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PubMed2006

Development and preliminary validation of Brace Questionnaire (BrQ): a new instrument for measuring quality of life of brace treated scoliotics.

BACKGROUND: The quality of life among children with idiopathic scoliosis during their adolescence has been reported to be affected by the brace itself. However, a controversy exists whether brace treated scoliotics experience a poor quality of life, thus there is a need for the development of a brace-oriented instrument, as the now-existing questionnaires that are commonly used, such as the SRS -22, take into consideration the effects of both the conservative and the surgical treatment on quality of life of scoliotic children. The aim of the present study is to assess the validity and reliability of Brace Questionnaire (BrQ), a new instrument for measuring quality of life of scoliotic adolescents who are treated conservatively with a brace. MATERIAL-METHOD: Methodology of development involved literature review, patient and health care professionals' in-depth interviews and content validity analysis on patients. A validation study was performed on 28 brace treated scoliotic children aged between 9 and 18 years old. BrQ was assessed for the following psychometric properties: item convergent validity, floor and ceiling effects, internal consistency reliability, clinical validity and responsiveness to change. RESULTS: BrQ is self administrated and developmentally appropriate for ages 9 to 18 years old and is consisted of 34 Likert-scale items associated with eight domains: general health perception, physical functioning, emotional functioning, self esteem and aesthetics, vitality, school activity, bodily pain and social functioning of scoliotic children treated conservatively with a brace. The subscales of these eight dimensions can be combined to produce a total score. Higher scores mean a better quality of life. An item convergent validity >/= 0.40 was satisfied by all items in the present study. A satisfactory internal consistency reliability for the BrQ was recorded (Cronbach's alpha coefficient was 0.82). There were no floor or ceiling effects. The correlation between BrQ overall scores and mild and moderate scoliosis was statistically significant (p < 0.001), revealing high clinical validity. An increase in effect sizes for the patient with improved scoliotic curves indicates that the BrQ is responsive to change in health status. CONCLUSION: BrQ is reliable, valid and responsive to change in adolescents with IS who are treated conservatively with a brace.

Journal Article↗
PubMed2003

Functional anterior cruciate ligament bracing: a survey of current brace prescription patterns.

This study surveyed orthopedic surgeons regarding anterior cruciate ligament (ACL) bracing practices. Surveys were mailed to 1194 members of the American Orthopaedic Society for Sports Medicine. The return rate was 24% (n = 287). Descriptive analysis revealed that 13% of physicians never brace ACL-reconstructed patients, whereas only 3% never brace ACL-deficient patients. Physicians prescribe off-the-shelf braces more frequently for ACL-deficient patients than ACL-reconstructed patients (P = .000). Half reported bracing less frequently than 5 years ago. The wide range of responses reflects the lack of scientific basis for bracing decisions. Continued research efforts are encouraged. In the interim, the physician's clinical judgment provides the basis for bracing decisions.

Anterior Cruciate Ligament↗
PubMed1998

Objective roentgenologic measurements of the influence of ankle braces on pathologic joint mobility. A comparison of 9 braces.

The stabilizing effect of external support (taping and nine different ankle braces) was tested in a total of 220 functionally unstable ankles. A standard surface EMG controlled stress Roentgen test protocol was used, measuring talar tilt (TT) without support and with tape bandage or brace. Different levels of TT restraining by external support could be identified. Tape bandage and two braces had a highly significant influence on the talar tilt. The mean TT without support was decreased by using from 13.4 degrees to 4.9 degrees, by using one brace to 4.8 degrees and by using another brace to 5.9 degrees. These two braces are effective for protection during functional treatment. A classification into three grades of effectiveness is proposed. It is concluded that the stabilizing influence offered by bandages and braces should be measured before using the external support as a treatment device for acute ankle sprain and as a reliable protection against sprain injuries in daily living and sports.

Activities of Daily Living↗
PubMed1991

Effect on atrial natriuretic peptide by bracing in scoliosis. Boston brace removal studied in 10 cases.

