eur Spine J 16:537–546. doi:10.1007/s00586-006-0214-9

    Article  PubMed  Google Scholar 

  17. Liljenqvist U, Witt KA, Bullmann V, Steinbeck J, Volker K (2006) Recommendations on sport activities for patients with idiopathic scoliosis. Sportverletz Sportschaden 20:36–42. doi:10.1055/s-2005-859029

    Article  PubMed  CAS  Google Scholar 

  18. Lowe TG, Line BG (2007) Evidence based medicine: analysis of Scheuermann kyphosis. Spine (Phila Pa 1976) 32:S115–S119. doi:10.1097/BRS.0b013e3181354501

    Article  Google Scholar 

  19. Mahaudens P, Banse X, Mousny M, Detrembleur C (2009) Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis. Eur Spine J 18:512–521. doi:10.1007/s00586-009-0899-7

    Article  PubMed  CAS  Google Scholar 

  20. Mahaudens P, Detrembleur C, Mousny M, Banse X (2009) Gait in adolescent idiopathic scoliosis: energy cost analysis. Eur Spine J10.1007/s00586-009-1002-0

  21. McDonald CM, Widman L, Abresch RT, Walsh SA, Walsh DD (2005) Utility of a step activity monitor for the measurement of daily ambulatory activity in children. Arch Phys Med Rehabil 86:793–801. doi:10.1016/j.apmr.2004.10.011

    Article  PubMed  Google Scholar 

  22. Morton A, Riddle R, Buchanan R, Katz D, Birch J (2008) Accuracy in the prediction and estimation of adherence to bracewear before and during treatment of adolescent idiopathic scoliosis. J Pediatr Orthop 28:336–341. doi:10.1097/BPO.0b013e318168d154

    Article  PubMed  Google Scholar 

  23. Mudge S, Stott NS (2008) Test-retest reliability of the StepWatch Activity Monitor outputs in individuals with chronic stroke. Clin Rehabil 22:871–877. doi:10.1177/0269215508092822

    Article  PubMed  Google Scholar 

  24. Müller C, Winter C, Rosenbaum D (2010) Current objective techniques for physical activity assessment in comparison with subjective methods. Dtsch Z Sportmed 61:11–18

    Google Scholar 

  25. Müller C, Winter C, Klein D, Damaske K, Schmidt C, Schulte T, Bullmann V, Rosenbaum D (2010) Objective assessment of brace wear times and physical activities in two patients with scoliosis. Biomed Tech (Berl) 55:117–120. doi:10.1515/BMT.2010.026

    Article  Google Scholar 

  26. Negrini S, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Vasiliadis ES (2010) Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev (1):CD006850. 10.1002/14651858.CD006850.pub2

  27. Nicholson GP, Ferguson-Pell MW, Smith K, Edgar M, Morley T (2003) The objective measurement of spinal orthosis use for the treatment of adolescent idiopathic scoliosis. Spine 28:2243–2250. doi:10.1097/01.BRS.0000085098.69522.52 (discussion 2250–2251)

    Article  PubMed  CAS  Google Scholar 

  28. Nicholson GP, Ferguson-Pell MW, Smith K, Edgar M, Morley T (2002) Quantitative measurement of spinal brace use and compliance in the treatment of adolescent idiopathic scoliosis. Stud Health Technol Inform 91:372–377

    PubMed  CAS  Google Scholar 

  29. Niemeyer T, Schubert C, Halm HF, Herberts T, Leichtle C, Gesicki M (2009) Validity and reliability of an adapted german version of scoliosis research society-22 questionnaire. Spine (Phila Pa 1976) 34:818–821. doi:10.1097/BRS.0b013e31819b33be

    Article  Google Scholar 

  30. Pham VM, Herbaux B, Schill A, Thevenon A (2007) Evaluation of the Cheneau brace in adolescent idiopathic scoliosis]. Ann Readapt Med Phys 50:125–133. doi:10.1016/j.annrmp.2006.11.003

    PubMed  Google Scholar 

  31. Poolman RW, Been HD, Ubags LH (2002) Clinical outcome and radiographic results after operative treatment of Scheuermann’s disease. Eur Spine J 11:561–569. doi:10.1007/s00586-002-0418-6

    Article  PubMed  CAS  Google Scholar 

  32. Rahman T, Bowen JR, Takemitsu M, Scott C (2005) The association between brace compliance and outcome for patients with idiopathic scoliosis. J Pediatr Orthop 25:420–422

    Article  PubMed  Google Scholar 

  33. Richards BS, Bernstein RM, D’Amato CR, Thompson GH (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976) 30:2068–2075 (discussion 2076–2077)

