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Table 10 Recommendation on bracing

From: 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

Recommendation Strength Evidence References
1. Bracing is recommended to treat adolescent idiopathic scoliosis B I [87, 90, 91, 122, 123, 166,167,168, 178,179,180, 188]
2. Bracing is recommended to treat juvenile and infantile idiopathic scoliosis as the first step in an attempt to avoid or at least postpone surgery to a more appropriate age B III [53, 94, 122, 244,245,246,247,248,249,250,251,252, 487, 488]
3. The use of brace is recommended in patients with evolutive idiopathic scoliosis above 25° during growth; in these cases PSSE alone (without bracing) should not be performed unless prescribed by a physicans expert in scoliosis. B I [87, 90, 91, 122, 123, 166,167,168, 178,179,180, 188]
4. Casting (or rigid bracing) is recommended to treat infantile idiopathic scoliosis to try stabilizing the curve B IV [129, 250, 252]
5. It is recommended not to apply bracing to treat patients with curves below 15° ± 5° Cobb, unless otherwise justified in the opinion of a clinician specialized in conservative treatment of spinal deformities B V  
6. Bracing is recommended to treat patients with curves above 20° ± 5° Cobb, still growing (Risser 0 to 3), and with demonstrated progression of deformity or elevated risk of worsening, unless otherwise justified in the opinion of a clinician specialized in conservative treatment of spinal deformities B I [87, 92, 123, 166, 167, 178,179,180, 188, 189]
7. Very hard rigid bracing (casting) is recommended to treat patients with curve between 45° and 60° to try avoiding surgery. C IV  
8. It is recommended that each treating team provide the brace that they know best, which means the brace they are more experienced and with perceived outcomes. This is due to the actual knowledge; there is no brace that can be recommended over the others. C IV [171, 179, 180, 189, 193]
9. It is recommended that braces are worn full time or no less than 18 h per day at the beginning of treatment, unless otherwise justified in the opinion of a clinician specialized in conservative treatment of spinal deformities B II [87, 106, 193, 207, 210]
10. Since there is a “dose-response” to treatment, it is recommended that the hours of bracing per day are in proportion with the severity of deformity, the age of the patient, the stage, aim and overall results of treatment, and the achievable compliance B II [87, 106, 193, 207, 210]
11. It is recommended that daily brace wear is proportionate to the deformity severity, age of patient, scoliosis stage, aim and overall results of treatment, and the expected compliance B II [87]
12. It is recommended that braces are worn until the end of vertebral bone growth and then the wearing time is gradually reduced, unless otherwise justified in the opinion of a clinician specialized in conservative treatment of spinal deformities B V  
13. It is recommended that the wearing time of the brace is gradually reduced, while performing stabilizing exercises, to allow adaptation of the postural system and maintain results B IV [112, 190, 191, 290, 489]
14. It is recommended that any mean is used to encourage compliance, including a careful adherence to the recommendations defined in the SOSORT Guidelines for Bracing Management B IV [135, 219,220,221,222,223,224, 226, 228, 490, 491]
15. It is recommended that compliance to bracing is regularly checked through compliance monitor devices. B V [259,60,61,, 261, 262, 315, 491]
16. It is recommended that quality of the brace is checked through an in-brace X-ray B IV [136, 205, 212, 229,230,231,232,233, 315]
17. It is recommended that the prescribing physician and the constructing orthotist are experts according to the criteria defined in the SOSORT Guidelines for Bracing Management C VI [135]
18. It is recommended that bracing is applied by a well-trained therapeutic team, including a physician, an orthotist and a therapist, according to the criteria defined in the SOSORT Guidelines for Bracing Management B V [135]
19. It is recommended that all the phases of brace construction (prescription, construction, check, correction, follow-up) are carefully followed for each single brace according to the criteria defined in the SOSORT Guidelines for Bracing Management B V [135]
20. It is recommended that the brace is specifically designed for the type of the curve to be treated B V  
21. It is recommended that the brace proposed for treating a scoliotic deformity on the frontal and horizontal planes should take into account the sagittal plane as much as possible A V  
22. It is recommended to use the least invasive brace in relation to the clinical situation, provided the same effectiveness, to reduce the psychological impact and to ensure better patient compliance A V  
23. It is recommended that braces do not so restrict thorax excursion in a way that reduces respiratory function B V  
24. It is recommended that braces are prescribed, constructed and fitted in an out-patient setting B V  
25. It is recommended that braces are regularly changed according to growth and/or specific pathological needs as judged by a scoliosis expert physician B V  
26. It is recommended that out of brace X-rays are regularly performed to check the effectiveness of bracing treatment: the number of hours out of brace before x-ray taking should correspond to the daily weaning time B V