The immediate effect of Boston brace removal on plasma levels of atrial natriuretic peptide and arginine vasopressin was studied in 10 patients with idiopathic scoliosis ranging in age from 12 to 16 years. Blood samples were drawn via the antecubital vein in the supine position with the brace on and 10 min after brace removal. ANP and AVP plasma levels were measured by radioimmunoassay. Although no differences were found in the plasma concentrations of arginine vasopressin while on and after removal of the brace, atrial natriuretic peptide levels showed an approximately 80 percent increase 10 min after brace removal, presumably due to central volume redistribution. The changes of atrial natriuretic peptide plasma levels observed may be related to previously reported changes of the glomerular filtration rate and urinary sodium excretion following brace removal.

Adolescent↗
PubMed1997

Is bracing after anterior cruciate ligament reconstruction necessary? A 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace.

The aim of this study was to evaluate the effect of a standard postoperative rehabilitation knee brace on function, stability and postoperative complications at the 2-year follow-up after anterior cruciate ligament (ACL) reconstructive surgery. Seventy-eight consecutive patients with a unilateral chronic ACL rupture reconstructed by the same surgeon using the endoscopic "all-inside" technique, patellar tendon autograft and interference screw fixation were included in the study. The rehabilitation followed a standard protocol. Group A included 39 patients who were supplied postoperatively with a knee brace for 4 (range 3-6) weeks. Group B included 39 patients for whom a brace was not used. The median age was 27 (range 16-48) years in group A and 26 (range 14-51) years in group B. The median time period between the injury and the index operation was 24 (range 3-150) months in group A and 18 (range 3-360) months in group B. All 78 patients were re-examined by two independent observers after a median follow-up period of 25 (range 23-28) months in group A and 24 (range 22-27) months in group B. The median KT-1000 total side-to-side difference between the reconstructed and the uninjured knees at 89 N was 3 (range -5.5-11) mm in group A and 3 (range -7-10) mm in group B (NS). When the anterior translation was tested separately at 89 N, the corresponding values were 3 (range -4-13) mm in group A and 3 (range -5-10) mm in group B (NS). The median one-leg hop quotient was 95% (range 50%-167%) of the uninjured leg in group A and 92% (range 64%-119%) in group B (NS). The median Lysholm score was 89 (range 39-100) points in group A and 85 (range 37-100) points in group B (NS). In group A, 27/39 (69%) patients and in group B 21/39 (54%) patients were classified as excellent or good (NS). The median Tegner activity level was 7 (range 3-9) in group A and 6 (range 3-9) in group B (NS). Using the IKDC scale, 27/39 (69%) in group A and 24/39 (62%) in group B were classified as normal or nearly normal (NS). The median sick leave in group A was 62 (range 0-357) days and 59 (range 0-243) days in group B (NS). No serious complications occurred during the first 6 postoperative weeks. Two serious complications were, however, registered after the 6th postoperative week. One patient in group A sustained a rupture of the reconstructed ACL 8 weeks postoperatively (3 weeks after removing the brace), and one patient in group B sustained an undislocated patellar fracture during the 7th postoperative week after a fall. This study indicates that the use of a postoperative rehabilitation brace after an arthroscopic ACL reconstruction did not appear to influence either objective stability or subjective function by the 2-year follow-up.

Adolescent↗
PubMed2006

Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace.

A new valgus brace was evaluated in 15 patients with medial osteoarthritis of the knee and a varus leg axis. Significant improvement of pain and function were found after 6 weeks of brace treatment. Gait analysis showed that the brace had a tendency of lowering the peak varus moment about the knee. This effect was more profound in the presence of higher initial varus deformity angle of the knee. Furthermore, bracing led to a small decrease of knee extension at the end of the swing phase and an increase of walking velocity. The mechanisms identified by gait analysis in this study may be of clinical importance for future developments in brace treatment.

Braces↗
PubMed1997

Ankle bracing in running: the effect of a Push type medium ankle brace upon movements of the foot and ankle during the stance phase.

