| 1. |
- Ahonen, Matti, et al.
(författare)
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Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis
- 2023
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 48:10, s. 665-671
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Tidskriftsartikel (refereegranskat)abstract
- Study Design.Comparative cohort study. Objective.The aim of the present study was to evaluate pain and health-related quality of life (HRQoL) in surgically managed patients with a minimum follow-up of 10 years compared with patients with untreated adolescent idiopathic scoliosis (AIS) and a healthy control group. Summary of Background Data.Posterior spinal fusion with pedicle screws is the standard treatment for AIS, although it remains unclear whether this procedure results in improved long-term HRQoL compared with untreated patients with AIS. Patients and Methods.Sixty-four consecutive patients at a minimum follow-up of 10 years, who underwent posterior pedicle screw instrumentation for AIS were prospectively enrolled. Fifty-three (83%) of these patients completed Scoliosis Research Society (SRS) 24 questionnaires, clinical examination, and standing spinal radiographs. Pain and HRQoL were compared with age and sex-matched patients with untreated AIS and healthy individuals. Results.The mean major curve was 57 degrees preoperatively and 15 degrees at the 10-year follow-up. SRS-24 self-image domain score showed a significant improvement from preoperative to 2 years and remained significantly better at the 10-year follow-up (P < 0.001). Patients fused to L3 or below had lower pain, satisfaction, and total score than patients fused to L2 or above (P < 0.05), but self-image, function, and activity scores did not differ between groups at 10-year follow-up. Pain, self-image, general activity, and total SRS domains were significantly better at 10-year follow-up in the surgically treated patients as compared with untreated patients (all P < 0.05). Healthy controls had significantly higher total scores than those surgically treated at 10-year follow-ups (P < 0.001). Conclusion.Patients undergoing segmental pedicle screw instrumentation for AIS maintain high-level HRQoL during a 10-year follow-up. Their HRQoL was significantly better than in the untreated patients with AIS, except for the function domain. However, HRQoL remained at a lower level than in healthy controls.
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| 2. |
- Charalampidis, Anastasios, et al.
(författare)
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Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis
- 2024
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Moderate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-timebracing. For patients who reject full-time bracing, the effects of alternative, conservativeinterventions are unknown.OBJECTIVE To determine whether self-mediated physical activity combined with either nighttimebracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA)in preventing Cobb angle progression in moderate-grade AIS.DESIGN, SETTING, AND PARTICIPANTS The Conservative Treatment for Adolescent IdiopathicScoliosis (CONTRAIS) randomized clinical trial was conducted from January 10, 2013, throughOctober 23, 2018, in 6 public hospitals across Sweden. Male and female children and adolescentsaged 9 to 17 years with an AIS primary curve Cobb angle of 25° to 40°, apex T7 or caudal, and skeletalimmaturity based on estimated remaining growth of at least 1 year were included in the study. Datesof analysis were from October 25, 2021, to January 28, 2023.INTERVENTIONS Interventions included self-mediated physical activity in combination with eitherNB or SSE or PA (control). Patients with treatment failure were given the option to transition to afull-time brace until skeletal maturity.MAIN OUTCOMES AND MEASURES The primary outcome was curve progression of 6° or less(treatment success) or curve progression of more than 6° (treatment failure) seen on 2 consecutiveposteroanterior standing radiographs compared with the inclusion radiograph before skeletalmaturity. A secondary outcome of curve progression was the number of patients undergoing surgeryup until 2 years after the primary outcome.RESULTS The CONTRAIS study included 135 patients (45 in each of the 3 groups) with a mean (SD)age of 12.7 (1.4) years; 111 (82%) were female. Treatment success was seen in 34 of 45 patients (76%)in the NB group and in 24 of 45 patients (53%) in the PA group (odds ratio [OR], 2.7; 95% CI, 1.1-6.6).The number needed to treat to prevent curve progression with NB was 4.5 (95% CI, 2.4-33.5).Treatment success occurred in 26 of 45 patients (58%) in the SSE group (OR for SE vs PA, 1.2; 95% CI,0.5-2.8). Up to 2 years after the primary outcome time point, 9 patients in each of the 3 groupsunderwent surgery.CONCLUSIONS AND RELEVANCE In this randomized clinical trial, treatment with NB preventedcurve progression of more than 6° to a significantly higher extent than did PA, while SSE did not; inaddition, allowing transition to full-time bracing after treatment failure resulted in similar surgicalfrequencies independent of initial treatment. These results suggest that NB may be an effectivealternative intervention in patients rejecting full-time bracing.
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| 3. |
- Diarbakerli, Elias, et al.