    Article  Google Scholar 

  34. Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D (1997) A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Jt Surg Am 79:664–674

    CAS  Google Scholar 

  35. Sawamura C, Hornicek FJ, Gebhardt MC (2008) Complications and risk factors for failure of rotationplasty: review of 25 patients. Clin Orthop Relat Res 466:1302–1308. doi:10.1007/s11999-008-0231-6

    Article  PubMed  Google Scholar 

  36. Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H, Liem D, Rosenbaum D, Bullmann V (2010) Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. Eur Spine J 19:1855–1864. doi:10.1007/s00586-010-1324-y

    Article  PubMed  Google Scholar 

  37. Takemitsu M, Bowen JR, Rahman T, Glutting JJ, Scott CB (2004) Compliance monitoring of brace treatment for patients with idiopathic scoliosis. Spine 29:2070–2074 (discussion 2074)

    Article  PubMed  Google Scholar 

  38. Trost SG (2001) Objective measurement of physical activity in youth: current issues, future directions. Exerc Sport Sci Rev 29:32–36

    Article  PubMed  CAS  Google Scholar 

  39. Tudor-Locke C, McClain JJ, Hart TL, Sisson SB, Washington TL (2009) Expected values for pedometer-determined physical activity in youth. Res Q Exerc Sport 80:164–174

    PubMed  Google Scholar 

  40. Tudor-Locke CE, Myers AM (2001) Methodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity. Res Q Exerc Sport 72:1–12

    PubMed  CAS  Google Scholar 

  41. Uhlenbrock K, Thorwesten L, Sandhaus M, Fromme A, Brandes M, Rosenbaum D, Dieterich S, Völker K (2008) Physical education and daily life activity of nine and eleven year-old pupils. Dtsch Z Sportmed 59:228–233

    Google Scholar 

  42. Vandal S, Rivard CH, Bradet R (1999) Measuring the compliance behavior of adolescents wearing orthopedic braces. Issues Compr Pediatr Nurs 22:59–73

    Article  PubMed  CAS  Google Scholar 

  43. Weiss HR (2003) Conservative treatment of idiopathic scoliosis with physical therapy and orthoses. Orthopade 32:146–156. doi:10.1007/s00132-002-0430-x

    Article  PubMed  Google Scholar 

  44. Weiss HR (1995) The Schroth scoliosis-specific back school—initial results of a prospective follow-up study]. Z Orthop Ihre Grenzgeb 133:114–117. doi:10.1055/s-2008-1039421 (discussion 118–119)

    Article  PubMed  CAS  Google Scholar 

  45. Weiss HR, Negrini S, Rigo M, Kotwicki T, Hawes MC, Grivas TB, Maruyama T, Landauer F, (SOSORT guideline committee) (2006) Indications for conservative management of scoliosis (guidelines). Scoliosis 1:5. doi:10.1186/1748-7161-1-5

    Article  PubMed  Google Scholar 

  46. Wong MS, Cheng CY, Ng BK, Lam TP, Sin SW, Lee-Shum LF, Chow HK, Tam YP (2008) The effect of rigid versus flexible spinal orthosis on the gait pattern of patients with adolescent idiopathic scoliosis. Gait Posture 27:189–195. doi:10.1016/j.gaitpost.2007.03.007

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

No financial support was provided by DePuy Spine.

Conflict of interest

The authors hereby state that there were no financial conflicts of interest in relation to any of the companies mentioned in this paper.

Author information

Authors and Affiliations

  1. Movement Analysis Lab, University Hospital Münster, Munster, Germany

    Carsten Müller, Corinna Winter & Dieter Rosenbaum

  2. Department of Orthopedics and Tumor Orthopedics, University Hospital Münster, Munster, Germany

    Katharina Fuchs, Carolin Schmidt, Viola Bullmann & Tobias L. Schulte

  3. Movement Analysis Lab, Institute of Experimental Musculoskeletal Medicine IEMM, University Hospital, Munster, Germany

    Carsten Müller

Authors
  1. Carsten Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katharina Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corinna Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dieter Rosenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carolin Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Viola Bullmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tobias L. Schulte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carsten Müller.

Additional information

C. Müller and K. Fuchs share authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müller, C., Fuchs, K., Winter, C. et al. Prospective evaluation of physical activity in patients with idiopathic scoliosis or kyphosis receiving brace treatment. Eur Spine J 20, 1127–1136 (2011). https://doi.org/10.1007/s00586-011-1791-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-1791-9

Keywords

Search

Navigation