背景:青少年时期每天佩戴脊柱矫形器16至23小时对于青少年特发性脊柱侧凸(AIS)患者来说可能具有挑战性和压力。在各种矫形器佩戴依从性下的临床结果调查可以为矫形器治疗剂量提供有用的见解。本系统评价旨在调查实际的矫形器佩戴依从性,并评估矫正治疗在不同程度的矫形器佩戴依从性下控制脊柱侧弯和预防AIS患者手术的有效性。
方法:对7个电子数据库进行文献检索,即PubMed,MEDLINE,科克伦图书馆,Scopus,CINAHL完成,WebofScience,和Embase,于2023年5月19日进行。参与者特征,矫形治疗方案,合规信息,结果衡量标准,并提取了关键发现。纽卡斯尔-渥太华量表用于评估纳入队列和病例对照研究的质量。
结果:这项研究系统地回顾了1,799项确定的研究中的17项,包括1,981个科目。实际依从性不一致,每天7.0至18.8小时不等。由于计算周期的异质性,每个研究中合规受试者的比例从16.0%到78.6%不等。测量方法,和矫形器处方时间。调查了13项研究,以确定在不同依从性组下矫形治疗在控制曲线畸形方面的有效性,2项研究比较了不同治疗结果下的依从性。曲线进展的速度,定义为矫形治疗后超过5°或6°的测量误差阈值,在整个研究中,差异从1.8%到91.7%。十项研究定义了治疗失败,手术,或手术指征为Cobb角进展到一定程度(例如,40°,45°,或50°),并且在不同的依从性水平组中,报告的失败/手术/手术适应症发生率为0.0%至91.7%。
结论:本综述发现,矫形治疗的实际依从性通常低于规定的佩戴时间,并且在不同研究中表现出很大差异。电子依从性监测器在常规矫正治疗实践中显示出希望。更重要的是,与依从性较低且不一致的组相比,依从性较高且一致的组的曲线进展明显较少,手术或失败率较低.建议进行进一步的研究,以研究接受不同类型矫形器治疗的AIS患者的最小矫形器佩戴依从性。
方法:三级,系统审查。有关证据级别的完整描述,请参阅作者说明。
BACKGROUND: Wearing spinal orthosis for 16 to 23 hours a day during the teenage years could be challenging and stressful for patients with adolescent idiopathic scoliosis (AIS). The investigation of clinical outcomes under various orthosis-wearing compliances can provide helpful insight into orthotic treatment dosage. This systematic review aims to investigate actual orthosis-wearing compliance and evaluate the effectiveness of orthotic treatment in controlling scoliotic curvature and preventing surgery for patients with AIS under various levels of orthosis-wearing compliance.
METHODS: A literature search of 7 electronic databases, namely PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL Complete, Web of Science, and Embase, was conducted on May 19, 2023. Participant characteristics, orthotic treatment protocols, compliance information, outcome measures, and key findings were extracted. The Newcastle-Ottawa Scales were used to evaluate the quality of included cohort and case-control studies.
RESULTS: This study systematically reviewed 17 of 1,799 identified studies, including 1,981 subjects. The actual compliance was inconsistent and ranged from 7.0 to 18.8 hours daily. The proportion of compliant subjects in each study varied from 16.0% to 78.6% due to the heterogeneity of calculation period, measurement methods, and orthosis prescription time. Thirteen studies were investigated to determine the effectiveness of orthotic treatment in controlling curve deformity under different compliance groups, and 2 studies compared the compliance under different treatment outcomes. The rate of curve progression, defined as surpassing the measurement error threshold of 5° or 6° after orthotic treatment, varied from 1.8% to 91.7% across the studies. Ten studies defined the treatment failure, surgery, or surgery indication as Cobb angle progressing to a certain degree (e.g., 40°, 45°, or 50°) and reported failure/surgery/surgery indication rates ranging from 0.0% to 91.7% among different compliance level groups.
CONCLUSIONS: This review found that the actual compliance with orthotic treatment was generally lower than the prescribed wearing time and exhibited wide variation among different studies. The electronic compliance monitors show promise in regular orthotic treatment practice. More importantly, the group with higher and consistent compliance has significantly less curve progression and lower surgery or failure rate than the group with lower and inconsistent compliance. Further studies are proposed to investigate the minimal orthosis-wearing compliance in patients with AIS treated with different types of orthoses.
METHODS: Level III, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.