(författare)
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Bone health in adolescents with idiopathic scoliosis : a comparison with age- and sex-matched controls
- 2020
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Ingår i: The Bone & Joint Journal. - London, United Kingdom : British Editorial Society of Bone and Joint Surgery. - 2049-4394 .- 2049-4408. ; 102-B:2, s. 268-272
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Tidskriftsartikel (refereegranskat)abstract
- AimsIdiopathic scoliosis is the most common spinal deformity in adolescents and children. The aetiology of the disease remains unknown. Previous studies have shown a lower bone mineral density in individuals with idiopathic scoliosis, which may contribute to the causation. The aim of the present study was to compare bone health in adolescents with idiopathic scoliosis with controls.MethodsWe included 78 adolescents with idiopathic scoliosis (57 female patients) at a mean age of 13.7 years (8.5 to 19.6) and 52 age- and sex-matched healthy controls (39 female patients) at a mean age of 13.8 years (9.1 to 17.6). Mean skeletal age, estimated according to the Tanner-Whitehouse 3 system (TW3), was 13.4 years (7.4 to 17.8) for those with idiopathic scoliosis, and 13.1 years (7.4 to 16.5) for the controls. Mean Cobb angle for those with idiopathic scoliosis was 29° (SD 11°). All individuals were scanned with dual energy x-ray absorptiometry (DXA) and peripheral quantitative CT (pQCT) of the left radius and tibia to assess bone density. Statistical analyses were performed with independent-samples t-test, the Mann-Whitney U test, and the chi-squared test.ResultsCompared with controls, adolescents with idiopathic scoliosis had mean lower DXA values in the left femoral neck (0.94 g/cm2 (SD 0.14) vs 1.00 g/cm2 (SD 0.15)), left total hip (0.94 g/cm2 (SD 0.14) vs 1.01 g/cm2 (SD 0.17)), L1 to L4 (0.99 g/cm2 (SD 0.15) vs 1.06 g/cm2 (SD 0.17)) and distal radius (0.35 g/cm2 (SD 0.07) vs 0.39 g/cm2 (SD 0.08; all p ≤ 0.024), but not in the mid-radius (0.72 g/cm2 vs 0.74 g/cm2; p = 0.198, independent t-test) and total body less head (1,559 g (SD 380) vs 1,649 g (SD 492; p = 0.0.247, independent t-test). Compared with controls, adolescents with idiopathic scoliosis had lower trabecular volume bone mineral density (BMD) on pQCT in the distal radius (184.7 mg/cm3 (SD 40.0) vs 201.7 mg/cm3 (SD 46.8); p = 0.029), but not in other parts of the radius or the tibia (p ≥ 0.062, Mann-Whitney U test).ConclusionIn the present study, idiopathic scoliosis patients seemed to have lower BMD at central skeletal sites and less evident differences at peripheral skeletal sites when compared with controls.
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| 4. |
- Diarbakerli, Elias, et al.
(författare)
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PReventing Idiopathic SCOliosis PROgression (PRISCOPRO) : A protocol for a quadruple-blinded, randomized controlled trial comparing 3D designed Boston brace to standard Boston brace
- 2021
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Ingår i: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 16:8
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionIdiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Patients are treated mainly with thoracolumbosacral orthosis (TLSO) if indicated. This form of brace treatment has been shown to be cumbersome and tough on growing individuals. However, computer aided design and manufactured (CAD/CAM) braces might increase comfortability and ultimately outcome if compliance is improved. In a multicenter, randomized controlled trial, we aim to compare CAD/CAM designed Boston 3D-brace to standard Boston brace.MethodsSubjects: 170 previously untreated and skeletally immature children diagnosed with idiopathic scoliosis, aged 9–17 years of age (curve magnitude Cobb 25–40 degrees) will be included. Interventions: Both groups will receive a physical activity prescription according to the World Health Organization recommendations. Randomization will be performed 1:1 to a 3D CAD/CAM designed Boston 3D-brace or a standard Boston brace, both with prescribed daily wear time of 20 hours. Outcome: The subjects will participate in the study until curve progression or until skeletal maturity. The primary outcome variable is failure of treatment, defined as progression of the Cobb angle more than 6 degrees compared to the baseline x-ray. The progression is confirmed if seen on two consecutive standing spinal x-rays. Radiographs will be taken at each six-month follow-up. Secondary outcome measures include patient and clinical reported outcomes, including number of individuals requiring surgical intervention.DiscussionThis study will show if efficacy in brace treatment can be improved with new brace designs.