Functional ankle braces are designed to limit medio-lateral movements of the ankle without affecting ankle dorsiflexion or plantar flexion. As running forms a basic activity in sports, the current study investigated the influence of wearing a Push type medium ankle brace upon movements of the foot and ankle during the stance phase in running. The movements of the lower extremity of seven trained male long-distance runners were filmed frontally (250 s-1) and sagittally (50 s-1) while running at 4.5 +/- 0.1 m.s-1 over a Kistler force platform. The tested brace significantly reduced the range (total subtalar eversion 13.3 deg vs 18.1 deg, p < 0.05) and rate of subtalar eversion (maximal velocity -309 deg.s-1 vs -533 deg.s-1). Plantar and dorsiflexion were not affected. The vertical impact force peak was not altered. It was argued that, although this might not be the prime design feature of the tested ankle brace, this orthotic offers a strategy to influence the range and the rate of subtalar eversion. It may have the potential to prevent runners from overuse injuries associated with overpronation, but interaction between the passive support by the brace and the muscular stabilization of the ankle joint needs further investigation.

Adult↗
PubMed1996

Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study.

Stable lateral malleolar fractures can be treated with dynamic braces and early mobilization. In a randomized clinical trial, 66 patients with supination-eversion stage II fractures were treated with Aircast Air-Stirrup ankle braces or DonJoy R.O.M.-Walker braces. Average bracing time was 5 weeks, and average time until return to work was 6 weeks. At 4 weeks, 70% to 80% of patients were able to walk without pain. Subjective satisfaction with comfort and ease of use was significantly higher with Aircast, although it was high in both groups. Pain relief and an inflammatory score were significantly better in the R.O.M.-Walker group after 4 weeks. Three months after injury, no differences were observed in grade of ambulation, pain, swelling, range of motion, or inflammatory score. Both braces can be recommended.

Air↗
PubMedDate not supplied

Nighttime bracing for adolescent idiopathic scoliosis with the Charleston Bending Brace: long-term follow-up.

We report long-term experience with the Charleston Bending Brace for treatment of adolescent idiopathic scoliosis. This brace holds the patient in maximal side-bending correction and is worn at nighttime only. Patients included in this prospective multicenter study met all of the following criteria: skeletal immaturity (Risser 0, 1, or 2), curvature >25 degrees before bracing, no prior treatment, and >1-year follow-up since completion of bracing (skeletal maturity or progression to surgery). All curves were monitored and reported. There were 149 structural curves in 98 patients. Sixty-five (66%) patients showed improvement or <5 degrees change in curvature. Seventeen (17%) patients progressed to the point of requiring surgery for their scoliosis. Based on these long-term results and improvement of the natural history of adolescent idiopathic scoliosis, continued use of the Charleston Bending Brace is justified.

Adolescent↗
PubMedDate not supplied

Functional fracture bracing in metacarpal fractures: the Galveston metacarpal brace versus a plaster-of-Paris bandage in a prospective study.

A total of 133 patients with fractures of the second through the fifth metacarpal bones were randomized to receive either a functional brace (the Galveston metacarpal brace) or a dorsal/ulnar plaster cast. Only 42% of the patients in the metacarpal-brace group completed the treatment, in contrast to 81% of the patients in the plaster-cast group. Complications with the brace were due to 60% of the exclusion. No difference according to gender, age, fracture type, hand affected (right/left), or mechanism of injury was observed between the patients who completed the treatment and those who were excluded. Reduction of fractures could not be demonstrated. Reduction of mobility was more frequent in the plaster-cast group, but three months postinjury no reduction of mobility was observed in either group.

Adolescent↗
PubMed1990

Nighttime bracing for adolescent idiopathic scoliosis with the Charleston bending brace. Preliminary report.

The authors report their preliminary experience with the Charleston bending brace for the treatment of adolescent idiopathic scoliosis. This brace holds the patient in the position of maximum side bend correction and is worn only at night. Patients in this prospective multicentered study met all the following criteria: skeletal immaturity (Risser 0, 1+, or 2+), curvature greater than 25 degrees before bracing, no prior treatment, and greater than 1-year follow-up since initiation of treatment. There were 191 structural curves in the 139 patients. One hundred fifteen patients (83%) showed improvement or less than 5 degree change in curvature. Twenty-four patients (17%) demonstrated an increase in curvature greater than 5 degrees. Based on these preliminary results, continued use of bending brace treatment at nighttime only is justified for adolescent idiopathic scoliosis. Patients with double curves should be observed closely for increase in compensatory curves.

