A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data

BACKGROUND: There is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population. METHODS: CINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence. RESULTS: Ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with follow-up times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study