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| 5. |
- Diarbakerli, Elias, et al.
(författare)
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PREventing Mild Idiopathic SCOliosis PROgression (PREMISCOPRO) : A protocol for a randomized controlled trial comparing scoliosis-specific exercises with observation in mild idiopathic scoliosis
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:5
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIdiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Mild scoliosis is in many cases observed or, in some cases, treated with scoliosis-specific exercises. More severe curves are treated mainly with a brace. The aim of this study is to investigate the effectiveness of scoliosis-specific exercises compared to observation in adolescents with mild idiopathic scoliosis.MethodsSubjects. Previously untreated and skeletally immature children aged 9–15 years of age with idiopathic scoliosis (curve magnitude Cobb 15–24 degrees) will be included. A total of 90 subjects will be included to receive one of two possible interventions.Interventions. Both groups will receive a physical activity prescription according to the World Health Organization recommendations. The intervention group will receive an additional active self-correction treatment strategy for curve correction and will have outpatient sessions once every two weeks for the first three months. They will be prescribed to do the exercises at least three times per week. The intervention will be performed until skeletal maturity or progression of the curve.Outcome. The subjects will participate in the study until curve progression or until skeletal maturity (defined as less than 1 cm growth for six months). The primary outcome variable is failure of treatment, defined as progression of the Cobb angle more than 6 degrees on two consecutive x-rays compared to the baseline x-ray. Secondary outcome measures include patient-reported outcomes, clinical characteristics (i.e. angle of trunk rotation and trunk asymmetry) and number requiring brace treatment. Clinical follow-ups will be performed every six months and radiographs will be taken annually.DiscussionThis study will compare effectiveness of an active self-corrective exercise strategy in mild idiopathic scoliosis with observation in terms of halting curve progression.
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| 6. |
- Diarbakerli, Elias, et al.
(författare)
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Quality of life in males and females with idiopathic scoliosis
- 2019
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 44:6, s. 404-410
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Cross-sectional.Objective. To describe quality of life in males and females with idiopathic scoliosis.Summary of Background Data. Idiopathic scoliosis is a three-dimensional deformity affecting the growing spine. The prevalence of larger curves, requiring treatment, is higher in females.Methods. This cross-sectional study comprised 1519 individuals with idiopathic scoliosis (211 males) with a mean (SD) age of 35.3 (14.9) years. They all answered the Scoliosis Research Society 22 revised (SRS-22r) questionnaire and EuroQol 5-dimension-index (EQ-5D). Five hundred twenty eight were surgically treated (78 males), 535 were brace treated (50 males), and 456 were untreated (83 males). The SRS-22r subscore (excluding the satisfaction domain), the SRS-22r domains and the EQ-5D index score were calculated. Subgroup analyses based on treatment and age were performed. Statistical comparisons were performed using analysis of covariance with adjustments for age and treatment. A P-value less than 0.05 was considered as statistical significant.Results. The mean (SD) SRS-22r subscore was 4.19 (0.61) in males and 4.05 (0.61) in females (P = 0.010). The males had higher scores on the SRS-22r domains function (4.56 vs. 4.42), pain (4.20 vs. 4.00), and mental health (4.14 vs. 3.92) (all P < 0.05). The mean (SD) EQ-5D index score was 0.85 (0.22) for males and 0.81 (0.21) for females (P = 0.10). There were minor differences when comparing males and females in treatment and age groups, but both treated and untreated groups had reduced quality of life compared with the national norms.Conclusion. When compared with females, males with idiopathic scoliosis tend to have slightly higher scores in the scoliosis specific SRS-22r but not in the generic quality of life measurement EQ-5D. Quality of life is overall similar between males and females in treatment and age groups, but reduced in comparison with the general population.Level of Evidence: 3
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| 7. |
- Diarbakerli, Elias
(författare)
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Quality of life, physical activity and bone health in idiopathic scoliosis
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Idiopathic scoliosis is a deformation of the spine affecting 1-3% of children and adolescents during growth. Severe deformities may lead to pulmonary dysfunction, pain and decreased quality of life. The etiology of the disease remains unknown. However, bone health and its possible role in the development of scoliosis has been discussed the last decade. A large cohort of individuals with idiopathic scoliosis (n=2,057), both adolescents and adults, was used to assess the impact of treatment characteristics, onset of the condition and gender on quality of life and physical activity. Furthermore, a cohort of non-scoliotic individuals (n=272) was assessed for quality of life and physical activity similarly in order to establish reference values. Another cohort of adolescents with idiopathic scoliosis (n=78) was examined and assessed regarding bone health and compared to non-scoliotic adolescents (n=52). We found that quality of life in individuals with idiopathic scoliosis was overall similar many years after treatment and management with marginally lower values for those who had been surgically treated. Gender and onset of idiopathic scoliosis did not have an impact on quality of life. However, the quality of life did not reach the level of the non-scoliotic cohort. Physical activity was found to be similar between individuals with and without idiopathic scoliosis. Our cohort of adolescents with idiopathic scoliosis had lower values at central skeletal sites such as the spine and hip on bone scans compared to the adolescents who did not have scoliosis. Despite this finding, sustained fractures did not differ in adulthood in our cohort of adults with idiopathic scoliosis compared to non-scoliotic adults.
