A scoping review of published reviews on the use of bracing in scoliosis

Purpose Scoliosis is a three-dimensional spinal deformity exceeding 10 degrees. Left untreated, it can lead to comorbidities, as well as surface deformity. Brace treatment is common in smaller curves (20–40 degrees), with strong evidence in adolescent idiopathic scoliosis (AIS), but overall effectiveness and impact on quality of life is controversial. This scoping review sought to map existing reviews on all aspects of bracing in scoliosis of any aetiology, to identify future research priorities.

Methods Searches were conducted in MEDLINE and EMBASE, excluding abstracts, narrative reviews and guidelines. Included articles reported on scoliosis patients of any age and aetiology and examined the use of spinal bracing. Four independent reviewers screened articles for inclusion and completed data extraction. Data were summarised narratively in themes, looking at effectiveness of bracing in AIS, patient factors influencing outcomes of AIS brace treatment, interventions to improve bracing success in AIS, patient and family experiences with bracing in AIS and bracing in adult and neuromuscular scoliosis. AMSTAR2 was used to assess confidence in the results in the reviews.

Results Searches yielded 59 eligible studies which were included. Whilst bracing is recommended for curves 20°–40° in AIS, it may be successful in those over 40° with good compliance. Bracing is effective in lowering rates of curve progression in AIS and therefore reducing surgery rates. There is no strong evidence that one brace type produces superior outcomes over another, compared to other treatments. Brace adherence is associated with significantly lower rates of curve progression; this is affected by appearance, comfort and psychology. Evidence shows adherence improves with sensor monitoring and psychosocial interventions. Some evidence suggests in-brace correction can be predicted by curve flexibility. More remaining growth potential and associated factors (younger age, lower Risser stage, pre-menarchial, open triradiate cartilage) can increase the risk of curve progression during bracing. Scoliosis-specific exercises may be beneficial alongside brace treatment. Long-term QoL does not appear to be affected by brace treatment. Some low-quality evidence suggests reduced QoL during bracing compared to observation. Function may be impacted by brace treatment, but pain is not increased. In degenerative spinal deformity, there may be some shorter term benefit for pain and function. Little evidence on bracing in neuromuscular scoliosis exists.

Conclusion There is a large research base of evidence to support bracing for AIS; however, this base is limited due to the substantial amount of low-quality research it includes. The aim of this scoping review was to identify gaps in the literature to guide future research.

This comprehensive review captured the breadth of existing review evidence on all aspects of bracing in scoliosis. Evidence supports bracing as an effective treatment in scoliosis, controlling curve progression, and often increasing patient satisfaction. Compliance is key, and measures such as compliance sensors can be effective. This scoping review has summarised the existing literature; however, the evidence base is limited. Further research could explore objective measures for compliance monitoring, optimal treatment protocols around brace cessation and effects of bracing on patient quality of life.