Adolescent↗
PubMed1984

Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster casts.

The use of Orthoplast cast-bracing to allow early hand function in the treatment of displaced Colles' fractures was investigated in 243 patients. They were randomly allocated into three groups: in the first a conventional Colles' type plaster was used; in the second an above-elbow cast-brace with the forearm in supination; and in the third a below-elbow cast-brace. Radiographic measurements were made at each stage of treatment, and the final anatomical result was scored using Sarmiento's (1975) criteria. Function was assessed at three months and at six months. The anatomical result was not influenced by the method of immobilisation but was related to the efficacy of reduction. Loss of position in the braces was no greater than in plaster. The functional result at three months also was uninfluenced by the method of immobilisation; it was, however, related to the severity of the initial displacement, and (to a lesser degree) to the anatomical result, an effect which was lost at six months. Early hand function and the supinated position advocated by Sarmiento were found to confer no anatomical or functional advantage; we could see no reason to change from the use of conventional plaster casts in the treatment of uncomplicated Colles' fractures.

Adolescent↗
PubMedDate not supplied

[Long-term effect of brace treatment on spinal decompensation in idiopathic scoliosis. A comparison of Milwaukee brace--Chêneau corset].

Spinal decompensation is a statistically important factor in idiopathic scoliosis. In our study we compared longterm influence of brace-treatment by Milwaukee brace and Chêneau-Orthosis. Twenty-six patients treated by Milwaukee Brace and 21 treated by Chêneau-Orthosis were followed up with an average of 7.8 (Milwaukee) and 4 (Chêneau) years. No correlation was found between spinal decompensation, expression and localisation of the major curve. Further we didn't find any correlation between spinal decompensation and development of the major curve under therapy. Chêneau-Orthosis showed better results significantly. In 61.9% of all patients decreased of spinal decompensation to 35% of the initial value was seen. With Milwaukee Brace only 38.5% of the patients did improve to 46.6% of the initial value. A prediction for development of spinal decompensation under therapy was not possible.

Braces↗
PubMed2002

Early weaning might reduce the psychological strain of Boston bracing: a study of 136 patients with adolescent idiopathic scoliosis at 3.5 years after termination of brace treatment.

From 1983 to 1990 a total of 136 patients with adolescent idiopathic scoliosis were treated with the Boston brace. With the aim of examining the social and psychological impact of the brace treatment all patients received a questionnaire at an average of 3.5 years after termination of the treatment. Ninety-three percent responded to the questionnaire. The overall picture was that the patient's daily activities and social contacts, not least with the opposite sex, were affected both during the bracing period and at follow-up. It is important that the indications for the treatment are assured, and weaning should be initiated at the latest 3 years after menarche.

Adaptation, Psychological↗
PubMed1995

Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society.

In a prospective study by the Scoliosis Research Society, 286 girls who had adolescent idiopathic scoliosis, a thoracic or thoracolumbar curve of 25 to 35 degrees, and a mean age of twelve years and seven months (range, ten to fifteen years) were followed to determine the effect of treatment with observation only (129 patients), an underarm plastic brace (111 patients), and nighttime surface electrical stimulation (forty-six patients). Thirty-nine patients were lost to follow-up, leaving 247 (86 per cent) who were followed until maturity or who were dropped from the study because of failure of the assigned treatment. The end point of failure of treatment was defined as an increase in the curve of at least 6 degrees, from the time of the first roentgenogram, on two consecutive roentgenograms. As determined with use of this end point, treatment with a brace failed in seventeen of the 111 patients; observation only, in fifty-eight of the 129 patients; and electrical stimulation, in twenty-two of the forty-six patients. According to survivorship analysis, treatment with a brace was associated with a success rate of 74 per cent (95 per cent confidence interval, 52 to 84) at four years; observation only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33 per cent (95 per cent confidence interval, 12 to 60).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