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| 8. |
- Diarbakerli, Elias, et al.
(författare)
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Swedish musculoskeletal researchers view on a collaborative network and future research priorities in Swedish healthcare
- 2024
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Ingår i: Musculoskeletal Care. - : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Musculoskeletal disorders (MSK) are a global burden causing significant suffering and economic impact. Systematic identification and targeting of research questions of highest interest for stakeholders can aid in improving MSK disorder knowledge and management.Objective: To obtain Swedish MSK researchers' opinions and views on a collaborative Swedish MSK network (SweMSK) and identify future research areas of importance for Swedish MSK research.Methods: A web-based survey was conducted July to September 2021 to collect data from 354 Swedish MSK researchers. The survey focused on the need, objectives, and structure of a SweMSK network and identified prioritised areas for future MSK research.Results: The study included 141 respondents, of which 82 were associate professors or professors. The majority (68%) supported the creation of a new musculoskeletal network. The most supported element was increased collaboration regarding nationwide and multicenter studies. Respondents recommended the creation of a homepage and the establishment of national work groups with different specific interests as the primary elements of a new network.Conclusion: The results demonstrated a need and desire for increased national research collaboration and the creation of a new musculoskeletal network. The high academic experience and active research participation of the respondents suggest the need for MSK disorder knowledge and management improvement in Sweden. Therefore, the SweMSK network may help facilitate effective collaboration and research efforts that can contribute to the advancement of MSK disorder management and care. This study may provide valuable insights for policymakers, clinicians, and researchers to improve MSK disorder care and management in Sweden.
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| 9. |
- Diarberkali, Elias, et al.
(författare)
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Adolescents with and without idiopathic scoliosis have similar self-reported level of physical activity : a cross-sectional study
- 2016
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Ingår i: Scoliosis and Spinal Disorders. - : BioMed Central. - 2397-1789. ; 11:17, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Little is known about physical activity levels in individuals with idiopathic scoliosis. The aim of this study was to describe the level of physical activity in adolescents with and without idiopathic scoliosis.METHODS:Two hundred thirty-nine adolescents, median (25th, 75th percentile) age 16.0 (14.4, 17.6) with idiopathic scoliosis and 58 randomly recruited population-based individuals without scoliosis aged 14.6 (12.8, 16.3) participated. The 239 idiopathic scoliosis patients consisted of 88 untreated, 43 previously braced, 36 with ongoing brace-treatment and 72 surgically treated individuals. Main outcome measure was the proportion achieving at least moderate activity level, as estimated by the International Physical Activity Questionnaire short form (IPAQ-SF). Other outcome measures were Metabolic Equivalent Task (MET) minutes/week, time spent sitting, spare time activity level and sporting activities. Statistical analyses were adjusted for age and sex.RESULTS:The proportion of individuals with scoliosis with moderate activity level was 180 out of 239 (75 %) and for individuals without scoliosis 49 out of 58 (85 %) (p = 0.14). Median MET-minutes/week (25th,75th percentile) was for individuals with scoliosis scoliosis 1977 (840,3777) and for individuals without scoliosis 2120 (887,4598) (p = 0.11). Sporting activities did not differ (p = 0.28). The ongoing brace-treatment group had a significantly higher proportion of individuals categorizing themselves at high spare time activity level compared to the surgically treated and previously braced individuals (p = 0.046). No difference was seen between the treatment groups regarding the proportion achieving moderate activity (p = 0.11) and sporting activities (p = 0.20). Median MET minutes/week was 2160 (794,3797) for the untreated group, 989 (661,2706) for the previously braced group, 2055 (1010, 4026) for the surgery group and 2106 (990,4480) for the ongoing brace-treatment group (p = 0.031).CONCLUSION:Adolescents with idiopathic scoliosis show similar levels of self-reported physical activity as individuals without idiopathic scoliosis. Bracing and surgery do not appear to inhibit physical activity.
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| 10. |
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